Abstract WP187: Correlation between Infarct Shape and Volume and Ischemic Risk Factors and Recurrent Ischemic Rates in Small Subcortical Stroke; Data from the SPS3 Randomized Controlled Trial
Bibliographic record
Abstract
Background: Most of lacunar infarcts (LI) are due to penetrating small vessel disease, although other mechanisms can be responsible for LI. We sought to determine the relationship between the size and shape of LI and underlying risk factors and recurrent ischemic stroke rates. Methods: 872 images from the 3020 patients enrolled in the Secondary Prevention of Small Subcortical Strokes (SPS3) trial were included in this analysis. SPS3 is a multi-center randomized trial of MRI proven lacunar stroke patients. Participants with confirmation of their index event by DWI were reviewed. Infarct volume was measured planimetrically, and shape was classified as ovoid/spheroid, slab, stick, or multi-component based on visual analysis after 3D reconstruction of axial MRI slices using OsiriX software. Results: Infarct shape was ovoid/spheroid in 67%, slab in 10%, stick in 6%, and multi-component in 17% of patients. Median infarct volumes differed by shape with the smallest LI volumes observed in ovoid/spheroid: 0.52, 0.76, 0.62, and 0.93 respectively, p < 0.001. Patients with ovoid/spheroid LI were of similar age (means 61 vs. 62 yr, p = 0.4), sex (57 vs 60%, p=0.5), and hypertension status (81% vs. 80%, p = 0.7), but more likely to be diabetic (43% vs. 32%, p = 0.003) and have IHD (17% vs. 10%, p =0.02) vs. those with other shapes combined. Prevalence of relevant intracranial large vessel occlusion on vascular imaging was 7% in the ovoid/spheroid S3 group and 9% in others (p = 0.5). The 6-year re-current stroke rate was 16.1% with 91 strokes occurring. There was no difference in reinfarction rate based on shape or volume. Conclusion: Lacunar strokes comprise a heterogeneous group of cerebral infarction likely secondary to variable etiologies. In this preliminary analysis infarct shape was correlated with risk factors but not with stroke infarct. Final analysis will be presented and likely the ongoing SPS3 data analyses will elucidate these differences.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".