Deans' stroke musings: Brain atrophy and white matter changes grading agreement on NCCT and MRI in ischemic stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, December 6, 2025

Brain atrophy and white matter changes grading agreement on NCCT and MRI in ischemic stroke

The first word; 'Evaluation' tells me NOTHING HERE GETS SURVIVORS RECOVERED! So useless! The only goal in stroke is 100% recovery; not predictions, biomarkers, prognosis or other useless crapola!

Brain atrophy and white matter changes grading agreement on NCCT and MRI in ischemic stroke

William Betzner University of Calgary

Nishita Singh University of Manitoba

Ibrahim Alhabli University of Calgary

Mohammed Almekhla University of Calgary

Fouzi Bala University of Calgary

Faysal Benali University of Calgary

Kaden Lam University of Calgary

Cody Doolan University of Calgary

Joseph Carere University of Calgary

Luciana Catanese McMaster University

Tolu Sajobi University of Calgary

Aleksander Tkach Kelowna General Hospital

Richard Swartz Sunnybrook Health Science Centre

Bijoy K Menon University of Calgary

Aravind Ganesh University of Calgary

Page 1/16 Research Article Keywords: Posted Date: November 4th, 2025 DOI: https://doi.org/10.21203/rs.3.rs-7687266/v1

License:   This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Additional Declarations: No competing interests reported.

Abstract

Purpose Evaluation of brain frailty measures like atrophy and white matter changes (WMC) are becoming increasingly relevant in stroke outcome prediction but are conventionally thought to be best seen on MRI compared to CT. We assessed agreement between baseline CT vs follow-up MRI ratings for brain atrophy and WMC; and compared their predictive validity of 90-day functional outcomes in acute ischemic stroke.

Methods

In this post-hoc, observational analysis of baseline CT and follow-up MRI data from the Alteplase compared to Tenecteplase (AcT) randomised-controlled trial, experts assessed brain atrophy as well as periventricular and deep WMC using established scales. Binary agreement (none-mild vs. moderate severe) and agreement across the full range of scores between atrophy and WMC measures on CT and MRI were calculated using Gwet’s agreement coe cient (AC1). Logistic regression and DeLong’s test were used to compare prediction of 90-day modi ed Rankin Scale (mRS) 0–1.

Results

Among 1,577 AcT participants, 491(31.1%) had interpretable CT and MRI. Binary agreement was substantial for periventricular (AC1 = 0.70) and total WMC (AC1 = 0.68) scores, Koedam scale (AC1 = 0.76) and frontal atrophy (AC1 = 0.80). Almost perfect agreement (AC1:0.81–0.97) was found for all other measures. There was no signi cant difference between NCCT or MRI in predicting 90-day mRS 0–1 for any measures.

Conclusions

CT ratings of brain atrophy and WMC by experts have substantial to almost-perfect agreement compared to MRI. Both generally achieve similar prediction of 90-day functional outcomes. This implies that it is reasonable to use CT scans to evaluate these brain frailty measures in clinical practice and stroke trials.