J Korean Soc Radiol.  2018 Apr;78(4):249-258. 10.3348/jksr.2018.78.4.249.

The Added Prognostic Value of Intracranial Artery Morphology to Predict Non-Cardioembolic Ischemic Stroke

Affiliations
  • 1Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. znee@catholic.ac.kr
  • 2Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

PURPOSE
To assess the added prognostic value of the morphologic characteristics of intracranial arteries in the risk modeling of a future non-cardioembolic stroke.
MATERIALS AND METHODS
This retrospective study included 86 patients without acute ischemic stroke who first underwent magnetic resonance imaging (MRI) including the time-of-flight magnetic resonance angiography (TOF-MRA) at 3T. Diffusion-weighted imaging (DWI) was performed for the follow-up imaging of these patients > 120 days after the initial MRI. The TOF-MRA result was used to analyze three morphological characteristics: dilatation, stenosis, and tortuosity. The presence of acute ischemic stroke was assessed using the follow-up DWI data. We built two prognostic models: model 1 includes the conventional stroke-risk factors, while model 2 includes the conventional risk factors and the morphologic characteristics of the intracranial arteries. We used the likelihood-ratio test to compare these two models. The models' performances were evaluated using Harrell's concordance index.
RESULTS
Fourteen patients suffered non-cardioembolic strokes. The performances of the two models differed significantly regarding the future-risk modeling of the non-cardioembolic stroke (p = 0.031). The Harrell's concordance index of model 2 (0.78 ± 0.05) exceeded that of model 1 (0.72 ± 0.07).
CONCLUSION
In addition to the conventional stroke-risk factors, the morphologic characteristics of the intracranial arteries were useful in the modeling of the future risk of the non-cardioembolic ischemic stroke.


MeSH Terms

Arteries*
Brain Infarction
Cerebral Arteries
Constriction, Pathologic
Dilatation
Follow-Up Studies
Humans
Intracranial Arteriosclerosis
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Retrospective Studies
Risk Factors
Stroke*

Figure

  • Fig. 1. Patient selection flow chart. After systematic evaluation of the radiology database, 86 patients were included in this study. Among them, 14 patients had acute non-cardioembolic ischemic strokes. DWI = diffusion-weighted imaging, FU = follow-up, MR = magnetic resonance, TOF-MRA = time-of-flight magnetic resonance angiography

  • Fig. 2. Survival curves of non-cardioembolic strokes according to three morphological characteristics. Three survival curves for non-cardioembolic stroke according to the intracranial arterial diameter (A), stenosis score (B) and tortuosity score (C). A mean intracranial arterial diameter > 3.1 was associated with significant risk for future non-cardioembolic stroke (p < 0.001). Tortuous intracranial arteries were also associated with a tendency toward a high probability of future non-cardioembolic stroke (p = 0.158).


Reference

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