Quantitative Rapid Assessment of Leukoaraiosis in CT
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The severity of white matter lesions (WML) is a risk factor of hemorrhage and predictor of clinical outcome after ischemic stroke; however, in contrast to magnetic resonance imaging (MRI) reliable quantification for this surrogate marker is limited for computed tomography (CT), the leading stroke imaging technique. We aimed to present and evaluate a CT-based automated rater-independent method for quantification of microangiopathic white matter changes.
Patients with suspected minor stroke (National Institutes of Health Stroke scale, NIHSS < 4) were screened for the analysis of non-contrast computerized tomography (NCCT) at admission and compared to follow-up MRI. The MRI-based WML volume and visual Fazekas scores were assessed as the gold standard reference. We employed a recently published probabilistic brain segmentation algorithm for CT images to determine the tissue-specific density of WM space. All voxel-wise densities were quantified in WM space and weighted according to partial probabilistic WM content. The resulting mean weighted density of WM space in NCCT, the surrogate of WML, was correlated with reference to MRI-based WML parameters.
The process of CT-based tissue-specific segmentation was reliable in 79 cases with varying severity of microangiopathy. Voxel-wise weighted density within WM spaces showed a noticeable correlation (r = −0.65) with MRI-based WML volume. Particularly in patients with moderate or severe lesion load according to the visual Fazekas score the algorithm provided reliable prediction of MRI-based WML volume.
Automated observer-independent quantification of voxel-wise WM density in CT significantly correlates with microangiopathic WM disease in gold standard MRI. This rapid surrogate of white matter lesion load in CT may support objective WML assessment and therapeutic decision-making during acute stroke triage.
KeywordsLeukoaraiosis White matter lesions Cerebral small vessel disease CT segmentation techniques Acute stroke
Conflict of interests
U. Hanning, P. Sporns, R. Schmidt,T. Niederstadt, J. Minnerup,G. Bier, S. Knecht and A. Kemmling declare that they have no competing interests.
- 1.Basile AM, Pantoni L, Pracucci G, Asplund K, Chabriat H, Erkinjuntti T, Fazekas F, Ferro JM, Hennerici M, O’Brien J, Scheltens P, Visser MC, Wahlund LO, Waldemar G, Wallin A, Inzitari D; LADIS Study Group. Age, hypertension, and lacunar stroke are the major determinants of the severity of age-related white matter changes. The LADIS (Leukoaraiosis and Disability in the Elderly) Study. Cerebrovasc Dis. 2006;21(5–6):315–22.CrossRefPubMedGoogle Scholar
- 4.Curtze S, Melkas S, Sibolt G, Haapaniemi E, Mustanoja S, Putaala J, Sairanen T, Tiainen M, Tatlisumak T, Strbian D. Cerebral computed tomography-graded white matter lesions are associated with worse outcome after thrombolysis in patients with stroke. Stroke. 2015;46(6):1554–60.CrossRefPubMedGoogle Scholar
- 6.Shi ZS, Loh Y, Liebeskind DS, Saver JL, Gonzalez NR, Tateshima S, Jahan R, Feng L, Vespa PM, Starkman S, Salamon N, Villablance JP, Ali LK, Ovbiagele B, Kim D, Viñuela F, Duckwiler GR. Leukoaraiosis predicts parenchymal hematoma after mechanical thrombectomy in acute ischemic stroke. Stroke. 2012;43(7):1806–11.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Maillard P, Delcroix N, Crivello F, Dufouil C, Gicquel S, Joliot M, Tzourio-Mazoyer N, Alpérovitch A, Tzourio C, Mazoyer B. An automated procedure for the assessment of white matter hyperintensities by multispectral (T1, T2, PD) MRI and an evaluation of its between-centre reproducibility based on two large community databases. Neuroradiology. 2008;50(1):31–42.CrossRefPubMedGoogle Scholar
- 13.Zhang J, Puri AS, Khan MA, Goddeau RP Jr, Henninger N. Leukoaraiosis predicts a poor 90-day outcome after Endovascular stroke therapy. AJNR Am J Neuroradiol. 2014;35(11):2070–5.Google Scholar
- 16.Debette S, Beiser A, DeCarli C, Au R, Himali JJ, Kelly-Hayes M, Romero JR, Kase CS, Wolf PA, Seshadri S. Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality: the Framingham Offspring Study. Stroke. 2010;41(4):600–6.CrossRefPubMedPubMedCentralGoogle Scholar