The Study Of Risk Factors And The Predict Model Of Cerebral Microbleeds

Background Cerebral microbleeds（CMBs）are hypointense lesions on T2*-weighted gradient-recalled echo（GRE）or susceptibility-weighted imaging（SWI）associated with increased risk of stroke and poor cognition.Previous studied has proved that age,male,cardiovascular risk factors and white matter hyperintensities（WMH）may increase the risk of CMBs and different locations of CMBs may associated with different pathologies and risk factors.A high burden of CMBs is independently associated with an increased risk of subsequent intracerebral hemorrhage（ICH）in patients after acute ischemic stroke（AIS）,especially when treated with intravenous thrombolysis（IVT）.Therefore,a high CMB burden should be included in individual risk stratification scores predicting ICH risk following IVT for AIS.Objective To determine the association of cardiovascular risk factors and WMH with the presence and anatomic location of CMBs,and construct a factor-based evaluating model to predict a high CMBs burden.Methods We considered consecutive patients admitted to the Neurology department of the Second Affiliated Hospital of CQMU from September 1,2017 to February 10,2021 who received a magnetic resonance imaging（MRI）including SWI sequences and fluid-attenuated inversion recovery（FLAIR）sequences.We assessed the relation of age,male,various cardiovascular risk factors,medication use,stroke histories and WMH to the presence and location（deep/mixed or strictly lobar）of CMBs with univariate analysis and multiple logistic regression.We related the degree of WMH to the prevalence of CMBs.Finally,we added risk factors for a high CMBs burden to a factor-based evaluating model score,through drawing the receiver-operating curve（ROC）and calculating the area under the curve（AUC）,we got the final model to predict CMBs ≥10.Results 485 patients were included in our study.Overall prevalence of CMBs was 41%,and CMBs were more prevalent with advanced age,male sex,more cardiovascular risk factors and WMH.Hypertension,alcohol use,hemorrhagic stroke and WMH were independently risk factors of CMBs after adjustment for confounders.The prevalence of CMBs was increased strongly with the degree of WMH.Male sex,hypertension,smoking,alcohol use,hemorrhagic stroke history,higher Hcy level and lower LDL-C level were related to CMBs in patients with high degree of WMH,but only Hcy level and hemorrhagic stroke history were independent risk factors.WMH and conventional vascular risk factors such as hypertension,alcohol use and stroke history were more relative to deep/mixed CMBs while statin use was related to CMBs in a strictly lobar location.Alcohol use,hemorrhagic stroke history and the degree of DWMH were independent predictors for a high CMBs burden（≥10）.We finally structured a prediction model-HPSAD₃ that consisted of hypertension,alcohol use,hemorrhagic stroke history and WMH（PVH and DWMH）to predict a high CMBs burden.The model-HPSAD₃ has a higher AUC（0.847;95% CI,0.803–0.892）and higher specificity and sensitivity to predict a high CMBs burden（≥10）when the score is 4.Conclusions Hypertension,alcohol use,stroke history,and WMH are associated with all CMBs and deep/mixed CMBs.Higher Hcy levels and hemorrhagic stroke history relate to the presence of CMBs in patients with high degree of WMH.We add hypertension,alcohol use,hemorrhagic stroke history and WMH into model-HPSAD₃ and there was a higher possibility of patients with CMBs ≥10 when the score of HPSAD₃ ≥4.