| Title: | Quantitative MRI burden score and risk of first-ever stroke: A nested case-control study in the UK Biobank |
| Journal: | Journal of Clinical Neuroscience |
| Published: | 11 Apr 2026 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/41967228/ |
| DOI: | https://doi.org/10.1016/j.jocn.2026.112019 |
Publication 18024
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Abstract
BACKGROUND: Composite scores of cerebral small vessel disease (CSVD) burden are used to estimate stroke risk, but most rely on semi-quantitative visual ratings and may miss diffuse microstructural injury. We developed a quantitative magnetic resonance imaging (MRI) Burden Score integrating volumetric and diffusion tensor imaging (DTI) metrics and evaluated its association with first-ever stroke in the general population.</p>
METHODS: This nested case-control study was conducted within the UK Biobank imaging cohort (N = 83,951). We identified 78 participants with incident first-ever stroke and matched them to 780 controls using incidence-density sampling. A principal component analysis-derived MRI Burden Score was constructed from 12 automated MRI markers, including white matter hyperintensity volume, total brain volume, and tract-specific fractional anisotropy and mean diffusivity. Associations with incident stroke were assessed using multivariable Cox models, restricted cubic splines, and reclassification analyses.</p>
RESULTS: The MRI Burden Score was higher in stroke cases than in controls (P = 0.036). After multivariable adjustment, each 1-SD increase in the score was associated with a 15% higher hazard of first-ever stroke (hazard ratio 1.15, 95% CI 1.04-1.28). Stroke risk increased nonlinearly, rising steeply above a score of approximately 0.45. Adding the MRI Burden Score to a clinical model improved risk stratification (continuous net reclassification improvement 10.8%; integrated discrimination improvement 1.9%; both P < 0.001).</p>
CONCLUSIONS: A data-driven MRI Burden Score capturing cumulative macro- and microstructural brain injury independently predicts first-ever stroke and provides incremental value beyond conventional clinical risk factors.</p>
15 Keywords
- Aged
- Biological Specimen Banks
- Brain
- Case-Control Studies
- Cerebral Small Vessel Diseases
- Diffusion Tensor Imaging
- Female
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Risk Factors
- Stroke
- UK Biobank
- United Kingdom
2 Authors
- Xiangjia Qi
- Zhenchang Zhang
1 Application
| Application ID | Title |
|---|---|
| 1091229 | Integrated Multi-Omics and Imaging-Based Modeling of Cerebrovascular Diseases and Cognitive Decline Using the UK Biobank |
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