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Shu L, Zhong K, Chen N, Gu W, Shang W, Liang J, Ren J, Hong H. Predicting the severity of white matter lesions among patients with cerebrovascular risk factors based on retinal images and clinical laboratory data: a deep learning study. Front Neurol 2023; 14:1168836. [PMID: 37492851 PMCID: PMC10363667 DOI: 10.3389/fneur.2023.1168836] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/20/2023] [Indexed: 07/27/2023] Open
Abstract
Background and purpose As one common feature of cerebral small vascular disease (cSVD), white matter lesions (WMLs) could lead to reduction in brain function. Using a convenient, cheap, and non-intrusive method to detect WMLs could substantially benefit to patient management in the community screening, especially in the settings of availability or contraindication of magnetic resonance imaging (MRI). Therefore, this study aimed to develop a useful model to incorporate clinical laboratory data and retinal images using deep learning models to predict the severity of WMLs. Methods Two hundred fifty-nine patients with any kind of neurological diseases were enrolled in our study. Demographic data, retinal images, MRI, and laboratory data were collected for the patients. The patients were assigned to the absent/mild and moderate-severe WMLs groups according to Fazekas scoring system. Retinal images were acquired by fundus photography. A ResNet deep learning framework was used to analyze the retinal images. A clinical-laboratory signature was generated from laboratory data. Two prediction models, a combined model including demographic data, the clinical-laboratory signature, and the retinal images and a clinical model including only demographic data and the clinical-laboratory signature, were developed to predict the severity of WMLs. Results Approximately one-quarter of the patients (25.6%) had moderate-severe WMLs. The left and right retinal images predicted moderate-severe WMLs with area under the curves (AUCs) of 0.73 and 0.94. The clinical-laboratory signature predicted moderate-severe WMLs with an AUC of 0.73. The combined model showed good performance in predicting moderate-severe WMLs with an AUC of 0.95, while the clinical model predicted moderate-severe WMLs with an AUC of 0.78. Conclusion Combined with retinal images from conventional fundus photography and clinical laboratory data are reliable and convenient approach to predict the severity of WMLs and are helpful for the management and follow-up of WMLs patients.
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Affiliation(s)
- Liming Shu
- Department of Neurology, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Department of Neurology, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kaiyi Zhong
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nanya Chen
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Wenxin Gu
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Wenjing Shang
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiahui Liang
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China
- Guangdong Key Laboratory of Non-human Primate Research, Guangdong-Hongkong-Macau Institute of CNS Regeneration, Jinan University, Guangzhou, China
| | - Jiangtao Ren
- School of Data and Computer Science, Sun Yat-sen University, Guangzhou, China
| | - Hua Hong
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Tao X, Zhou H, Mo D, Zhang W, Chang Z, Zeng Y, Luo Y, Wu S, Tang W, Yang C, Wang Q. Erythrocytes Are an Independent Protective Factor for Vascular Cognitive Impairment in Patients With Severe White Matter Hyperintensities. Front Aging Neurosci 2022; 14:789602. [PMID: 35250538 PMCID: PMC8894857 DOI: 10.3389/fnagi.2022.789602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Hemoglobin is one of the main proteins in erythrocytes. There are significant correlations between low hemoglobin and white matter hyperintensities (WMH) and cognitive impairment. This study explored whether erythrocytopenia has predictive value for vascular cognitive impairment (VCI) in patients with WMH. Method: We conducted a cross-sectional study of 302 patients, including 62 with cerebral small vessel disease and 240 with stroke. Basic demographic data and fasting blood were collected. First, all patients were divided into normal cognition (NC), mild VCI (mVCI), and severe VCI (sVCI) groups (subgroups later) based on cognitive behavior scores. Second, all patients were divided into mild WMH (mWMH) and severe WMH (sWMH) groups based on Fazekas scores. The differences in blood markers between different groups or subgroups with different cognitive levels were analyzed by univariate analysis. Then, binary logistic regression was used to analyze the diagnostic value of erythrocyte counts for VCI in the sWMH group, and ordinal logistic regression was used to analyze the predictive value of multiple variables for different cognitive levels. Results: Univariate analysis showed that erythrocytes, hemoglobin, high-sensitivity C-reactive protein, retinol binding protein and prealbumin were potential blood markers for different cognitive levels in sWMH patients. Among them, erythrocytopenia has good predictive value for the diagnosis of mVCI (AUC = 0.685, P = 0.008) or sVCI (AUC = 0.699, P = 0.003) in patients with sWMH. Multivariate joint analysis showed that erythrocytes were an independent protective factor reducing the occurrence of VCI in patients with sWMH (OR = 0.633, P = 0.045). Even after adjusting for age, there was still a significant difference (P = 0.047). Conclusion: Erythrocytes are an independent protective factor for VCI in patients with sWMH. Promoting hematopoietic function may have potential value for prevention of cognitive decline in patients with cerebrovascular disease.
