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Abstract
Background and Objectives While chronological age is one of the most influential determinants of poststroke 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 patients with stroke 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 with 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% female patients). 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.
Glossary
- AF=
- atrial fibrillation;
- DM=
- diabetes mellitus;
- HTN=
- hypertension;
- MRI-GENIE=
- MRI-GENetics Interface Exploration;
- MAE=
- mean absolute error;
- mRS=
- modified Rankin scale;
- NIHSS=
- NIH Stroke Scale;
- RBA=
- relative brain age;
- WMH=
- white matter hyperintensity
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Previously published at www.researchsquare.com, https://doi.org/10.21203/rs.3.rs-923769/v1.
Submitted and externally peer reviewed. The handling editor was José Merino, MD, MPhil, FAAN.
- Received October 6, 2021.
- Accepted in final form October 6, 2022.
- © 2022 American Academy of Neurology
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