Wi-Sun Ryu1, Sung-Ho Woo1, Dawid Schellingerhout1, Moo K Chung1, Chi Kyung Kim1, Min Uk Jang1, Kyoung-Jong Park1, Keun-Sik Hong1, Sang-Wuk Jeong1, Jeong-Yong Na1, Ki-Hyun Cho1, Joon-Tae Kim1, Beom Joon Kim1, Moon-Ku Han1, Jun Lee1, Jae-Kwan Cha1, Dae-Hyun Kim1, Soo Joo Lee1, Youngchai Ko1, Yong-Jin Cho1, Byung-Chul Lee1, Kyung-Ho Yu1, Mi-Sun Oh1, Jong-Moo Park1, Kyusik Kang1, Kyung Bok Lee1, Tai Hwan Park1, Juneyoung Lee1, Heung-Kook Choi1, Kiwon Lee1, Hee-Joon Bae2, Dong-Eog Kim2. 1. From the Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Korea (W.-S.R., S.-H.W., S.-W.J., J.-Y.N., D.-E.K.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston (D.S.); Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison (M.K.C.); WeBace Co, Ltd, Busan, Korea (K.-J.P.); Department of Neurology, Seoul National University Hospital, Seoul, Korea (C.K.K.); Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea (M.U.J.); Department of Neurology, Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., J.-T.K.); Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L., Y.K.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Eulji General Hospital, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Seoul Medical Center, Seoul, Korea (T.H.P.); Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.); Department of Computer Science, Inje University, Busan, Korea (H.-K.C.); and Departments of Neurology and Neurosurgery, The University of Texas Health Science Center, Houston (K.L.). 2. From the Stroke Center and Korean Brain MRI Data Center, Dongguk University Ilsan Hospital, Goyang, Korea (W.-S.R., S.-H.W., S.-W.J., J.-Y.N., D.-E.K.); Department of Radiology, University of Texas M. D. Anderson Cancer Center, Houston (D.S.); Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison (M.K.C.); WeBace Co, Ltd, Busan, Korea (K.-J.P.); Department of Neurology, Seoul National University Hospital, Seoul, Korea (C.K.K.); Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, Korea (M.U.J.); Department of Neurology, Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., J.-T.K.); Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L., Y.K.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.); Department of Neurology, Eulji General Hospital, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.); Department of Neurology, Seoul Medical Center, Seoul, Korea (T.H.P.); Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.); Department of Computer Science, Inje University, Busan, Korea (H.-K.C.); and Departments of Neurology and Neurosurgery, The University of Texas Health Science Center, Houston (K.L.). kdongeog@duih.org braindoc@snu.ac.kr.
Abstract
BACKGROUND AND PURPOSE: We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke. METHODS: We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.0 years) enrolled consecutively from 11 nationwide stroke centers, from patient (fluid-attenuated-inversion-recovery) MRIs onto a standard brain template set. Using multivariable analyses, we assessed the impact of major (age/hypertension) and minor risk factors on WMH variability. RESULTS: We have produced a large reference data library showing the location and quantity of WMHs as topographical frequency-volume maps. This easy-to-use graphical reference data set allows the quantitative estimation of the severity of WMH as a percentile rank score. For all patients (median age=69 years), multivariable analysis showed that age, hypertension, atrial fibrillation, and left ventricular hypertrophy were independently associated with increasing WMH (0-9.4%, median=0.6%, of the measured brain volume). For younger (≤69) hypertensives (n=819), age and left ventricular hypertrophy were positively associated with WMH. For older (≥70) hypertensives (n=944), age and cholesterol had positive relationships with WMH, whereas diabetes mellitus, hyperlipidemia, and atrial fibrillation had negative relationships with WMH. For younger nonhypertensives (n=578), age and diabetes mellitus were positively related to WMH. For older nonhypertensives (n=328), only age was positively associated with WMH. CONCLUSIONS: We have generated a novel graphical WMH grading (Kim statistical WMH scoring) system, correlated to risk factors and adjusted for age/hypertension. Further studies are required to confirm whether the combined data set allows grading of WMH burden in individual patients and a tailored patient-specific interpretation in ischemic stroke-related clinical practice.
BACKGROUND AND PURPOSE: We aimed to generate rigorous graphical and statistical reference data based on volumetric measurements for assessing the relative severity of white matter hyperintensities (WMHs) in patients with stroke. METHODS: We prospectively mapped WMHs from 2699 patients with first-ever ischemic stroke (mean age=66.8±13.0 years) enrolled consecutively from 11 nationwide stroke centers, from patient (fluid-attenuated-inversion-recovery) MRIs onto a standard brain template set. Using multivariable analyses, we assessed the impact of major (age/hypertension) and minor risk factors on WMH variability. RESULTS: We have produced a large reference data library showing the location and quantity of WMHs as topographical frequency-volume maps. This easy-to-use graphical reference data set allows the quantitative estimation of the severity of WMH as a percentile rank score. For all patients (median age=69 years), multivariable analysis showed that age, hypertension, atrial fibrillation, and left ventricular hypertrophy were independently associated with increasing WMH (0-9.4%, median=0.6%, of the measured brain volume). For younger (≤69) hypertensives (n=819), age and left ventricular hypertrophy were positively associated with WMH. For older (≥70) hypertensives (n=944), age and cholesterol had positive relationships with WMH, whereas diabetes mellitus, hyperlipidemia, and atrial fibrillation had negative relationships with WMH. For younger nonhypertensives (n=578), age and diabetes mellitus were positively related to WMH. For older nonhypertensives (n=328), only age was positively associated with WMH. CONCLUSIONS: We have generated a novel graphical WMH grading (Kim statistical WMH scoring) system, correlated to risk factors and adjusted for age/hypertension. Further studies are required to confirm whether the combined data set allows grading of WMH burden in individual patients and a tailored patient-specific interpretation in ischemic stroke-related clinical practice.
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