Association of Stroke Lesion Pattern and White Matter Hyperintensity Burden With Stroke Severity and Outcome

被引：37

作者：

Bonkhoff, Anna K. ^{[1
]}

Hong, Sungmin ^{[1
]}

Bretzner, Martin ^{[1
,2
]}

Schirmer, Markus D. ^{[1
,3
]}

Regenhardt, Robert W. ^{[1
]}

Arsava, E. Murat ^{[1
]}

Donahue, Kathleen ^{[1
]}

Nardin, Marco ^{[1
]}

Dalca, Adrian ^{[4
,5
]}

Giese, Anne-Katrin ^{[6
]}

Etherton, Mark R. ^{[1
]}

Hancock, Brandon L. ^{[5
]}

Mocking, Steven J. T. ^{[5
]}

McIntosh, Elissa ^{[5
]}

Attia, John ^{[7
]}

Benavente, Oscar ^{[9
]}

Cole, John W. ^{[10
,11
]}

Donatti, Amanda ^{[12
,13
]}

Griessenauer, Christoph ^{[14
,15
]}

Heitsch, Laura ^{[16
,17
,18
]}

Holmegaard, Lukas ^{[19
]}

Jood, Katarina ^{[19
]}

Jimenez-Conde, Jordi ^{[20
]}

Kittner, Steven ^{[10
,11
]}

Lemmens, Robin ^{[21
,22
]}

Levi, Christopher ^{[8
]}

McDonough, Caitrin W. ^{[23
,24
]}

Meschia, James ^{[25
]}

Phuah, Chia-Ling ^{[17
,18
]}

Rolfs, Arndt ^{[26
]}

Ropele, Stefan ^{[27
]}

Rosand, Jonathan ^{[1
,5
,28
]}

Roquer, Jaume ^{[20
]}

Rundek, Tatjana ^{[29
,30
]}

Sacco, Ralph L. ^{[29
,30
]}

Schmidt, Reinhold ^{[27
]}

Sharma, Pankaj ^{[31
]}

Slowik, Agnieszka ^{[32
]}

Soederholm, Martin ^{[33
]}

Sousa, Alessandro ^{[12
,13
]}

Stanne, Tara M. ^{[35
]}

Strbian, Daniel ^{[36
,37
]}

Tatlisumak, Turgut ^{[19
]}

Thijs, Vincent ^{[38
,39
]}

Vagal, Achala ^{[40
]}

Wasselius, Johan ^{[41
]}

Woo, Daniel ^{[42
]}

Zand, Ramin ^{[43
]}

McArdle, Patrick ^{[44
]}

Worrall, Bradford B. ^{[45
,46
]}

机构：

[1] Harvard Med Sch, Massachusetts Gen Hosp, J Philip Kistler Stroke Res Ctr, Boston, MA 02115 USA

[2] Univ Lille, INSERM, CHU Lille, U1171 LiINCog OPARQ Lille Neurosci & Cognit, Lille, France

[3] Univ Hosp Bonn, Clin Neuroradiol, Bonn, Germany

[4] MIT, Comp Sci & Artifidal Intelligence Lab, Boston, MA USA

[5] Massachusetts Gen Hosp, Dept Radiol, Athinoula A Martinos Ctr Biomed Imaging, Charlestown, MA USA

[6] Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Hamburg, Germany

[7] Hunter Med Res Inst, Newcastle, NSW, Australia

[8] Univ Newcastle, Sch Med & Publ Hlth, Newcastle, NSW, Australia

[9] Univ British Columbia, Div Neurol, Dept Med, Vancouver, BC, Canada

[10] Univ Maryland, Sch Med, Dept Neurol, Baltimore, MD 21201 USA

[11] Vet Affairs Maryland Hlth Care Syst, Baltimore, MD USA

[12] Univ Campinas UNICAMP, Sch Med Sci, Campinas, SP, Brazil

[13] Brazilian Inst Neurosci & Neurotechnol BRAINN, Campinas, SP, Brazil

[14] Geisinger, Dept Neurosurg, Danville, PA USA

[15] Paracelsus Med Univ, Christian Doppler Clin, Dept Neurosurg, Salzburg, Austria

[16] Washington Univ, Sch Med, Dept Emergency Medidne, St Louis, MO 14263 USA

[17] Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA

[18] Barnes Jewish Hosp, St Louis, MO USA

[19] Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, Dept Clin Neurosci, Gothenburg, Sweden

[20] Univ Autonoma Barcelona, IMIM Hosp del Mar Inst Hosp del Mar Invest Med, Neurovasc Res Grp NEUVAS, Dept Neurol, Barcelona, Spain

[21] Univ Leuven, KU Leuven, Dept Neurosci Expt Neurol, Leuven, Belgium

[22] Univ Leuven, KU Leuven, Leuven Res Inst Neurosci & Dis LIND, Leuven, Belgium

