Predictive Model of Dysphagia and Brain Lesion-Symptom Mapping in Acute Ischemic Stroke

Lulu Zhang; Xiang Tang; Can Wang; Dongxue Ding; Juehua Zhu; Yun Zhou; Shanshan Diao; Yan Kong; Xiuying Cai; Cuiping Li; Ye Yao; Qi Fang

doi:10.3389/fnagi.2021.753364

Predictive Model of Dysphagia and Brain Lesion-Symptom Mapping in Acute Ischemic Stroke

Front Aging Neurosci. 2021 Oct 20:13:753364. doi: 10.3389/fnagi.2021.753364. eCollection 2021.

Authors

Lulu Zhang¹, Xiang Tang¹, Can Wang¹, Dongxue Ding¹, Juehua Zhu¹, Yun Zhou¹, Shanshan Diao¹, Yan Kong¹, Xiuying Cai¹, Cuiping Li², Ye Yao^{3

4

5}, Qi Fang¹

Affiliations

¹ Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, China.
² Shanghai Zhiyu Software Technology Co., Ltd., Shanghai, China.
³ Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China.
⁴ National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
⁵ Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.

Abstract

Background and purpose: Early recognition and management of post-stroke dysphagia (PSD) based on MRI may reduce the incidence of complications. Combining clinical symptoms with applications of MRI, we aimed to identify the risk factors of PSD, develop a prediction scale with high accuracy and map key dysphagia brain areas. Methods: A total of 275 acute ischemic stroke patients were enrolled in this study, and 113 (41.1%) patients were diagnosed with PSD. All patients underwent the water-swallowing test (WST) and volume-viscosity swallow test (V-VST) within first 24 h following admission to assess swallowing. Vascular factors were evaluated and MRI brain scans were obtained within 3 days after symptom onset for each participant admitted to the hospital. T-test, chi-squared test and Fisher's exact test were used to investigate the associations of various patient characteristics with dysphagia, and multivariable logistic regression models were used to construct a prediction scale. Scale accuracy was assessed using receiver operating characteristic (ROC) analysis. We extracted white matter hyperintensities for each patient as potential brain lesions. Voxel-based lesion-symptom mapping (VLSM) was used to identify key brain areas for dysphagia. Results: Risk factors related with PSD were older age, history of atrial fibrillation, higher fasting blood glucose, NIH stroke scale, TOAST classification, progressive stroke, middle cerebral artery lesion and anterior cerebral artery lesion. Three variables with most significant associations, including NIH stroke scale, TOAST classification and progressive stroke, combined with age and gender, were used to construct a dysphagia prediction scale with high accuracy (AUC = 0.86). VLSM identified left inferior parietal gyrus as a key brain region for PSD. Conclusion: Risk factors of PSD were identified and a predictive model of dysphagia was constructed intelligently and automatically. The left inferior parietal gyrus was identified as a key brain area for dysphagia, which provides a new symptom-based treatment target for early rehabilitation in the future.

Keywords: MRI; post-stroke dysphagia; volume-viscosity swallow test; voxel-based lesion-symptom mapping; water-swallowing test.