A web-based dynamic nomogram for individualized risk prediction of magnetic resonance imaging-defined cerebral...

BackgroundTo develop and internally validate a web-based dynamic nomogram to predict magnetic resonance imaging-defined cerebral small-vessel disease.MethodsWe retrospectively enrolled 164 hospitalized adults who underwent brain magnetic resonance imaging between January 2022 and March 2023. The binary outcome was the presence versus absence of magnetic resonance imaging-defined cerebral small-vessel disease according to standardized STandards for ReportIng Vascular changes on nEuroimaging markers. Candidate clinical and laboratory variables were screened using univariable logistic regression and entered into multivariable logistic regression with stepwise selection. Model performance was assessed by receiver operating characteristic analysis, bootstrap calibration (1000 resamples), and decision curve analysis.ResultsCerebral small-vessel disease was present in 73/164 (44.5%) patients. The final model included hypertension, glycated hemoglobin, homocysteine, C-reactive protein, triglycerides, and total cholesterol. Discrimination, defined as the model's ability to distinguish patients with magnetic resonance imaging-defined cerebral small-vessel disease from those without magnetic resonance imaging-defined cerebral small-vessel disease, was good (area under the receiver operating characteristic curve: 0.82, 95% confidence interval: 0.77-0.88), with acceptable calibration after bootstrapping. Decision curve analysis showed a net clinical benefit across threshold probabilities of 0.10-0.80. An online dynamic nomogram was created to facilitate point-of-care risk estimation.ConclusionA simple model based on routine clinical data can provide individualized cerebral small-vessel disease risk estimates and may help prioritize magnetic resonance imaging evaluation and intensify the management of modifiable risk factors.