Lung cancer is associated with acute ongoing cerebral ischemia: A population-based study

Abstract

Background and Objectives: Cerebral microinfarcts (CMI) are the most common type of brain ischemia, however they are extremely rare in the general population. CMI can be detected by Magnetic resonance diffusion-weighted imaging (MRI-DWI) only for a very short period of approximately 2 weeks after their formation, and are associated with an increased stroke risk and cognitive impairment. We aimed to examine CMI detection rate in patients with lung cancer (LC), which is strongly associated with ischemic stroke risk relative to other cancer types. Methods: We used Clalit health services record (representing more than 5 million patients) to identify adults with LC, breast, pancreatic or colon cancer (non-lung-cancer, NLC) who underwent brain MRI scan within 5 years following cancer diagnosis. All brain MRI scans were reviewed and CMI were documented, as well as cardiovascular risk factors. Methods: Our cohort contained a total of 2056 MRI scans of LC patients and 1598 of NLC patients. A total of 143 CMI were found in 73/2056 (3.5%) MRI scans of LC group, compared to a total of 29 CMI in 22/1598 (1.4%) MRI scans of NLC,(p<0.01). Cancer type (e.g., LC vs. NLC) was the only associated factor with CMI incidence on multivariate analysis. After calculating accumulated risk, we found an incidence of 2.5 CMI per year in LC patients, and 0.5 in NLC. Discussion: CMI are common findings in cancer patients, especially in LC patients, therefore might serve as a marker for occult brain ischemia, cognitive decline and CRS risk.

Association of Acute Incidental Cerebral Microinfarcts With Subsequent Ischemic Stroke in Patients With Cancer

“…14,21 We then performed subgroup analysis of the "active lung cancer group" including only patients with lung cancer who underwent MRI scan 1 year before and 1 year after cancer diagnosis because lung cancer is associated with the highest rate of acute incidental CMI. 10,11 A secondary analysis was performed, the "extended time frame group," for patients with cancer who underwent MRI scan between 6 years before and 5 years after cancer diagnosis.…”

“…For the purpose of this study, we used our previously described acute incidental CMI in patients with cancer as study exposure. 10,11 We rereviewed our previously described acute incidental CMI and redefined them according to the recently published STRIVE-2 criteria as small hyperintense lesions on DWI, with a correlated hypointense lesion in apparent diffusion coefficient sequence 22 (Figure 1). We defined acute incidental CMI as smaller than 5 mm.…”

“…CMI location (e.g., cortical vs subcortical) was also defined. We previously described our protocol for acute incidental CMI identification and exclusion of mimics 10,11 (see eMethods).…”

“…9 Our previous studies demonstrated the common occurrence of these lesions in patients with cancer, particularly lung cancer, before and after cancer diagnosis. 10,11 However, whether acute incidental CMI increases the risk of subsequent ischemic stroke in patients with cancer is unknown. Cancerrelated stroke (CRS) is an emerging subtype of ischemic stroke, characterized by unique pathomechanisms.…”

Treating inflammation to reduce stroke risk, non-motor symptoms after stroke, cerebral microinfarcts in cancer, and prognosis in cervical dissection

“…Also in this issue, Naftali reviewed diffusion brain MRI scans in patients with lung cancer (2056 scans) and breast, pancreatic, or colon cancer (non-lung cancer, NLC, 1598 scans). 25 They found an incidence of 2.5 cerebral microinfarcts (CMIs) per years in the lung cancer group, and 0.5 in the NLC group. Cancer type (lung cancer versus NLC) was the only factor associated with CMI incidence on multivariate analysis.…”