Association between white matter hyperintensities and stroke in a West African patient population: Evidence from the Stroke Investigative Research and Educational Network study

• Published in: NeuroImage (Orlando, Fla.) Vol. 215; p. 116789
• Main Authors: Li, Jingfei, Ogbole, Godwin, Aribisala, Benjamin, Affini, Murtala, Yaria, Joseph, Kehinde, Issa, Rahman, Mukaila, Adekunle, Fakunle, Banjo, Rasaq, Faniyan, Moyinoluwalogo, Akinyemi, Rufus, Ovbiagele, Bruce, Owolabi, Mayowa, Sammet, Steffen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.07.2020; Elsevier Limited; Elsevier
• Subjects: Africa, Western - epidemiology; Age; Aged; Brain - diagnostic imaging; Brain - pathology; Clinical outcomes; Computed tomography; Datasets; Disease; Female; Hip; Humans; Lesion segmentation; Lifestyles; Magnetic Resonance Imaging; Magnetic resonance imaging (MRI); Male; Middle Aged; Multivariate Analysis; Neuroimaging; Patients; Risk Factors; Segmentation; SIREN; Stroke; Stroke - epidemiology; Stroke - pathology; Substantia alba; Volumetric analysis; West Africa; White Matter - diagnostic imaging; White Matter - pathology; White matter hyperintensity; Africa, Western; Ghana; Nigeria; West Africa; Sub-Saharan Africa; Africa; Magnetic resonance imaging (MRI); White matter hyperintensity; SIREN; Stroke; Lesion segmentation; West Africa
• ISSN: 1053-8119; 1095-9572; 1095-9572
• DOI: 10.1016/j.neuroimage.2020.116789

This study is part of the Stroke Investigative Research and Educational Network (SIREN), the largest study of stroke patients in Africa to date, with computed tomography (CT) or magnetic resonance (MR) imaging data for each patient to confirm stroke. Prior imaging studies performed using high-field MR (≥1.5T) have shown that white matter hyperintensities (WMH), signs of microangiopathy in the subcortical brain, are correlated with many stroke risk factors as well as poor stroke outcomes. The aim of this study was the evaluation of MR images (0.3T–1.5T) from the SIREN study to determine associations between WMH volumes in West African patients and both stroke outcomes and stroke risk factors identified in the SIREN study. Brain MR images of 130 Western African stroke patients (age ​= ​57.87 ​± ​14.22) were processed through Lesion Segmentation Toolbox of the Statistical Parametric Mapping software to extract all areas of hyperintensity in the brain. WMH was separated from stroke lesion hyperintensity and WMH volume was computed and summed. A stepwise linear regression and multivariate analysis was performed between patients’ WMH volume and sociodemographic and clinical indices. Multivariate analysis showed that high WMH volume was statistically significantly positively correlated with age (β ​= ​0.44, p ​= ​0.001), waist/hip ratio (β ​= ​0.22, p ​= ​0.03), and platelet count (β ​= ​0.19, p ​= ​0.04) after controlling for head size in a Western African stroke population. Associations between WMH and age and waist/hip ratio previously identified in Western countries were demonstrated for the first time in a resource-limited, homogeneous black African community using low-field MR scanners. •Brain MR images of 130 West African stroke patients were collected and analyzed•Low field scanners (0.3 and 0.36T) were used due to resource constraints in Nigeria•This is the largest study using MRI for stroke in West African patients to date•White matter hyperintensities were segmented and verified by radiologists•Age, waist/hip ratio and platelet count were associated with higher WMH volumes