Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke

 

ASSESSMENTS DO NOTHING FOR RECOVERY! What a load of crap!

Useless crapola once again because stroke survivors aren't running the show. I'd have you all fired!

Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke

Tanaporn Jaroenngarmsamer, Faysal Benali, Joachim Fladt, Nishita Singh, Fouzi Bala, Michael Tymianski, Michael D. Hill, Mayank Goyal and Aravind Ganesh On behalf of the ESCAPE-NA1 Investigators

American Journal of Neuroradiology August 2023, DOI: https://doi.org/10.3174/ajnr.A7981

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Abstract

BACKGROUND AND PURPOSE: Brain atrophy is an important surrogate for brain reserve, the capacity of the brain to cope with acquired injuries such as acute stroke. It is unclear how well atrophy measurements on MR imaging can be reproduced using NCCT imaging. We aimed to compare pragmatic atrophy measures on NCCT with MR imaging in patients with acute ischemic stroke.

MATERIALS AND METHODS: This is a post hoc analysis, including baseline NCCT and 24-hour follow-up MR imaging data from the Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke (ESCAPE-NA1) trial. Cortical atrophy was measured using the global cortical atrophy scale, and subcortical atrophy was measured using the intercaudate distance-to-inner-table width (CC/IT) ratio. Agreement and correlation between these measures on NCCT and MR imaging were calculated using the Gwet agreement coefficient 1 and Pearson correlation coefficients, respectively.

RESULTS: Among 1105 participants in the ESCAPE-NA1 trial, interpretable NCCT and 24-hour MR imaging were available in 558 (50.5%) patients (mean age, 67.2 [SD, 13.7] years; 282 women). Cortical atrophy assessments performed on NCCT underestimated atrophy severity compared with MR imaging (eg, patients with global cortical atrophy of ≥1 assessed on NCCT = 133/558 [23.8%] and on MR imaging = 247/558 [44.3%]; a 20.5% difference). Overall, cortical (ie, global cortical atrophy) atrophy assessments on NCCT had substantial or better agreement with MR imaging (Gwet agreement coefficient 1 of > 0.784; P < .001). Subcortical atrophy measures (CC/IT ratio) showed strong correlations between NCCT and MR imaging (Pearson correlation = 0.746, P < .001).

CONCLUSIONS: Brain atrophy can be evaluated using simple measures in emergently acquired NCCT. Subcortical atrophy assessments on NCCT show strong correlations with MR imaging. Although cortical atrophy assessments on NCCT are strongly correlated with MR imaging ratings, there is a general underestimation of atrophy severity on NCCT.

ABBREVIATIONS:

AC1

agreement coefficient 1

CC/IT

intercaudate distance-to-inner-table width

ESCAPE-NA1

Safety and Efficacy of Nerinetide (NA-1) in Subjects Undergoing Endovascular Thrombectomy for Stroke

GCA

global cortical atrophy

h-ICD

hemi-intercaudate distance

MTA

medial temporal atrophy

Brain atrophy is considered an important imaging surrogate of brain reserve, the ability of the brain to cope with acquired tissue injuries, such as stroke, demyelination, or trauma.^{1⇓⇓⇓⇓⇓-7} There is compelling evidence on the role that atrophy and other measures of brain reserve play in moderating functional recovery and neurocognitive sequelae after such brain injuries, leading to burgeoning interest in assessing these markers in research and practice.^8⇓-10 Several methods to assess brain atrophy on NCCT have been developed, including sophisticated automated volumetrics.^11,12 However, pragmatic visual ratings and measurements are currently the mainstay in clinical practice.^13⇓-15

Such pragmatic scales include cortical atrophy assessments, which are based on the width of the sulci and volume of the gyri (global cortical atrophy [GCA]):¹³ hippocampal atrophy assessments, based on the height/volume of the hippocampus (medial temporal atrophy [MTA] scale)¹⁵ and parietal lobe atrophy assessments based on the width of the posterior cingulate and parieto-occipital sulci (Koedam scale).¹⁴ Subcortical atrophy is assessed less commonly but can be quantified using simple measurements and calculations like the intercaudate distance-to-inner-table width (CC/IT) ratio.¹⁶

MR imaging is the preferred imaging tool for the aforementioned scales and measures because they were originally developed as part of the work-up for neurodegenerative disorders.¹⁷ However, NCCT is more widely available and more often used in emergency settings like acute stroke. In addition, some patients cannot undergo MR imaging due to claustrophobia, excessive agitation, metal implants, or other contraindications.^18,19 Therefore, should atrophy assessments on NCCT be comparable with those on MR imaging, this similarity would help facilitate the routine consideration of brain atrophy in the evaluation and prognostication of patients with acute neurologic injuries like stroke.

Prior studies comparing the use of NCCT and MR imaging for atrophy assessment included patients with neurodegenerative disorders rather than acute injuries like stroke^12,20 and used less established scales or measurements.²¹ The few studies that included patients with acute stroke share the important limitation of not considering confounding of measurements by mass effect from infarct-related edema, which can complicate around 5% of all ischemic strokes.^22,23

In this study, we aimed to compare the pragmatic assessment of cortical and subcortical atrophy using well-known and standardized rating scales applied on NCCT versus MR imaging in a large randomized controlled trial–derived population of patients with acute stroke.

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