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Research ArticleBrain

A Preliminary Prediction Model with MR Plaque Imaging to Estimate Risk for New Ischemic Brain Lesions on Diffusion-Weighted Imaging after Endarterectomy or Stenting in Patients with Carotid Stenosis

N. Akutsu, K. Hosoda, A. Fujita and E. Kohmura
American Journal of Neuroradiology September 2012, 33 (8) 1557-1564; DOI: https://doi.org/10.3174/ajnr.A3002
N. Akutsu
aFrom the Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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K. Hosoda
aFrom the Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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A. Fujita
aFrom the Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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E. Kohmura
aFrom the Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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    Fig 1.

    Coregistered multisequence MR imaging cross-sections of carotid plaque. Left: T1WI-BB. Right: T2WI-BB. The regions of interest are outlined in green. Arrows indicate the lumen of the ICA.

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    Fig 2.

    Forest plot of ORs of the full penalized logistic regression model for new occurrences of hyperintense lesions on DWI after CEA or CAS. All odds of continuous variables (T1-SIR, T2-SIR, stenosis, and clinical score) are represented as odds per increase, described in parentheses. Squares and horizontal bars represent ORs and 95% CIs, respectively, on a log scale. The size of the squares represents precision.

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    Fig 3.

    Effects of all of the predictors on the probability of new occurrences of hyperintense lesions on DWI after CEA or CAS, holding other predictors to their medians. See text for details.

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    Fig 4.

    Preliminary nomogram for predicting the probability of new occurrences of hyperintense lesions on DWI after treatment (CEA or CAS) from the full penalized logistic model, by using an approximate model fitted by using ordinary least squares (R2 = 0.992 against the predicted logits of the full penalized logistic model). Points are assigned for each of the 4 predictors. The total points correspond to an absolute predicted risk for occurrence of new hyperintense lesions on DWI after treatment. For each predictor, read the points assigned on the 0–100 scale and add these points. Read the results on the Total Points scale and then read the corresponding predictions below it. Postop. indicates postoperative.

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    Fig 5.

    An example using the preliminary nomogram for predicting the probability of new occurrences of hyperintense lesions on DWI after treatment (CEA or CAS). Left: right carotid angiogram. Right upper: T1WI-BB. Right lower: T2WI-BB. Arrows indicate the lumen of the ICA. See text and Table 2 for details.

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    Table 1:

    Baseline characteristics of patients with or without hyperintense lesions on DWI after CEA or CAS

    PredictorHyperintense Lesions on Postprocedural DWIP Value
    Positive (n = 25)Negative(n = 79)
    Age (yr)72.9 ± 6.271.3 ± 7.2.30
    Male (%)23 (92%)70 (89%)1
    Vascular risk factors (%)
        Hypertension20 (80%)54 (68%).32
        Hyperlipidemia21 (84%)57 (72%).30
        Statin use20 (80%)64 (81%)1
        DM10 (40%)23 (29%).33
        Smoking17 (68%)43 (54%).26
        IHD8 (32%)16 (20%).28
    Symptomatic stenosis (%)15 (60%)38 (48%).36
    Clinical score0.073 ± 0.97−0.023 ± 1.02.67
    Degree of stenosis (%)75.2 ± 11.475.8 ± 9.8.82
    CAS (%)14 (56%)27 (34%).063
    Plaque imaging
        T1-SIR1.69 ± 0.401.36 ± 0.29.00054
        T2-SIR1.49 ± 0.451.75 ± 0.80.045
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    Table 2:

    Hypothetic examples with the calculated predicted probability of new HI on DWI after treatment

    PredictorExample
    Risk of CEARisk of CAS
    ValuesPointsValuesPoints
    Stenosis (%)852852
    T1-SIR1.4301.430
    T2-SIR1.1491.149
    CEA or CASCEA0CAS14
    Total points8195
    Probability of new HI on postop. DWI19%34%
    • Note:—postop. indicates postoperative; HI, hyperintensity.

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American Journal of Neuroradiology: 33 (8)
American Journal of Neuroradiology
Vol. 33, Issue 8
1 Sep 2012
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N. Akutsu, K. Hosoda, A. Fujita, E. Kohmura
A Preliminary Prediction Model with MR Plaque Imaging to Estimate Risk for New Ischemic Brain Lesions on Diffusion-Weighted Imaging after Endarterectomy or Stenting in Patients with Carotid Stenosis
American Journal of Neuroradiology Sep 2012, 33 (8) 1557-1564; DOI: 10.3174/ajnr.A3002

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A Preliminary Prediction Model with MR Plaque Imaging to Estimate Risk for New Ischemic Brain Lesions on Diffusion-Weighted Imaging after Endarterectomy or Stenting in Patients with Carotid Stenosis
N. Akutsu, K. Hosoda, A. Fujita, E. Kohmura
American Journal of Neuroradiology Sep 2012, 33 (8) 1557-1564; DOI: 10.3174/ajnr.A3002
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