A new study finds that the difference between a stroke patient’s brain age and chronological age may help physicians predict which patients are likely to have a poorer outcome.
Stroke patients with high relative brain age (RBA), as measured by MRI, had significantly worse functional outcomes after ischemic stroke than patients with low RBA.
Although more work is needed, the researchers say that using open source radiomics software to extract features from MRI scans could allow clinicians to better target post-stroke therapy.
“Patients with older-looking brains were less likely to achieve good functional outcomes after stroke,” said investigator Martin Bretzner, MD, a research fellow in neurology at Harvard Medical School and an interventional neuroradiologist at Lilly University Hospital. Medscape Medical News, “Maybe we can use relative brain age to make patients more aggressive or more attentive with therapy.”
The findings were presented today at the European Stroke Organization Conference (ESOC) 2022 Annual Meeting in Lyon, France.
brain age gap detection
The difference between a person’s chronological age and their brain age has been implicated in earlier studies as biomarkers for risk of dementia, schizophrenia, Alzheimer’s disease, and other conditions.
Bretzner and his colleagues wanted to know whether the difference in brain age was also a predictor for outcomes after a stroke.
“Time passes at the same rate for everyone, but we all age differently, with some people ageing faster than others,” Bretzner said. “Related brain age is one way to apply neuroscience and brain imaging and stroke patients to this study.”
The researchers used an open-source radiomics program to analyze T2-FLAIR MRI images captured within 24-48 hours of stroke in 4163 patients (median age, 62.8 years). They estimated each patient’s age based on those brain images, then compared the RBA figure to the patient’s actual chronological age.
Most patients had RBA either higher or lower than their actual age, with very few cases matching RBA and chronological age. They then measured the prevalence of stroke risk factors such as diabetes, high blood pressure, and prior stroke history to see if there were differences among patients with higher brain ages.
Having a prior stroke was the most influential clinical factor influencing RBA (P <.001), followed by diabetes (P = .003), hypertension (P = .021), and smoking (P = .024).
When they examined patients with the worst post-stroke functional outcomes, they found that those with higher RBAs were far worse off than those with lower brain ages. In fact, RBA was the most important determinant of poor outcomes (adjusted odds ratio [aOR]0.76; P <.001), followed by age, prior stroke, and National Institutes of Health Stroke Scale (NIHSS) scores.
“When you’re trying to predict outcomes after stroke, you usually end up with age and the NIHSS as factors and everything else just falls off the board,” Bretzner said. “But we saw that RBA was a sufficiently strong factor to predict stroke outcome, as were age and NIHSS.”
and work remains
Commenting on studies for Medscape Medical NewsLee Schwam, MD, volunteer chair of the American Stroke Association Advisory Committee and chair in vascular neurology at Massachusetts General Hospital in Boston, said the study offers interesting possibilities for patient care, but many questions remain.
“What is most useful from my point of view is that the method is reliable and quantitative, and therefore can be used to characterize the accumulated risk for patients at any age,” Schwam said.
“It will be important to understand how much manual work is needed to measure RBA, and if this can be automated and reported as a standard element in imaging interpretation,” Schwam said. “Until it can be at least semi-automatic and has high reproducibility, low error rates and high inter-rater reliability, it will remain a primarily research tool.”
This study was funded by the ISITE-ULNE Foundation, the Mass General Brigham Hospital, the French Society of Neuroradiology, the French Society of Radiology and the Therese and René Planiol Foundation. Bretzner and Schwamm have not disclosed any relevant financial relationships.
European Stroke Organization Conference (ESOC) 2022 Annual Meeting: Abstract 312. Introduced on May 5, 2022.
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