Lateral Ventricle Volume from Computed Tomography Scans Is Correlated with Pre-Stroke Impairment and Post-Stroke Cognitive Performance

Abstract

Introduction: The link between neurodegenerative disease and stroke is well established and there is a need to understand pre-morbid brain anatomy to explain between-subject differences. Ventricular volume is one robust biomarker of neurodegeneration. Given the clinical dominance of Computed Tomography head scans, this study has the following aims:Aim-1: Test whether an automated lateral ventricle volume estimate from head CT will correlate with pre-stroke modified Rankin Scale (mRS); Aim-2: Determine if the CT-based lateral ventricle volume estimate is independently associated with cognitive performance post-stroke using the Trails A and B test scores. Methods: A total of N= 532 stroke (482 ischaemic and 61 hemorrhagic) participants were accessed from the Nor-COAST study across 5 stroke centres. Using an external data source of N=89 head CT scans, a deep learning neural network was trained to segment the lateral ventricles based on a 3- dimensional no-new U-Net architecture (data not shown). The lateral ventricle segmentation tool was tested, validated, and then applied for use on Nor-COAST data. In Aim 1, we tested for an association between lateral ventricle volume (dependent variable) and demographic and select stroke clinical variables in a regression model. Two other regression models (Aim 2A & 2B) were performed: we tested whether Trails A and Trails B completion times were associated with lateral ventricle volume after accounting for age, sex, education, and pre-stroke mRS. Results: Aim-1: we found that increased ventricle volume was associated with pre-stroke mRS. Sex and hemorrhage status were also corrected with ventricle volume, while age and diabetes status were not (adjusted R-squared=0.09, 525 degrees of freedom [df]).Aim-2A: Trails A was associated with ventricle volume, as well as age, education, and pre-stroke mRS, while sex was not (adj-R-squared=0.25 with df=398).Aim-2B: Trails B score was associated with lateral ventricle volume, with similar influences from covariates as Aim-2A (adj-R-squared=0.32 with df=290). Discussion: This study provides evidence that automated volumetric lateral ventricle assessment can be incorporated into analyses that characterise pre-stroke impairment and post-stroke cognitive performance.