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Updated: May 16, 2025
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Neuroimaging biomarkers on routine Computed Tomography (CT) after acute stroke and their association with post-stroke
Amanda Barugh1, Andrew Farrall2, Karen Ferguson2
1NHS Lothian, Medicine of the Elderly and Stroke, Royal Infirmary, 51 Little France Crescent, Edinburgh EH16 4SA, UK.
Background:
Delirium affects a quarter of patients after acute stroke and predicts poorer outcomes. The aim of this pragmatic study was to determine whether either qualitative assessment or quantitative assessments of the regional atrophy obtained from routinely performed computed tomography (CT) brain imaging could identify patients most at risk of developing delirium.
Methods:
We recruited 95 patients with acute stroke (age ≥60) (ischaemic or intracerebral haemorrhage) over one year. Follow-up for delirium and cognition was performed at 1, 3, 5, 7, 14, 21, 28 days, 4 months and 12 months. All participants underwent routine CT brain (Toshiba 64-slice or 128-slice scanner) (within 24 h of stroke onset). White matter lesions and atrophy were rated qualitatively (mild, moderate, severe). Atrophy in multiple specific areas was measured quantitatively.
Results:
Twenty-six (27 %) developed delirium during the 12 months of follow-up. On univariable analysis, delirium was associated with increasing age, being female, less independent in pre-stroke activities of daily living, pre-existing cognitive impairment, increasing stroke severity, having had a total anterior circulation stroke and global cerebral atrophy on brain CT. Multivariable analysis demonstrated that only global cerebral atrophy, being female and having a more severe stroke predicted delirium. This model accounted for between 38 % and 55 % of the variance in delirium. For quantitative CT analysis, on univariable analysis, delirium was associated with atrophy in several specific brain areas. On multivariable analysis, only NIHSS (for every one point increase OR 1.23, 95 % CI 1.06-1.43; p = 0.006)) and cistern ambiens ratio (OR 1.41, 95 % CI 1.48-4.96; p = 0.028) were significantly associated. This model accounted for between 35.1 % and 51.2 % of delirium variance.
Conclusion:
Clinical variables together with either qualitative atrophy assessment or cistern ambiens ratio on routine CT brain could identify stroke patients most at risk of delirium and to stratify patients in clinical trials of delirium prevention and treatment.
