Stroke Mechanism Subtypes and Prognosis in Patients With Symptomatic Intracranial Atherosclerosis Based on Multiparametric <scp>MRI</scp>
Bibliographic record
Abstract
BACKGROUND: Different stroke mechanisms present with distinct imaging characteristics and prognosis. Multiparametric MRI can characterize these variations and may contribute to stroke secondary prevention. PURPOSE: To investigate the stroke mechanism subtypes and prognosis in patients with symptomatic intracranial atherosclerosis using multiparametric MRI. STUDY TYPE: Retrospective. POPULATION: Two hundred and seventeen ischemic stroke patients (147 males; age 55.5 ± 11.7 years) with intracranial atherosclerosis. FIELD STRENGTH/SEQUENCE: 3-T, dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI); High-resolution vessel wall imaging (HR-VWI): three-dimensional (3D) T1-weighted Sampling Perfection with Application optimized Contrast using different flip angle Evolution (SPACE) and contrast-enhanced T1-SPACE. ASSESSMENT: All patients underwent multiparametric MRI within 7 days of stroke symptom onset. The stroke mechanisms included branch occlusive disease (BOD), artery-to-artery embolism, hypoperfusion, and mixed mechanisms. The following imaging characteristics were assessed by three radiologists independently. HR-VWI plaque characteristics included plaque area, lipid area, lipid ratio, occlusive thrombus, degree of stenosis, plaque burden, enhancement ratio, remodeling index, and intraplaque hemorrhage (IPH). The mean transit time-Alberta Stroke Program Early Computed Tomography score (MTT-ASPECTS) based on DSC-PWI was used to evaluate perfusion impairment. During a median follow-up period of 15 months, the correlation between different stroke mechanisms and prognosis was analyzed. STATISTICAL TESTS: Chi-squared or Fisher's exact, Kruskal-Wallis H-tests, multivariate logistic regression, and Kaplan-Meier curves. All p-values were corrected by Bonferroni correction, and p-values < 0.05 were considered statistically significant. RESULTS: Mixed mechanism was the most common subtype (32.7%). Significant differences were observed in perfusion impairment, degree of stenosis, plaque burden, enhancement ratio, IPH, and remodeling among stroke mechanisms. Of these characteristics, MTT-ASPECTS (odds ratio [OR] 0.70, 95% CI 0.562-0.863) and IPH (OR 2.30, 95% CI 1.042-5.051) were significantly associated with non-BOD mechanisms. Hypoperfusion mechanism was associated with a higher risk of stroke recurrence during a median follow-up of 15 months (hazard ratio 3.97, 95% CI 1.43-11.03). DATA CONCLUSION: Multiparametric MRI may reveal differences in imaging characteristics among stroke mechanisms. Hypoperfusion may be associated with an increased risk of stroke recurrence. EVIDENCE LEVEL: 3. Technical Efficacy: Stage 3.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
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".