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Related Experiment Video

Updated: Jan 8, 2026

A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
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Simple MRI Lesion Levels Improve Two-Year Prognostic Accuracy Beyond Clinical History in CADASIL.

Ruiting Zhang1,2, Chih-Hao Chen3, Louis Lambert2,4

  • 1Department of Radiology, the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China (R.Z.).

Stroke
|December 24, 2025
PubMed
Summary

The CADASIL MRI Inventory Tool effectively predicts stroke, migraine with aura, cognitive impairment, and disability in CADASIL patients. These MRI findings offer valuable prognostic information beyond clinical data for improved risk stratification.

Keywords:
NOTCH3 mutationcerebral atrophyischemic strokelacunelongitudinalmicrobleedwhite matter hyperintensities

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Area of Science:

  • Neurology
  • Radiology
  • Genetics

Background:

  • Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common inherited cerebrovascular disorder.
  • The CADASIL MRI Inventory Tool standardizes MRI findings into type-specific lesion levels.
  • This study evaluated the predictive capacity of these MRI lesion levels in addition to clinical information.

Purpose of the Study:

  • To assess the independent predictive value of CADASIL MRI Inventory Tool lesion levels for clinical outcomes.
  • To determine if MRI findings can enhance risk stratification in CADASIL patients.
  • To explore the prognostic information provided by specific MRI lesion types.

Main Methods:

  • A cohort of 743 CADASIL patients from three countries was analyzed.
  • Baseline MRI scans were assessed using the CADASIL MRI Inventory Tool for various lesion types.
  • Outcomes including stroke, migraine with aura (MA), cognitive impairment, and disability were tracked over 2 years.
  • Multivariable logistic regression adjusted for clinical covariates was employed.

Main Results:

  • Higher levels of deep white matter hyperintensities and lacunes were associated with stroke.
  • Cerebral microbleeds and superficial atrophy showed an inverse association with MA.
  • Lacune levels independently predicted ischemic stroke events (OR, 6.10).
  • Superficial atrophy and white matter hyperintensities predicted a lower risk of MA (OR, 0.29 and 0.21).
  • Lacunes, deep atrophy, and superficial atrophy were linked to disability and cognitive impairment.

Conclusions:

  • CADASIL MRI Inventory Tool lesion levels are significantly associated with CADASIL manifestations.
  • These MRI measures provide independent prognostic information for 2-year outcomes.
  • The tool can supplement clinical evaluation for improved risk stratification and patient selection in trials.