Abstract：
OBJECTIVE: Incidental diffuse-weighted imaging (DWI)-positive subcortical and cortical lesions, or acute incidental cerebral microinfarcts (CMIs), are a common type of brain ischemia, which can be detected on magnetic resonance DWI for approximately 2 weeks after occurrence. Acute incidental CMI was found to be more common in patients with cancer. Whether acute incidental CMI predicts future ischemic stroke is still unknown. We aimed to examine the association between acute incidental CMI in patients with cancer and subsequent ischemic stroke or transient ischemic attack (TIA).
METHODS: This is a retrospective cohort study. We used Clalit Health Services records, representing over half of the Israeli population, to identify adults with lung, breast, pancreatic, or colon cancer who underwent brain MRI between January 2014 and April 2020. We included patients who underwent scan between 1 year before cancer diagnosis and 1 year after diagnosis. Primary outcome was ischemic stroke or TIA using International Classification of Diseases, Ninth Revision codes. Secondary outcomes were intracranial hemorrhage (ICH) and mortality. Records were followed from first MRI until primary outcome, death, or end of follow-up (January 2023). Cox proportional hazards models were used to calculate hazard ratio (HR) for patients with and without acute incidental CMI, as a time-dependent covariate.
RESULTS: The study cohort included 1,618 patients with cancer, among whom, 59 (3.6%) had acute incidental CMI on at least 1 brain MRI. The median (interquartile range) time from acute incidental CMI to stroke or TIA was 26 days (14-84). On multivariable analysis, patients with acute incidental CMI had a higher stroke or TIA risk (HR 2.97, 95% CI 1.08-8.18, p = 0.035) compared with their non-CMI counterparts. Acute incidental CMIs were also associated with mortality after multivariable analysis (HR 2.76, 95% CI 2.06-3.71, p < 0.001); no association with ICH was found.
CONCLUSIONS: Acute incidental CMI on brain MRI in patients with active cancer is associated with an increased risk of near-future ischemic stroke or TIA and mortality. This finding might suggest that randomly detected acute incidental CMI in patients with cancer may guide primary cerebrovascular risk prevention and etiologic workup.
METHODS: This is a retrospective cohort study. We used Clalit Health Services records, representing over half of the Israeli population, to identify adults with lung, breast, pancreatic, or colon cancer who underwent brain MRI between January 2014 and April 2020. We included patients who underwent scan between 1 year before cancer diagnosis and 1 year after diagnosis. Primary outcome was ischemic stroke or TIA using International Classification of Diseases, Ninth Revision codes. Secondary outcomes were intracranial hemorrhage (ICH) and mortality. Records were followed from first MRI until primary outcome, death, or end of follow-up (January 2023). Cox proportional hazards models were used to calculate hazard ratio (HR) for patients with and without acute incidental CMI, as a time-dependent covariate.
RESULTS: The study cohort included 1,618 patients with cancer, among whom, 59 (3.6%) had acute incidental CMI on at least 1 brain MRI. The median (interquartile range) time from acute incidental CMI to stroke or TIA was 26 days (14-84). On multivariable analysis, patients with acute incidental CMI had a higher stroke or TIA risk (HR 2.97, 95% CI 1.08-8.18, p = 0.035) compared with their non-CMI counterparts. Acute incidental CMIs were also associated with mortality after multivariable analysis (HR 2.76, 95% CI 2.06-3.71, p < 0.001); no association with ICH was found.
CONCLUSIONS: Acute incidental CMI on brain MRI in patients with active cancer is associated with an increased risk of near-future ischemic stroke or TIA and mortality. This finding might suggest that randomly detected acute incidental CMI in patients with cancer may guide primary cerebrovascular risk prevention and etiologic workup.
摘要：
目的：偶然弥散加权成像（DWI）阳性皮质下和皮质病变，或急性偶发性脑微梗塞（CMIs），是一种常见的脑缺血，可以在发生后大约2周内在磁共振DWI上检测到。急性偶发性CMI在癌症患者中更为常见。急性偶发性CMI是否能预测未来的缺血性卒中仍然未知。我们旨在研究癌症患者的急性偶发CMI与随后的缺血性卒中或短暂性脑缺血发作（TIA）之间的关系。
方法：这是一项回顾性队列研究。我们使用了Clalit健康服务记录,代表了以色列一半以上的人口，为了识别成年人的肺部，乳房,胰腺,或在2014年1月至2020年4月期间接受脑MRI检查的结肠癌。我们纳入了在癌症诊断前1年至诊断后1年之间接受扫描的患者。主要结果是缺血性卒中或TIA，使用国际疾病分类，第九次修订代码。次要结果是颅内出血（ICH）和死亡率。记录从第一次MRI直到主要结果，死亡,或随访结束（2023年1月）。Cox比例风险模型用于计算有和没有急性附带CMI的患者的风险比（HR），作为时间依赖的协变量。
结果：研究队列包括1,618例癌症患者，其中,59（3.6％）在至少1次脑部MRI上出现急性偶发CMI。从急性偶发CMI到中风或TIA的中位时间（四分位距）为26天（14-84）。在多变量分析中，急性偶发CMI患者的卒中或TIA风险较高(HR2.97,95%CI1.08~8.18,p=0.035).多变量分析后，急性偶发CMI也与死亡率相关（HR2.76，95％CI2.06-3.71，p<0.001）；未发现与ICH相关。
结论：活动期癌症患者脑MRI上的急性偶发CMI与近期缺血性卒中或TIA和死亡率的风险增加相关。这一发现可能表明，在癌症患者中随机检测到的急性偶发CMI可能会指导主要的脑血管风险预防和病因检查。
方法：这是一项回顾性队列研究。我们使用了Clalit健康服务记录,代表了以色列一半以上的人口，为了识别成年人的肺部，乳房,胰腺,或在2014年1月至2020年4月期间接受脑MRI检查的结肠癌。我们纳入了在癌症诊断前1年至诊断后1年之间接受扫描的患者。主要结果是缺血性卒中或TIA，使用国际疾病分类，第九次修订代码。次要结果是颅内出血（ICH）和死亡率。记录从第一次MRI直到主要结果，死亡,或随访结束（2023年1月）。Cox比例风险模型用于计算有和没有急性附带CMI的患者的风险比（HR），作为时间依赖的协变量。
结果：研究队列包括1,618例癌症患者，其中,59（3.6％）在至少1次脑部MRI上出现急性偶发CMI。从急性偶发CMI到中风或TIA的中位时间（四分位距）为26天（14-84）。在多变量分析中，急性偶发CMI患者的卒中或TIA风险较高(HR2.97,95%CI1.08~8.18,p=0.035).多变量分析后，急性偶发CMI也与死亡率相关（HR2.76，95％CI2.06-3.71，p<0.001）；未发现与ICH相关。
结论：活动期癌症患者脑MRI上的急性偶发CMI与近期缺血性卒中或TIA和死亡率的风险增加相关。这一发现可能表明，在癌症患者中随机检测到的急性偶发CMI可能会指导主要的脑血管风险预防和病因检查。