[23] Univ Florida, Dept Pharmacotherapy & Translat Res, Gainesville, FL USA

[24] Univ Florida, Ctr Pharmacogen, Gainesville, FL USA

[25] Mayo Clin, Dept Neurol, Jacksonville, FL USA

[26] Centogene AG, Rostock, Germany

[27] Med Univ Graz, Clin Div Neurogeriatr, Dept Neurol, Graz, Austria

[28] Massachusetts Gen Hosp, Henry & Allison McCance Ctr Brain Hlth, Boston, MA 02114 USA

[29] Univ Miami, Miller Sch Med, Dept Neurol, Coral Gables, FL 33124 USA

[30] Univ Miami, Miller Sch Med, Evelyn F McKnight Brain Inst, Coral Gables, FL 33124 USA

[31] Royal Holloway Univ London ICR2UL, Inst Cardiovasc Res, Egham, Surrey, England

[32] Jagiellonian Univ Med Coll, Dept Neurol, Krakow, Poland

[33] Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden

[34] Skane Univ Hosp, Dept Neurol, Lund, Sweden

[35] Univ Gothenburg, Sahlgrenska Acad, Inst Biomed, Dept Lab Med, Gothenburg, Sweden

[36] Helsinki Univ Hosp, Dept Neurol, Helsinki, Finland

[37] Univ Helsinki, Helsinki, Finland

[38] Austin Hlth, Florey Inst Neurosdence & Mental Hlth, Stroke Div, Heidelberg, Vic, Australia

[39] Austin Hlth, Dept Neurol, Heidelberg, Vic, Australia

[40] Univ Cincinnati, Coll Med, Dept Radiol, Cincinnati, OH 45221 USA

[41] Lund Univ, Dept Clin Sci Lund, Radiol, Lund, Sweden

[42] Univ Cincinnati, Coll Med, Dept Neurol & Rehabil Med, Cincinnati, OH 45221 USA

[43] Geisinger, Dept Neurol, Danville, PA USA

[44] Univ Maryland, Sch Med, Dept Med, Div Endocrinol,Diabet & Nutr, Baltimore, MD 21201 USA

[45] Univ Virginia, Dept Neurol, Charlottesville, VA USA

[46] Univ Virginia, Dept Publ Hlth Sci, Charlottesville, VA USA

[47] Sahlgrens Univ Hosp, Dept Clin Genet & Genom, Gothenburg, Sweden

[48] Univ Technol Sydney, Sydney, NSW, Australia

[49] McGill Univ, Sch Comp Sci, Fac Med,Dept Biomed Engn, McConnell Brain Imaging Ctr,Montreal Neurol Inst, Montreal, PQ, Canada

[50] Mila Quebec Artificial Intelligence Inst, Montreal, PQ, Canada

来源：

NEUROLOGY | 2022年 / 99卷 / 13期

关键词：

NETWORK; TOPOGRAPHY; GENETICS; NEGLECT; MRI;

D O I：

10.1212/WNL.0000000000200926

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Objectives To examine whether high white matter hyperintensity (WMH) burden is associated with greater stroke severity and worse functional outcomes in lesion pattern-specific ways. Methods MR neuroimaging and NIH Stroke Scale data at index stroke and the modified Rankin Scale (mRS) score at 3-6 months after stroke were obtained from the MRI-Genetics Interface Exploration study of patients with acute ischemic stroke (AIS). Individual WMH volume was automatically derived from fluid-attenuated inversion recovery images. Stroke lesions were automatically segmented from diffusion-weighted imaging (DWI) images, parcellated into atlas-defined brain regions and further condensed to 10 lesion patterns via machine learning-based dimensionality reduction. Stroke lesion effects on AIS severity and unfavorable outcomes (mRS score >2) were modeled within purpose-built Bayesian linear and logistic regression frameworks. Interaction effects between stroke lesions and a high vs lowWMHburden were integrated via hierarchical model structures. Models were adjusted for age, age2, sex, total DWI lesion and WMH volumes, and comorbidities. Data were split into derivation and validation cohorts. Results A total of 928 patients with AIS contributed to acute stroke severity analyses (age: 64.8 [14.5] years, 40% women) and 698 patients to long-term functional outcome analyses (age: 65.9 [14.7] years, 41% women). Stroke severity was mainly explained by lesions focused on bilateral subcortical and left hemispherically pronounced cortical regions across patients with both a high and low WMH burden. Lesions centered on left-hemispheric insular, opercular, and inferior frontal regions and lesions affecting right-hemispheric temporoparietal regions had more pronounced effects on stroke severity in case of high compared with low WMH burden. Unfavorable outcomes were predominantly explained by lesions in bilateral subcortical regions. In difference to the lesion location-specific WMH effects on stroke severity, higher WMH burden increased the odds of unfavorable outcomes independent of lesion location. Discussion Higher WMH burden may be associated with an increased stroke severity in case of stroke lesions involving left-hemispheric insular, opercular, and inferior frontal regions (potentially linked to language functions) and right-hemispheric temporoparietal regions (potentially linked to attention). Our findings suggest that patients with specific constellations of WMH burden and lesion locations may have greater benefits from acute recanalization treatments. Future clinical studies are warranted to systematically assess this assumption and guide more tailored treatment decisions.

引用

页码：E1364 / E1379

页数：16

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