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Updated: Jun 23, 2026

A Versatile Murine Model of Subcortical White Matter Stroke for the Study of Axonal Degeneration and White Matter Neurobiology
Published on: March 17, 2016
Association of Stroke Lesion Pattern and White Matter Hyperintensity Burden With Stroke Severity and Outcome
Anna K Bonkhoff1, Sungmin Hong2, Martin Bretzner2
1From the J. Philip Kistler Stroke Research Center (A.K.B., S.H., M.B., M.D.S., R.W.R., E.M.A., K.D., M.N., M.R.E., J. Rosand, N.S.R.), Massachusetts General Hospital, Harvard Medical School, Boston; Univ. Lille (M.B.), Inserm, CHU Lille, U1171-LilNCog (JPARC)-Lille Neurosciences & Cognition, France; Clinic for Neuroradiology (M.D.S.), University Hospital Bonn, Germany; Computer Science and Artificial Intelligence Lab (A. Dalca, P.G.), Massachusetts Institute of Technology, Boston; Athinoula A. Martinos Center for Biomedical Imaging (A. Dalca, B.L.H., S.J.T.M., E.M., J. Rosand, O.W.), Department of Radiology, Massachusetts General Hospital, Charlestown; Department of Neurology (A.-K.G.), University Medical Center Hamburg-Eppendorf, Germany; Hunter Medical Research Institute (J.A.), Newcastle; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia; Department of Medicine (O.B.), Division of Neurology, University of British Columbia, Vancouver, Canada; Department of Neurology (J.W.C., S.K.), University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore; School of Medical Sciences (A. Donatti, A. Sousa), University of Campinas (UNICAMP) and the Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), Campinas, SP, Brazil; Department of Neurosurgery (C.G.), Geisinger, Danville, PA; Department of Neurosurgery (C.G.), Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria; Department of Emergency Medicine (L. Heitsch), Washington University School of Medicine; Department of Neurology (L. Heitsch, C.-L.P.), Washington University School of Medicine & Barnes-Jewish Hospital, St. Louis, MO; Department of Clinical Neuroscience (L. Holmegaard, K.J., T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg; Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (J.J.-C., J. Roquer), Neurovascular Research Group (NEUVAS), IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Spain; KU Leuven-University of Leuven (R.L.), Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND); VIB, Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Department of Neurology, Belgium; School of Medicine and Public Health (C.L.), University of Newcastle; Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia; Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics (C.W.M.), University of Florida, Gainesville; Department of Neurology (J. Meschia), Mayo Clinic, Jacksonville, FL; Centogene AG (A.R.), Rostock, Germany; Department of Neurology (S.R., R.S.), Clinical Division of Neurogeriatrics, Medical University Graz, Austria; Henry and Allison McCance Center for Brain Health (J. Rosand), Massachusetts General Hospital, Boston; Department of Neurology and Evelyn F. McKnight Brain Institute (T.R., R.L.S.), Miller School of Medicine, University of Miami, FL; Institute of Cardiovascular Research (P.S.), Royal Holloway University of London (ICR2UL), Egham, UK St Peter's and Ashford Hospitals, United Kingdom; Department of Neurology (A. Slowik), Jagiellonian University Medical College, Krakow, Poland; Department of Clinical Sciences Malmö (M.S.), Lund University; Department of Neurology, Skåne University Hospital, Lund and Malmö; Department of Laboratory Medicine (T.M.S., C.J.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Neurology (D.S.), Helsinki University Hospital and University of Helsinki, Finland; Stroke Division (V.T.), Florey Institute of Neuroscience and Mental Health and Department of Neurology, Austin Health, Heidelberg, Australia; Department of Radiology (A.V.), University of Cincinnati College of Medicine, OH; Department of Clinical Sciences Lund (J.W.), Radiology, Lund University; Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden; Department of Neurology and Rehabilitation Medicine (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology (R.Z.), Geisinger, Danville, PA; Division of Endocrinology (P.M.), Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville; Department of Clinical Genetics and Genomics (C.J.), Sahlgrenska University Hospital, Gothenburg; Department of Neurology (A.G.L.), Skåne University Hospital, Lund; Department of Clinical Sciences Lund, Neurology, Lund University, Sweden; University of Technology Sydney (J. Maguire), Australia; Department of Biomedical Engineering (D.B.), McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, School of Computer Science, McGill University; and Mila-Quebec Artificial Intelligence Institute (D.B.), Montreal, Canada. abonkhoff@mgh.harvard.edu.
