Peng Yuling, Luo Dan, Zeng Peng, Zeng Bang, Xiang Yayun, Wang Dan, Chai Ying, Li Yongmei, Chen Xiaoya, Luo Tianyou
Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Department of Radiology, Mianyang Central Hospital, Mianyang, 621000, China.
Brain Imaging Behav. 2025 Apr;19(2):269-278. doi: 10.1007/s11682-024-00962-y. Epub 2025 Jan 4.
Studies on the impact of white matter hyperintensity (WMH) on function outcome have primarily concentrated on WMH volume, overlooking the potential significance of WMH location. This study aimed to investigate the relationship between WMH location and outcome in patients with their first-ever acute ischemic stroke (AIS).
Patients who underwent their first AIS between September 2021 and September 2022 were recruited. Function outcome was assessed using the 90-day modified Rankin Scale (mRS). The association between the location of WMH and functional outcome was examined at the voxel level and subsequently at the region of interest tract-based level.
A total of 134 patients were included (mean age, 66.28 years ± 12.48; 90 male [67.16%]). The median mRS was 2 (IQR, 1-3). The median total WMH volume was 3.80 cm (IQR, 2.07-6.78). WMH volume was significantly correlated with mRS (r = 0.28, p = 0.001). WMH in the splenium of corpus callosum, the left superior corona radiata, the left posterior corona radiata, and the bilateral posterior thalamic radiation were associated with poor mRS. The strategic WMH score (OR, 1.18; 95% CI, 1.06-1.32; p = 0.003), derived from these five specific tracts, was an independent predictor of mRS after accounting for the effects of total WMH volume (OR, 1.02; 95% CI, 0.90-1.16; p = 0.771) and infarct lesion volume (OR, 1.26; 95% CI, 1.08-1.48; p = 0.004).
Our findings indicated that the impact of WMH on function outcome is location-dependent, mainly involving five strategic tracts. Evaluating WMH location may help to more accurately predict the functional outcome of AIS.
关于白质高信号（WMH）对功能结局影响的研究主要集中在WMH体积上，而忽略了WMH位置的潜在重要性。本研究旨在探讨首次急性缺血性卒中（AIS）患者中WMH位置与结局之间的关系。
招募2021年9月至2022年9月期间首次发生AIS的患者。使用90天改良Rankin量表（mRS）评估功能结局。在体素水平以及随后基于感兴趣区域的层面上检查WMH位置与功能结局之间的关联。
共纳入134例患者（平均年龄66.28岁±12.48；90例男性[67.16%]）。mRS中位数为2（四分位间距，1 - 3）。WMH总体积中位数为3.80 cm³（四分位间距，2.07 - 6.78）。WMH体积与mRS显著相关（r = 0.28，p = 0.001）。胼胝体压部、左侧放射冠上部、左侧放射冠后部以及双侧丘脑后辐射的WMH与较差的mRS相关。源自这五条特定神经束的策略性WMH评分（比值比，1.18；95%置信区间，1.06 - 1.32；p = 0.003）在考虑WMH总体积（比值比，1.02；95%置信区间，0.90 - 1.16；p = 0.771）和梗死灶体积（比值比，1.26；95%置信区间，1.08 - 1.48；p = 0.004）的影响后，是mRS的独立预测因素。
我们的研究结果表明，WMH对功能结局的影响取决于位置，主要涉及五条策略性神经束。评估WMH位置可能有助于更准确地预测AIS的功能结局。
