Cerebral Small Vessel Disease MRI Features Do Not Improve the Prediction of Stroke Outcome.
Neurology. 2021-01-26; 96(4):
DOI: 10.1212/wnl.0000000000011208
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Coutureau J(1), Asselineau J(1), Perez P(1), Kuchcinski G(1), Sagnier S(1),Renou P(1), Munsch F(1), Lopes R(1), Henon H(1), Bordet R(1), Dousset V(1),Sibon I(1), Tourdias T(2).
Author information:
(1)From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle
de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et
Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU
de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département
de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille;
Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H.,
R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S.,
I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI
Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre
Magendie, Bordeaux, France.
(2)From the Neuroimagerie Diagnostique et Thérapeutique (J.C., V.D., T.T.), Pôle
de Santé Publique, Unité de Soutien Méthodologique à la Recherche Clinique et
Epidémiologique (J.A., P.P.), and Unité Neurovasculaire (S.S., P.R., I.S.), CHU
de Bordeaux; Université de Bordeaux (J.C., S.S., V.D., I.S., T.T.); Département
de Neuroradiologie (G.K., R.L.) and Unité Neurovasculaire (H.H.), CHU de Lille;
Université de Lille (G.K., R.L., H.H., R.B.); INSERM U1171 (G.K., R.L., H.H.,
R.B.), Troubles Cognitifs Dégénératifs et Vasculaires, Lille; UMR 5287 (S.S.,
I.S.), CNRS, Neuroimagerie et Cognition, Bordeaux, France; Division of MRI
Research (F.M.), Department of Radiology, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, MA; and INSERM (V.D., T.T.), U1215, Neurocentre
Magendie, Bordeaux, France. .
OBJECTIVE: To determine whether the total small vessel disease (SVD) score adds
information to the prediction of stroke outcome compared to validated
predictors, we tested different predictive models of outcome in patients with
stroke.
METHODS: White matter hyperintensity, lacunes, perivascular spaces, microbleeds,
and atrophy were quantified in 2 prospective datasets of 428 and 197 patients
with first-ever stroke, using MRI collected 24 to 72 hours after stroke onset.
Functional, cognitive, and psychological status were assessed at the 3- to
6-month follow-up. The predictive accuracy (in terms of calibration and
discrimination) of age, baseline NIH Stroke Scale score (NIHSS), and infarct
volume was quantified (model 1) on dataset 1, the total SVD score was added
(model 2), and the improvement in predictive accuracy was evaluated. These 2
models were also developed in dataset 2 for replication. Finally, in model 3,
the MRI features of cerebral SVD were included rather than the total SVD score.
RESULTS: Model 1 showed excellent performance for discriminating poor vs good
functional outcomes (area under the curve [AUC] 0.915), and fair performance for
identifying cognitively impaired and depressed patients (AUCs 0.750 and 0.688,
respectively). A higher SVD score was associated with a poorer outcome (odds
ratio 1.30 [1.07-1.58], p = 0.0090 at best for functional outcome). However,
adding the total SVD score (model 2) or individual MRI features (model 3) did
not improve the prediction over model 1. Results for dataset 2 were similar.
CONCLUSIONS: Cerebral SVD was independently associated with functional,
cognitive, and psychological outcomes, but had no clinically relevant added
value to predict the individual outcomes of patients when compared to the usual
predictors, such as age and baseline NIHSS.
© 2020 American Academy of Neurology.