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Affiliation(s)
- Xi Tao
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Hang Zhou
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Danheng Mo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wenjie Zhang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zihan Chang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yiheng Zeng
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yuqi Luo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Siyuan Wu
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wenjing Tang
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Chen Yang
- Department of Neurological Rehabilitation, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Qing Wang
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Qing Wang
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Wang X, Yin H, Ji X, Sang S, Shao S, Wang G, Lv M, Xue F, Du Y, Sun Q. Association between homocysteine and white matter hyperintensities in rural-dwelling Chinese people with asymptomatic intracranial arterial stenosis: A population-based study. Brain Behav 2021; 11:e02205. [PMID: 34032023 PMCID: PMC8323025 DOI: 10.1002/brb3.2205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Although homocysteine (Hcy) has been proven to be associated with the incidence of white matter hyperintensities (WMH) in patients with stroke, this association remains unclear in participants with asymptomatic intracranial arterial stenosis (aICAS). This study aimed to investigate the association of Hcy with WMH in participants with aICAS. MATERIALS AND METHODS This was a cross-sectional study based on the Kongcun Town Study. Participants diagnosed with aICAS by magnetic resonance angiography in the Kongcun Town Study were enrolled in this study. Data on demographics, lifestyle, medical histories, and Hcy levels were collected via interviews, clinical examinations, and laboratory tests. The volume of WMH was calculated using the lesion segmentation tool system for the Statistical Parametric Mapping package based on magnetic resonance imaging. The association between Hcy and WMH volume was analyzed using linear and logistic regression analyses. RESULTS A total of 137 aICAS participants were enrolled in the present study. Hcy was associated with the incidence of severe WMH (4th quartile, ≥4.20 ml) after adjustment for certain covariates [Hcy as a continuous variable, odds ratio (95% confidence interval) (OR (95% CI)): 1.09 (1.00, 1.19), p = .047; as a categorical variable (Hcy ≥15 μmol/L), OR (95% CI): 3.74 (1.37, 10.19), p = .010)]. After stratification according to the degree of aICAS, this relationship remained significant only in the moderate-to-severe stenosis group (stenosis ≥50%). (Hcy as continuous variable, OR (95% CI): 1.14 (1.02, 1.27), p = .025; as a categorical variable (Hcy ≥15 μmol/L), OR (95% CI): 5.59 (1.40, 15.25), p = .015). CONCLUSION Serum Hcy concentration may be positively associated with the volume of WMH in rural-dwelling Chinese people with moderate-to-severe (stenosis ≥50%) aICAS.
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Affiliation(s)
- Xiang Wang
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Hao Yin
- Department of Neurology, Jining No.1 People's Hospital, Jining, China
| | - Xiaokang Ji
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Shaowei Sang
- Department of Clinical Epidemiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Sai Shao
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guangbin Wang
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ming Lv
- Department of Clinical Epidemiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Yifeng Du
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Qinjian Sun
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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