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Updated: Aug 25, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Nomogram based on clinical and brain computed tomography characteristics for predicting more than 5 cerebral
Xin-Bin Wang1, Hao Dong1, Yong-Gang Qiu1
1Department of Radiology, Xiaoshan Affiliated Hospital of Wenzhou Medical University, The First People's Hospital of Xiaoshan District, Hangzhou, China.
Background:
Cerebral microbleeds (CMBs) are common in the hypertensive population and can only be detected with magnetic resonance imaging (MRI). The anticoagulation and thrombolytic regimens for patients with >5 CMBs are different from those for patients with ≤ 5 CMBs. However, MRI is not suitable for evaluating CMBs in patients with MRI contraindications or acute ischemic stroke urgently requiring thrombolysis. We aimed to develop and validate a nomogram combining clinical and brain computed tomography (CT) characteristics for predicting >5 CMBs in a hypertensive population.
Materials And Methods:
In total, 160 hypertensive patients from 2016 to 2020 who were confirmed by MRI to have >5 (77 patients) and ≤ 5 CMBs (83) were retrospectively analyzed as the training cohort. Sixty-four hypertensive patients from January 2021 to February 2022 were included in the validation cohort. Multivariate logistic regression was used to evaluate >5 CMBs. A combined nomogram was constructed based on the results, while clinical and CT models were established according to the corresponding characteristics. Receiver operating characteristic (ROC) and calibration curves and decision curve analysis (DCA) were used to verify the models.
Results:
In the multivariable analysis, the duration of hypertension, level of homocysteine, the number of lacunar infarcts (LIs), and leukoaraiosis (LA) score were included as factors associated with >5 CMBs. The clinical model consisted of the duration of hypertension and level of homocysteine, while the CT model consisted of the number of LIs and LA. The combined model consisted of the duration of hypertension, level of homocysteine, LI, and LA. The combined model achieved an area under the curve (AUC) of 0.915 (95% confidence interval [CI]: 0.860-0.953) with the training cohort and 0.887 (95% CI: 0.783-0.953) with the validation cohort, which were higher than those of the clinical model [training cohort: AUC, 0.797 (95% CI: 0.726, 0.857); validation cohort: AUC, 0.812 (95% CI: 0.695, 0.899)] and CT model [training cohort: AUC, 0.884 (95% CI: 0.824, 0.929); validation cohort: AUC, 0.868 (95% CI: 0.760, 0.940)]. DCA showed that the clinical value of the combined model was superior to that of the clinical model and CT model.
Conclusion:
A combined model based on clinical and CT characteristics showed good diagnostic performance for predicting >5 CMBs in hypertensive patients.
Insights
A new nomogram combining clinical and brain CT data effectively predicts over 5 cerebral microbleeds (CMBs) in hypertensive patients. This tool aids in treatment decisions when MRI is not feasible.
Area of Science:
- Neurology
- Radiology
- Cardiovascular Medicine
Background:
- Cerebral microbleeds (CMBs) are prevalent in hypertensive individuals and typically detected via MRI.
- Treatment protocols differ for patients with >5 CMBs versus ≤5 CMBs.
- MRI is often unsuitable for urgent cases or patients with contraindications.
Purpose of the Study:
- To develop and validate a nomogram using clinical and brain CT characteristics to predict >5 CMBs in hypertensive patients.
- To provide an alternative prediction tool when MRI is not an option.
Main Methods:
- Retrospective analysis of 160 hypertensive patients (training cohort) and 64 (validation cohort).
- Multivariate logistic regression identified factors associated with >5 CMBs.
- Developed and compared combined, clinical, and CT models using ROC curves and DCA.
Main Results:
- Duration of hypertension, homocysteine levels, lacunar infarcts (LIs), and leukoaraiosis (LA) were significant predictors.
- The combined model demonstrated high predictive accuracy (AUC 0.915 training, 0.887 validation).
- Combined model outperformed individual clinical and CT models in both cohorts.
Conclusions:
- A nomogram integrating clinical and CT data offers robust prediction of >5 CMBs in hypertensive patients.
- This combined model shows superior clinical utility compared to models using only clinical or CT data.
- The developed nomogram can assist in managing hypertensive patients with potential CMBs.
