In Neurology ; h5-index 107.0
BACKGROUND AND OBJECTIVES : While chronological age is one of the most influential determinants of post-stroke outcomes, little is known of the impact of neuroimaging-derived biological "brain age". We hypothesized that radiomics analyses of T2-FLAIR images texture would provide brain age estimates and that advanced brain age of stroke patients will be associated with cardiovascular risk factors and worse functional outcomes.
METHODS : We extracted radiomics from T2-FLAIR images acquired during acute stroke clinical evaluation. Brain age was determined from brain parenchyma radiomics using an ElasticNet linear regression model. Subsequently, relative brain age (RBA), which expresses brain age in comparison to chronological age-matched peers, was estimated. Finally, we built a linear regression model of RBA using clinical cardiovascular characteristics as inputs, and a logistic regression model of favorable functional outcomes taking RBA as input.
RESULTS : We reviewed 4,163 patients from a large multisite ischemic stroke cohort (mean age=62.8 years, 42.0% females). T2-FLAIR radiomics predicted chronological ages (mean absolute error=6.9 years, r=0.81). After adjustment for covariates, RBA was higher and therefore described older-appearing brains in patients with hypertension, diabetes mellitus, a history of smoking, and a history of a prior stroke. In multivariate analyses, age, RBA, NIHSS, and a history of prior stroke were all significantly associated with functional outcome (respective adjusted Odds-Ratios: 0.58, 0.76, 0.48, 0.55; all p-values<0.001). Moreover, the negative effect of RBA on outcome was especially pronounced in minor strokes.
DISCUSSION : T2-FLAIR radiomics can be used to predict brain age and derive RBA. Older appearing brains, characterized by a higher RBA, reflect cardiovascular risk factor accumulation and are linked to worse outcomes after stroke.
Bretzner Martin, Bonkhoff Anna K, Schirmer Markus D, Hong Sungmin, Dalca Adrian, Donahue Kathleen, Giese Anne-Katrin, Etherton Mark R, Rist Pamela M, Nardin Marco, Regenhardt Robert W, Leclerc Xavier, Lopes Renaud, Gautherot Morgan, Wang Clinton, Benavente Oscar R, Cole John W, Donatti Amanda, Griessenauer Christoph, Heitsch Laura, Holmegaard Lukas, Jood Katarina, Jimenez-Conde Jordi, Kittner Steven J, Lemmens Robin, Levi Christopher R, McArdle Patrick F, McDonough Caitrin W, Meschia James F, Phuah Chia-Ling, Rolfs Arndt, Ropele Stefan, Rosand Jonathan, Roquer Jaume, Rundek Tatjana, Sacco Ralph L, Schmidt Reinhold, Sharma Pankaj, Slowik Agnieszka, Sousa Alessandro, Stanne Tara M, Strbian Daniel, Tatlisumak Turgut, Thijs Vincent, Vagal Achala, Wasselius Johan, Woo Daniel, Wu Ona, Zand Ramin, Worrall Bradford B, Maguire Jane, Lindgren Arne G, Jern Christina, Golland Polina, Kuchcinski Grégory, Rost Natalia S
2022-Nov-28
