MRI Assessment of Brain Frailty and Clinical Outcome in Patients With Acute Posterior Perforating Artery Infarction

Abstract

BackgroundGlobal brain health has gained increasing attention recently. Imaging markers of brain frailty have been related to functional outcomes in previous studies on anterior circulation; however, little data are available on imaging markers and posterior circulation.PurposeTo investigate the impact of brain frailty on functional outcomes in patients with acute perforating artery infarction (PAI) of the posterior circulation.Study TypeProspective.PopulationOne hundred patients (60.78 ± 9.51 years, 72% men) with acute posterior circulation PAI (determined by diffusion‐weighted magnetic resonance imaging (MRI)/time‐of‐flight MR angiography).Field Strength/SequenceT1‐ and T2‐weighted fast spin echo, T2‐weighted fluid‐attenuated inversion recovery, diffusion‐weighted echo planar, gradient echo (susceptibility‐weight imaging), and 3D time‐of‐flight MR angiography sequences at 3.0 T.AssessmentPeriventricular and deep white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS) in the basal ganglia and centrum semiovale area, lacunes, cerebral microbleeds (CMB), and total brain frailty score by calculating the above imaging characters were rated visually by three radiologists with 9, 10, and 11 years of experience and one neuroradiologist with 12. Infarction volume was assessed using baseline diffusion‐weighted imaging (DWI) data obtained within 24 hours of symptom onset. A modified Rankin Scale (mRS) score >1 on day 90 defined an adverse functional outcome. Associations between the imaging markers of brain frailty and functional outcomes were assessed.Statistical TestsFisher's exact test, Mann–Whitney U test, and multivariable binary logistic regression. A P value <0.05 was considered statistically significant.ResultsAdverse prognoses (mRS > 1) were observed in 34 (34%) patients. Infarction volume, periventricular WMH, deep WMH, basal ganglia EPVS, CMB, and the brain frailty score were significantly associated with adverse functional outcomes. An increased brain frailty score was significantly associated with unfavorable mRS score on day 90 (odds ratio 1.773, 95% confidence interval 1.237–2.541).Data ConclusionAdvanced MRI imaging markers of brain frailty, individually or combined as a total brain frailty score, were associated with worse functional outcomes after acute posterior circulation PAI.Level of Evidence3Technical EfficacyStage 3

Brain frailty associated with stroke events in anterior circulation large artery occlusion

“…Second, this study did not analyze the effect of brain frailty on the long-term prognosis of patients with ACI. Brain frailty is an indicator of brain health and brain reserve, which may affect patients in later recovery [ 37 ]. In the future, we will continue to follow patients and investigate the relationship between brain frailty and long-term outcome of ACI in AC patients.…”

Editorial for “MRI Assessment of Brain Frailty and Clinical Outcome in Patients With Acute Posterior Perforating Artery Infarction”

“…In this issue of the JMRI , the authors have utilized a longitudinal model to investigate the small vessel disease in posterior circulation territory (acute posterior perforating artery infarction [PAI]) and its impact on frailty. The study demonstrated that imaging markers of brain frailty, both individually and combined as a total brain frailty score, were associated with worse functional outcomes in patients with acute PAI 7 . It is certainly logical to conclude that the posterior circulation ischemia has more significant impact on the clinical outcomes and frailty is an important adjunct to this.…”