Measuring ‘Brain Age’ Biomarkers May Better Predict Stroke Care and Recovery

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Examining “brain age” biomarkers through MRI scans may help clinicians better treat strokes and provide clearer insights on recovery outcomes for patients. Kalut/Photonews/Getty Images
  • New research examined the use of radiomics, a kind of image-quantifying technology, as a way to measure biomarkers from MRI scans for stroke surveillance and post-stroke recovery.
  • In the study of 4,000, stroke patients who had a higher estimated brain age than their actual chronological age were more likely to have diabetes, hypertension, a history of smoking, or a previous history of stroke.
  • These scans may provide clinicians with meaningful insights into how to tailor care and predict recovery times as well outcomes.

An emerging form of technology can help estimate relative brain age in stroke patients.

A study presented recently at the European Stroke Organisation Conference found that radiomics, a kind of image-quantifying technology, can extract biomarkers from an MRI scan and be used in stroke surveillance, as well as for predictions in post-stroke recovery. A preprint of the research, that has not been peer-reviewed, was posted in September 2021.

“Age is one of the most influential determinants of post-stroke outcomes, but little is known about the impact of neuroimaging-derived biological ‘brain age,’” Dr. Martin Bretzner, lead author of the study and a researcher from Harvard Medical School said in a press release.

“Our results show that quantifying relative brain age in stroke patients can be beneficial in assessing a patient’s brain health globally, and useful in predicting how well the patient will recover from a stroke. It would also be very easy to communicate on this biomarker with clinicians and patients, as everyone instinctively understands the negative implications of an accelerated brain aging process.”

What the study shows

In undertaking their research, Bretzner and colleagues reviewed more than 4000 stroke patients in Europe and the United States.

They used radiomics to estimate relative brain age. Radiomics is an emerging technology that utilizes mathematical analysis to extract certain biomarkers from neuroimages, like MRI scans.

The researchers found that stroke patients who had a higher estimated brain age than their actual chronological age were more likely to have diabetes, hypertension, a history of smoking, or a previous history of stroke.

Those who had a relatively older brain age also didn’t have as positive post-stroke outcomes when compared with those with a younger relative brain age.

The researchers say that by using radiomics to estimate the actual age of a person’s brain, physicians will be able to learn how resilient the brain is to factors like time and cardiovascular risk factors. It will also help clinicians estimate how well a person might recover from a stroke.

Future applications

Dr. Kambiz Nael, a professor of radiology at the David Geffen School of Medicine at UCLA says the use of technology like radiomics could present a new opportunity.

“With advances in image processing, improved computational power, and artificial intelligence, imaging-derived radiomics can open a new window of opportunity to extract hidden information beyond human limited visual system. This study has taken a first step in this direction, although we need further validations. I’m cautiously optimistic about the utilization of radiomics and big data for future outcome assessment and risk stratification,” he said.

Other experts agree.

Jason Tarpley, MD, a stroke neurologist and director of the Stroke and Neurovascular Center for Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, says the technology may also be helpful in guiding patients to modify their risk factors.

“It can be useful, even in just to sort of show patients that, hey, there are modifiable risk factors, and your brain is showing some evidence of damage related to those,” he said.

“You can actually understand what that brain has been through.”

But Dr. Benjamin Emanuel, a neurologist at Keck Medicine of USC argues knowing the relative brain age of a person isn’t helpful in the context of stroke.

“I don’t think for the purposes of stroke, it really matters. I think it’s really applicable in neurodegenerative disease or in neuroimmunology, where the changes are very subtle over time … I think it’d be very useful in those fields. I don’t think it’s really helpful for stroke,” he said.

The researchers of the study argue that radiomics could contribute to the development of new stroke prevention and recovery strategies.

It is an idea that Sandra Billinger, PhD, a professor of Physical Therapy and Rehabilitation Science at the University of Kansas Medical Center says could have a significant impact on the field of stroke rehabilitation.

But she says further research is needed to confirm just how useful radiomics will be in stroke surveillance and recovery. “If the information gleaned from this study and future work helps with acute stroke treatment and stroke rehabilitation treatment protocols that can drive [the] best treatment approaches, then the radiomics technology could have [a] tremendous impact on the field. However, more studies with a larger sample will be needed,” she said.

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