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Research ArticleAdult Brain
Open Access

Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke

Tanaporn Jaroenngarmsamer, Faysal Benali, Joachim Fladt, Nishita Singh, Fouzi Bala, Michael Tymianski, Michael D. Hill, Mayank Goyal and Aravind Ganesh On behalf of the ESCAPE-NA1 Investigators
American Journal of Neuroradiology August 2023, DOI: https://doi.org/10.3174/ajnr.A7981
Tanaporn Jaroenngarmsamer
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
bFaculty of Medicine Ramathibodi Hospital (T.J.), Mahidol University, Bangkok, Thailand
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  • ORCID record for Tanaporn Jaroenngarmsamer
Faysal Benali
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
cDepartment of Radiology and Nuclear Medicine (F. Benali), Maastricht University Medical Center+ (MUMC+), Maastricht, the Netherlands
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Joachim Fladt
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
dDepartment of Neurology and Stroke Center (J.F.), University Hospital Basel, Basel, Switzerland
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Nishita Singh
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
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Fouzi Bala
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
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Michael Tymianski
eNoNO Inc (M.T.), Toronto, Ontario, Canada
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Michael D. Hill
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
fDepartment of Radiology (M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
gDepartment of Community Health Sciences (M.D.H.), University of Calgary, Calgary, AB, Canada
hHotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education (M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
iDepartment of Medicine, (M.D.H.), University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Mayank Goyal
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
fDepartment of Radiology (M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
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Aravind Ganesh
aFrom the Department of Clinical Neurosciences (T.J., F. Benali, J.F., N.S., F. Bala, M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
hHotchkiss Brain Institute and the Mathison Centre for Mental Health Research and Education (M.D.H., M.G., A.G.), University of Calgary, Calgary, Alberta, Canada
iDepartment of Medicine, (M.D.H.), University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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    FIG 1.

    Flow diagram showing inclusion and exclusion of cases.

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    FIG 2.

    Scatterplot and Bland-Altman plot for the CC/IT ratio (n = 558). Scatterplot (A) and Bland-Altman plot (B) for the CC/IT ratio measured on NCCT and MR imaging. The Bland-Alman plot had a mean difference of 0.0002 (95% limits of agreement, −0.005–0.005). Highly concentrated areas could be observed, which can be seen in highly correlated measurements.

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    Table 1:

    Baseline characteristics (n = 558)

    Clinical Characteristics
    Age (mean) (yr)67.2 (SD, 13.7)
    Sex (female) (No.) (%)282 (50.5)
    Hypertension (No.) (%)386 (69.2)
    Current smoker (No.) (%)130 (23.3), n = 557
    Dyslipidemia (No.) (%)245 (43.9)
    Atrial fibrillation (No.) (%)172 (30.8)
    Coronary artery disease (No.) (%)121 (21.7)
    Diabetes mellitus (No.) (%)92 (16.5)
    Any prior stroke (No.) (%)76 (13.6)
    Peripheral vascular disease (No.) (%)19 (3.4)
    Systolic blood pressure (mean) (mm Hg)147.4 (SD, 25.1) n = 557
    ASPECTS (median) (IQR)8 (7–9) n = 552
    • Note:—IQR indicates interquartile range.

    • View popup
    Table 2:

    Agreement and correlation between NCCT and MR imaging for cortical and subcortical atrophy assessments, respectivelya

    NCCTMRIGwet AC1a
    GCA (median) (min-max)b0 (0–2)0 (0–3)0.815
    GCA ≥1 (No.) (%)133 (23.8)245 (43.9)0.500
    Koedam (median) (min-max)b0 (0–2)0 (0–3)0.784
    Koedam ≥1 (No.) (%)172 (30.8)261 (46.8)0.512
    MTA (median) (min-max)b0 (0–4)0 (0–4)0.833
    MTA ≥1 (No.) (%)123 (22.0)213 (38.2)0.554
    CC/IT ratio (median) (IQR)b0.12 (0.09–0.14)0.12 (0.09–0.15)0.746 (Pearson correlation)
    CC/IT ratio ≥0.16 (No.) (%)c87 (15.6)93 (16.7)0.523
    • Note:—min indicates minimum; max, maximum.

    • ↵a All P values are <.001.

    • ↵b Full categoric scale is provided. Linear-weighted Gwet AC1.

    • ↵c Cutoff is chosen on the basis of prior literature.35

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Cite this article
Tanaporn Jaroenngarmsamer, Faysal Benali, Joachim Fladt, Nishita Singh, Fouzi Bala, Michael Tymianski, Michael D. Hill, Mayank Goyal, Aravind Ganesh
Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke
American Journal of Neuroradiology Aug 2023, DOI: 10.3174/ajnr.A7981

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Cortical and Subcortical Brain Atrophy Assessment Using Simple Measures on NCCT Compared with MRI in Acute Stroke
Tanaporn Jaroenngarmsamer, Faysal Benali, Joachim Fladt, Nishita Singh, Fouzi Bala, Michael Tymianski, Michael D. Hill, Mayank Goyal, Aravind Ganesh
American Journal of Neuroradiology Aug 2023, DOI: 10.3174/ajnr.A7981
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