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Ischemic stroke
Original research
Impact of imaging biomarkers from body composition analysis on outcome of endovascularly treated acute ischemic stroke patients
  1. Hanna Styczen1,
  2. Volker Maus2,3,
  3. Daniel Weiss4,
  4. Lukas Goertz5,
  5. René Hosch1,6,
  6. Christian Rubbert4,
  7. Nikolas Beck1,
  8. Mathias Holtkamp1,6,
  9. Luca Salhöfer1,6,
  10. Rosa Schubert1,
  11. Cornelius Deuschl1,
  12. Felix Nensa1,6,
  13. Johannes Haubold1,6
    1. 1Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
    2. 2Department of Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Langendreer, Ruhr-University Bochum, Bochum, Germany
    3. 3Klinikum Aschaffenburg-Alzenau, Institute for Radiology and Neuroradiology, Aschaffenburg, Germany
    4. 4Department of Diagnostic and Interventional Radiology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
    5. 5Department of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
    6. 6Institute for Artificial Intelligence in Medicine (IKIM), University Hospital Essen, Essen, Germany
    1. Correspondence to Dr Hanna Styczen; Hanna.Styczen{at}uk-essen.de

    Abstract

    Background We investigate the association of imaging biomarkers extracted from fully automated body composition analysis (BCA) of computed tomography (CT) angiography images of endovascularly treated acute ischemic stroke (AIS) patients regarding angiographic and clinical outcome.

    Methods Retrospective analysis of AIS patients treated with mechanical thrombectomy (MT) at three tertiary care-centers between March 2019–January 2022. Baseline demographics, angiographic outcome and clinical outcome evaluated by the modified Rankin Scale (mRS) at discharge were noted. Multiple tissues, such as muscle, bone, and adipose tissue were acquired with a deep-learning-based, fully automated BCA from CT images of the supra-aortic angiography.

    Results A total of 290 stroke patients who underwent MT due to cerebral vessel occlusion in the anterior circulation were included in the study. In the univariate analyses, among all BCA markers, only the lower sarcopenia marker was associated with a poor outcome (P=0.007). It remained an independent predictor for an unfavorable outcome in a logistic regression analysis (OR 0.6, 95% CI 0.3 to 0.9, P=0.044). Fat index (total adipose tissue/bone) and myosteatosis index (inter- and intramuscular adipose tissue/total adipose tissue*100) did not affect clinical outcomes.

    Conclusion Acute ischemic stroke patients with a lower sarcopenia marker are at risk for an unfavorable outcome. Imaging biomarkers extracted from BCA can be easily obtained from existing CT images, making it readily available at the beginning of treatment. However, further research is necessary to determine whether sarcopenia provides additional value beyond established outcome predictors. Understanding its role could lead to optimized, individualized treatment plans for post-stroke patients, potentially improving recovery outcomes.

    • Stroke
    • Thrombectomy
    • CT Angiography

    Data availability statement

    Data are available upon reasonable request.

    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/jnis-2024-022275

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • Contributors HS, JH: conception and design; HS, VM, DW: acquisition of data; HS, LG, DW, RH, CR, NB, MH, LS, RS, CD, FN, JH: analysis and interpretation of data; HS, LG, RS: drafting the article. All authors have read and approved the manuscript. The corresponding author HS is the guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests MH received financial support from the Clinician Scientist Program of the University Medicine Essen Clinician Scientist Academy (UMEA), which is funded by the German Research Foundation (DFG) (FU 356/12-2).

      • Provenance and peer review Not commissioned; internally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.