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Updated: Jul 16, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
HR-MRI-based nomogram network calculator to predict stroke recurrence in high-risk non-disabling ischemic
1Department of Radiology Center, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
Insights
High-resolution MRI plaque characteristics, including intra-plaque hemorrhage and normalized wall index, combined with the modified Essen score, predict stroke recurrence in high-risk non-disabling ischemic cerebrovascular events (HR-NICE) patients.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Intracranial atherosclerosis is a major cause of stroke.
- Identifying high-risk patients for stroke recurrence is crucial for effective management.
- High-resolution magnetic resonance imaging (HR-MRI) offers detailed plaque characterization.
Purpose of the Study:
- To assess HR-MRI plaque characteristics in culprit lesions.
- To evaluate the predictive value of these characteristics combined with the modified Essen score for stroke recurrence.
- To develop a predictive model for recurrence risk in high-risk non-disabling ischemic cerebrovascular events (HR-NICE) patients.
Main Methods:
- Retrospective analysis of 180 HR-NICE patients (discovery cohort) and 65 (validation cohort).
- HR-MRI vessel wall imaging and clinical data analysis using VesselExplorer2 software.
- Logistic regression and nomogram construction for risk prediction, validated with ROC, calibration curves, and DCA.
Main Results:
- Intra-plaque hemorrhage, homocysteine, and normalized wall index were independent risk factors for stroke recurrence.
- The nomogram model demonstrated superior predictive performance (AUC=0.830) compared to the modified Essen score (AUC=0.660).
- The nomogram showed good performance in the validation group (AUC=0.785) with favorable calibration and clinical utility.
Conclusions:
- HR-MRI plaque characteristics combined with the modified Essen score effectively predict recurrence risk in HR-NICE patients.
- A nomogram model based on these factors provides a valuable tool for identifying high-risk individuals.
- This approach holds promise for improved clinical decision-making and patient management.
Background And Objective:
To investigate the use of high-resolution magnetic resonance imaging (HR-MRI) to identify the characteristics of culprit plaques in intracranial arteries, and to evaluate the predictive value of the characteristics of culprit plaques combined with the modified Essen score for the recurrence risk of high-risk non-disabling ischemic cerebrovascular events (HR-NICE) patients.
Methods:
A retrospective analysis was conducted on 180 patients with HR-NICE at the First Affiliated Hospital of Xinxiang Medical University, including 128 patients with no recurrence (non-recurrence group) and 52 patients with recurrence (recurrence group). A total of 65 patients with HR-NICE were collected from the Sixth Affiliated Hospital of Shanghai Jiaotong University as a validation group, and their modified Essen scores, high-resolution magnetic resonance vessel wall images, and clinical data were collected. The culprit plaques were analyzed using VesselExplorer2 software. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for recurrence, and a nomogram was constructed using R software to evaluate the discrimination of the model. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was used to evaluate the model performance. Calibration curves and Decision Curve Analysis (DCA) were used to evaluate the model efficacy.
Results:
Intra-plaque hemorrhage (OR = 3.592, 95% CI = 1.474-9.104, p = 0.006), homocysteine (OR = 1.098, 95% CI = 1.025-1.179, p = 0.007), and normalized wall index (OR = 1.114, 95% CI = 1.027-1.222, p = 0.015) were significantly higher in the recurrent stroke group than in the non-recurrent stroke group, and were independent risk factors for recurrent stroke. The performance of the nomogram model (AUC = 0.830, 95% CI: 0.769-0.891; PR-AUC = 0.628) was better than that of the modified Essen scoring model (AUC = 0.660, 95% CI: 0.583-0.738) and the independent risk factor combination model (AUC = 0.827, 95% CI: 0.765-0.889). The nomogram model still had good model performance in the validation group (AUC = 0.785, 95% CI: 0.671-0.899), with a well-fitting calibration curve and a DCA curve indicating good net benefit efficacy for patients.
Conclusion:
High-resolution vessel wall imaging combined with a modified Essen score can effectively assess the recurrence risk of HR-NICE patients, and the nomogram model can provide a reference for identifying high-risk populations with good clinical application prospects.
