Predictive Model of Dysphagia and Brain Lesion-Symptom Mapping in Acute Ischemic Stroke

Frontiers in Aging Neuroscience

Lulu Zhang²  Xiang Tang²  Qi Fang²  Yun Zhou²  Yan Kong²  Shanshan Diao²  Xiuying Cai²  Dongxue Ding²  Can Wang²  Juehua Zhu²  Ye Yao³  Cuiping Li⁵ 

[1] Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China;Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China;Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China;National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China;Shanghai Zhiyu Software Technology Co., Ltd., Shanghai, China;

关键词: post-stroke dysphagia;    MRI;    water-swallowing test;    volume-viscosity swallow test;    voxel-based lesion-symptom mapping;   

DOI  :  10.3389/fnagi.2021.753364

来源: DOAJ

【 摘 要 】

Background and purpose: Early recognition and management of post-stroke dysphagia (PSD) based on MRI may reduce the incidence of complications. Combining clinical symptoms with applications of MRI, we aimed to identify the risk factors of PSD, develop a prediction scale with high accuracy and map key dysphagia brain areas.Methods: A total of 275 acute ischemic stroke patients were enrolled in this study, and 113 (41.1%) patients were diagnosed with PSD. All patients underwent the water-swallowing test (WST) and volume-viscosity swallow test (V-VST) within first 24 h following admission to assess swallowing. Vascular factors were evaluated and MRI brain scans were obtained within 3 days after symptom onset for each participant admitted to the hospital. T-test, chi-squared test and Fisher’s exact test were used to investigate the associations of various patient characteristics with dysphagia, and multivariable logistic regression models were used to construct a prediction scale. Scale accuracy was assessed using receiver operating characteristic (ROC) analysis. We extracted white matter hyperintensities for each patient as potential brain lesions. Voxel-based lesion-symptom mapping (VLSM) was used to identify key brain areas for dysphagia.Results: Risk factors related with PSD were older age, history of atrial fibrillation, higher fasting blood glucose, NIH stroke scale, TOAST classification, progressive stroke, middle cerebral artery lesion and anterior cerebral artery lesion. Three variables with most significant associations, including NIH stroke scale, TOAST classification and progressive stroke, combined with age and gender, were used to construct a dysphagia prediction scale with high accuracy (AUC = 0.86). VLSM identified left inferior parietal gyrus as a key brain region for PSD.Conclusion: Risk factors of PSD were identified and a predictive model of dysphagia was constructed intelligently and automatically. The left inferior parietal gyrus was identified as a key brain area for dysphagia, which provides a new symptom-based treatment target for early rehabilitation in the future.

【 授权许可】

Unknown