Kawas Mohammad I, Shamulzai Ahmad, Atcheson Kyle M, Horn Alex C, Ma Renate, Kittel Carol, Curry Brian, Lipford Megan, Kim Jeongchul, Solingapuram Sai Kiran K, Wolfe Stacey Q, Whitlow Christopher T
Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Physiology and Biochemistry (M.I.K.), Faculty of Medicine, University of Jordan, Amman, Jordan.
J Neuroimaging. 2025 Jan-Feb;35(1):e70013. doi: 10.1111/jon.70013.
Endovascular thrombectomy (EVT) is the standard for acute ischemic stroke from large vessel occlusion, but post-EVT functional independence varies. Brain atrophy, linked to higher cerebrospinal fluid volume (CSFV), may affect outcomes. Baseline CSFV could predict EVT benefit by assessing brain health. We aimed to quantify total CSFV from clinical T1-weighted (w) magnetic resonance imaging (MRI) to assess global brain atrophy and its association with functional outcomes following successful EVT.
We performed a retrospective analysis of patients achieving thrombolysis-in-cerebral-infarction ≥2b revascularization via prospectively maintained single-institution stroke thrombectomy registry (n = 432) between 2015 and 2021. We included 214 patients (mean age 67.5 ± 14.6, 49% female) with acceptable quality MRI within 14 days of EVT and available modified Rankin-scale (mRS) at 90 days post EVT. Clinical T1w images were transformed into high-resolution images using the convolutional neural-network SynthSR. FreeSurfer software was then used to estimate total cranial CSFV. To correct for head size, percentage of CSFV to intracranial volume was used.
Baseline CSFV% significantly predicted 90-day mRS in an ordinal regression model adjusted for baseline mRS (p < 0.001). Further modeling was performed to account for age, sex, 24-h National-Institutes-Health-Stroke-Scale (NIHSS), smoking history, prior stroke, hypertension, congestive heart failure, hemoglobin-A1c, atrial fibrillation, and Alberta-Stroke-Program-Early-CT-Score (ASPECTS). Total CSFV% remained an independent predictor of 90-day mRS (p = 0.012). CSFV% did not significantly predict the occurrence of any type of hemorrhagic transformation in a logistic regression model.
Increased CSFV% correlates with poorer functional outcomes post EVT. Total CSFV% may serve as a useful imaging biomarker for clinicians determining patient prognostication prior to EVT.
血管内血栓切除术（EVT）是治疗大血管闭塞所致急性缺血性卒中的标准方法，但EVT术后的功能独立性存在差异。脑萎缩与较高的脑脊液体积（CSFV）有关，可能会影响治疗结果。基线CSFV可通过评估脑健康状况来预测EVT的疗效。我们旨在通过临床T1加权（w）磁共振成像（MRI）对总CSFV进行量化，以评估全脑萎缩及其与成功EVT后功能结局的相关性。
我们对2015年至2021年间通过前瞻性维护的单机构卒中血栓切除术登记系统实现脑梗死溶栓≥2b级血管再通的患者进行了回顾性分析（n = 432）。我们纳入了214例患者（平均年龄67.5±14.6岁，49%为女性），这些患者在EVT后14天内有质量可接受的MRI，且在EVT后90天有可用的改良Rankin量表（mRS）评分。使用卷积神经网络SynthSR将临床T1w图像转换为高分辨率图像。然后使用FreeSurfer软件估计总的颅内容积CSFV。为校正头部大小，采用CSFV占颅内体积的百分比。
在根据基线mRS进行校正的有序回归模型中，基线CSFV%显著预测了90天mRS（p < 0.001）。进一步进行建模以纳入年龄、性别、24小时美国国立卫生研究院卒中量表（NIHSS）、吸烟史、既往卒中史、高血压、充血性心力衰竭、糖化血红蛋白、心房颤动和阿尔伯塔卒中项目早期CT评分（ASPECTS）。总CSFV%仍然是90天mRS的独立预测因素（p = 0.012）。在逻辑回归模型中，CSFV%未显著预测任何类型出血转化的发生。
CSFV%升高与EVT术后较差的功能结局相关。总CSFV%可为临床医生在EVT前确定患者预后提供一种有用的影像学生物标志物。
