Background: Global brain health has gained increasing attention recently. Imaging
markers of brain frailty have been related to functional outcomes in previous studies
on anterior circulation; however, little data are available on imaging markers and
posterior circulation.Purpose: To investigate the impact of brain frailty on functional
outcomes in patients with acute perforating artery infarction (PAI) of the posterior
circulation.Study Type: Prospective.Population: One hundred patients (60.78 +/- 9.51
years, 72% men) with acute posterior circulation PAI (determined by diffusion-weighted
magnetic resonance imaging (MRI)/time-of-flight MR angiography).Field Strength/Sequence:
T1- and T2-weighted fast spin echo, T2-weighted fluid-attenuated inversion recovery,
diffusion-weighted echo planar, gradient echo (susceptibility-weight imaging), and
3D time-of-flight MR angiography sequences at 3.0 T.Assessment: Periventricular and
deep white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS) in the
basal ganglia and centrum semiovale area, lacunes, cerebral microbleeds (CMB), and
total brain frailty score by calculating the above imaging characters were rated visually
by three radiologists with 9, 10, and 11 years of experience and one neuroradiologist
with 12. Infarction volume was assessed using baseline diffusion-weighted imaging
(DWI) data obtained within 24 hours of symptom onset. A modified Rankin Scale (mRS)
score >1 on day 90 defined an adverse functional outcome. Associations between the
imaging markers of brain frailty and functional outcomes were assessed.Statistical
Tests: Fisher's exact test, Mann-Whitney U test, and multivariable binary logistic
regression. A P value <0.05 was considered statistically significant.Results: Adverse
prognoses (mRS > 1) were observed in 34 (34%) patients. Infarction volume, periventricular
WMH, deep WMH, basal ganglia EPVS, CMB, and the brain frailty score were significantly
associated with adverse functional outcomes. An increased brain frailty score was
significantly associated with unfavorable mRS score on day 90 (odds ratio 1.773, 95%
confidence interval 1.237-2.541).