Background And Objectives:
To examine whether high white matter hyperintensity (WMH) burden is associated with greater stroke severity and worse functional outcomes in lesion pattern-specific ways.
Methods:
MR neuroimaging and NIH Stroke Scale data at index stroke and the modified Rankin Scale (mRS) score at 3-6 months after stroke were obtained from the MRI-Genetics Interface Exploration study of patients with acute ischemic stroke (AIS). Individual WMH volume was automatically derived from fluid-attenuated inversion recovery images. Stroke lesions were automatically segmented from diffusion-weighted imaging (DWI) images, parcellated into atlas-defined brain regions and further condensed to 10 lesion patterns via machine learning-based dimensionality reduction. Stroke lesion effects on AIS severity and unfavorable outcomes (mRS score >2) were modeled within purpose-built Bayesian linear and logistic regression frameworks. Interaction effects between stroke lesions and a high vs low WMH burden were integrated via hierarchical model structures. Models were adjusted for age, age2, sex, total DWI lesion and WMH volumes, and comorbidities. Data were split into derivation and validation cohorts.
Results:
A total of 928 patients with AIS contributed to acute stroke severity analyses (age: 64.8 [14.5] years, 40% women) and 698 patients to long-term functional outcome analyses (age: 65.9 [14.7] years, 41% women). Stroke severity was mainly explained by lesions focused on bilateral subcortical and left hemispherically pronounced cortical regions across patients with both a high and low WMH burden. Lesions centered on left-hemispheric insular, opercular, and inferior frontal regions and lesions affecting right-hemispheric temporoparietal regions had more pronounced effects on stroke severity in case of high compared with low WMH burden. Unfavorable outcomes were predominantly explained by lesions in bilateral subcortical regions. In difference to the lesion location-specific WMH effects on stroke severity, higher WMH burden increased the odds of unfavorable outcomes independent of lesion location.
Discussion:
Higher WMH burden may be associated with an increased stroke severity in case of stroke lesions involving left-hemispheric insular, opercular, and inferior frontal regions (potentially linked to language functions) and right-hemispheric temporoparietal regions (potentially linked to attention). Our findings suggest that patients with specific constellations of WMH burden and lesion locations may have greater benefits from acute recanalization treatments. Future clinical studies are warranted to systematically assess this assumption and guide more tailored treatment decisions.
Insights
High white matter hyperintensity (WMH) burden worsens stroke severity and outcomes, especially with lesions in specific brain areas. This suggests tailored treatments may benefit patients with particular WMH and lesion patterns.
Area of Science:
- Neuroimaging
- Stroke Neurology
- Medical Statistics
Background:
- White matter hyperintensity (WMH) is a common finding in neuroimaging.
- The association between WMH burden, stroke severity, and functional outcomes requires further investigation, particularly concerning specific lesion patterns.
Purpose of the Study:
- To determine if a high white matter hyperintensity (WMH) burden is linked to greater stroke severity and worse functional outcomes.
- To explore these associations in a pattern-specific manner related to stroke lesion locations.
Main Methods:
- Utilized MR neuroimaging and NIH Stroke Scale data from the MRI-Genetics Interface Exploration study for acute ischemic stroke (AIS) patients.
- Employed machine learning for stroke lesion segmentation and pattern identification, analyzed with Bayesian regression models.
- Investigated interaction effects between stroke lesions and WMH burden, adjusting for clinical factors and comorbidities.
Main Results:
- Stroke severity was primarily associated with lesions in bilateral subcortical and left cortical regions, irrespective of WMH burden.
- High WMH burden exacerbated stroke severity for lesions in left insular/frontal and right temporoparietal regions.
- Higher WMH burden independently increased the odds of unfavorable outcomes, regardless of lesion location.
Conclusions:
- Elevated WMH burden may amplify stroke severity in specific lesion locations, potentially impacting language and attention functions.
- Patients with distinct WMH burden and lesion patterns might benefit more from acute recanalization therapies.
- Further clinical studies are needed to validate these findings and inform personalized stroke treatment strategies.
Related Concept Videos
Ischemic Stroke l: Introduction
Ischemic Stroke ll: Pathophysiology
Hemorrhagic Stroke ll: Pathophysiology

