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Research paper
Mapping the contribution and strategic distribution patterns of neuroimaging features of small vessel disease in poststroke cognitive impairment
  1. Lin Shi1,2,3,
  2. Lei Zhao4,
  3. Fu Ki Yeung4,
  4. Shun Yiu Wong5,
  5. Ronald K T Chan5,
  6. Ming Fai Tse5,
  7. Sze Chun Chan5,
  8. Yee Ching Kwong5,
  9. Ka Chun Li5,
  10. Kai Liu1,
  11. Jill M Abrigo1,
  12. Alexander Y L Lau4,6,7,
  13. Adrian Wong4,6,7,
  14. Bonnie Y K Lam4,6,7,
  15. Thomas W H Leung4,
  16. Jianhui Fu8,
  17. Winnie C W Chu1,
  18. Vincent C T Mok2,4,6,7
  1. 1Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
  2. 2Chow Yuk Ho Technology Centre for Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
  3. 3BrainNow Medical Technology Limited, Hong Kong Science and Technology Park, Hong Kong, China
  4. 4Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
  5. 5Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
  6. 6Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
  7. 7Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
  8. 8Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
  1. Correspondence to Dr Lin Shi, Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China; shilin{at}cuhk.edu.hk and Dr Vincent C T Mok, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9th floor, Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China; vctmok{at}cuhk.edu.hk

Abstract

Objectives Individual neuroimaging features of small vessel disease (SVD) have been reported to influence poststroke cognition. This study aimed to investigate the joint contribution and strategic distribution patterns of multiple types of SVD imaging features in poststroke cognitive impairment.

Methods We studied 145 first-ever ischaemic stroke patients with MRI and Montreal Cognitive Assessment (MoCA) examined at baseline. The local burdens of acute ischaemic lesion (AIL), white matter hyperintensity, lacune, enlarged perivascular space and cross-sectional atrophy were quantified and entered into support vector regression (SVR) models to associate with the global and domain scores of MoCA. The SVR models were optimised with feature selection through 10-fold cross-validations. The contribution of SVD features to MoCA scores was measured by the prediction accuracy in the corresponding SVR model after optimisation.

Results The combination of the neuroimaging features of SVD contributed much more to the MoCA deficits on top of AILs compared with individual SVD features, and the cognitive impact of different individual SVD features was generally similar. As identified by the optimal SVR models, the important SVD-affected regions were mainly located in the basal ganglia and white matter around it, although the specific regions varied for MoCA and its domains.

Conclusions Multiple types of SVD neuroimaging features jointly had a significant impact on global and domain cognitive functionings after stroke on top of AILs. The map of strategic cognitive-relevant regions of SVD features may help clinicians to understand their complementary impact on poststroke cognition.

  • white matter hyperintensity
  • enlarged perivascular space
  • lacune
  • atrophy
  • small vessel disease
  • cognitive impairment
  • ischemic stroke
  • support vector regression
  • feature selection

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Footnotes

  • LS and LZ contributed equally.

  • Contributors LS designed the study and experiments and contributed to the main body of the manuscript. LZ performed literature survey, image registration, statistical analysis and prepared the manuscript. FKY ensured the consistency of lesion delineation. SYW, RKTC, MFT, SCC, YCK and KCL performed lesion delineation and contributed to literature survey. KL provided clinical advice on lesion delineation. JMA, , BYKL, TWHL and WCWC contributed to data collection. VCTM and JF contributed to study design. VCTM, AYLL and AW contributed to clinical evaluation.

  • Funding This study was supported by the National Key Research and Development Programme of China (2016YFC1300603), and the Research Grants Council (Project No.: CUHK 14113214) and the grants from the Innovation and Technology Commission (Project No: GHP-025-17SZ and GHP/028/14SZ) of the Hong Kong Special Administrative Region, China.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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