Data Sheet 1_Association of white matter hyperintensity burden and infarct volume in the anterior choroidal artery territory with early neurological progression: a dual-center retrospective study.docx

ObjectiveTo investigate the associations of white matter hyperintensity (WMH) burden and infarct volume with early neurological progression in anterior choroidal artery (AChA) territory infarction, and to identify potential imaging-based predictive thresholds.
MethodsThis retrospective cohort study consecutively enrolled AChA infarct patients admitted to two comprehensive stroke centers between September 2018 and September 2024. WMH burden and infarct volume were assessed using the Fazekas visual rating scale and an automated volumetric quantification method based on lesion prediction algorithm, respectively. The primary outcome was early neurological progression. Multivariate logistic regression models with stepwise adjustment for confounders were used to evaluate the associations of WMH burden and infarct volume with early progression. Restricted cubic spline regression was performed to explore non-linear relationships and to determine thresholds. Continuous variables were standardized, and piecewise regression analysis was conducted based on the identified thresholds. Subgroup analyses with interaction tests were performed to assess the consistency of these associations across different populations.
ResultsA total of 216 patients were included, of whom 82 (38.0%) experienced early neurological progression. After adjustment for potential confounders, WMH burden showed a significant non-linear association with progression risk. For WMH volumes <66.1 mL, each standard deviation increase was associated with a 74% higher risk of progression (standardized OR: 1.74, 95% CI: 1.29–2.40, p < 0.001). Compared with the lowest quartile, patients in the highest WMH quartile showed significantly increased risk (adjusted OR: 5.32, 95% CI: 1.48–13.88, p = 0.009). This association was confirmed by Fazekas scale analysis, with grade 3 patients showing substantially higher risk than grade 0 (adjusted OR: 6.22, 95% CI: 1.74–25.42, p = 0.007). Infarct volume demonstrated a similar non-linear pattern; for volumes <1.1 mL, each standard deviation increase was associated with 59% higher progression risk (standardized OR: 1.59, 95% CI: 1.04–2.47, p = 0.036). Quartile analysis revealed the highest risk in the third quartile compared to the lowest (adjusted OR: 5.63, 95% CI: 2.06–15.40, p < 0.001).
ConclusionThis study revealed non-linear associations of WMH and infarct volume with early progression in AChA infarct patients.

研究目的
探讨脑白质高信号（white matter hyperintensity, WMH）负荷与梗死体积对脉络膜前动脉（anterior choroidal artery, AChA）供血区脑梗死患者早期神经功能恶化的关联，并识别基于影像学的潜在预测阈值。

研究方法
本项回顾性队列研究连续纳入2018年9月至2024年9月期间，于两家综合卒中中心收治的AChA脑梗死患者。分别采用Fazekas视觉评分量表（Fazekas visual rating scale）与基于病变预测算法的自动化体积定量法，评估患者的WMH负荷与梗死体积。本研究的主要结局为早期神经功能恶化。采用校正混杂因素的多因素logistic回归模型（multivariate logistic regression models），通过逐步调整混杂因素，评估WMH负荷与梗死体积与早期病情进展的关联。通过限制性立方样条回归（restricted cubic spline regression）探索非线性关联并确定预测阈值。对连续变量进行标准化处理，并基于确定的阈值开展分段回归分析。此外，进行带有交互检验的亚组分析，以评估不同人群中上述关联的一致性。

研究结果
本研究共纳入216例患者，其中82例（38.0%）出现早期神经功能恶化。校正潜在混杂因素后，WMH负荷与病情进展风险呈显著非线性关联。当WMH体积<66.1 mL时，每增加1个标准差，病情进展风险升高74%（标准化优势比（odds ratio, OR）：1.74，95%置信区间（confidence interval, CI）：1.29–2.40，p < 0.001）。与WMH负荷最低四分位数（quartile）组相比，最高四分位数组患者的病情进展风险显著升高（校正后OR：5.32，95% CI：1.48–13.88，p = 0.009）。该关联经Fazekas量表分析得到验证：Fazekas 3级患者的病情进展风险显著高于Fazekas 0级患者（校正后OR：6.22，95% CI：1.74–25.42，p = 0.007）。梗死体积亦呈现相似的非线性模式：当梗死体积<1.1 mL时，每增加1个标准差，病情进展风险升高59%（标准化OR：1.59，95% CI：1.04–2.47，p = 0.036）。四分位数分析显示，与最低四分位数组相比，第三四分位数组患者的病情进展风险最高（校正后OR：5.63，95% CI：2.06–15.40，p < 0.001）。

研究结论
本研究揭示了AChA供血区脑梗死患者的WMH负荷与梗死体积和早期病情进展之间的非线性关联。