The ipsilesional DTI-ALPS index provides modest incremental prognostic value beyond clinical models for 90-day outcome in patients with acute MCA occlusion treated with intravenous thrombolysis: a prospective exploratory cohort study
5 affiliations
- 1Department of Ultrasound Diagnosis, Taixing People’s Hospital , , ,
- 2Department of Radiology, Taixing People’s Hospital , , ,
- 3Department of Neurology, Taixing People’s Hospital , , ,
- 4Department of Interventional Radiology, Taixing People’s Hospital , , ,
- 5Department of Psychology, Taixing People’s Hospital , , ,
Abstract
Background and purpose: Impaired perivascular fluid dynamics may contribute to secondary brain injury after acute ischemic stroke, yet its prognostic relevance remains uncertain. We investigated whether the Diffusion Tensor Image Analysis along the Perivascular Space (ALPS) index—a quantitative MRI marker of perivascular fluid dynamics—provides incremental predictive value for long-term functional outcomes in patients with acute middle cerebral artery occlusion (MCAO) treated with intravenous thrombolysis.
Methods: In this prospective observational cohort study, 128 patients underwent multimodal brain MRI within 24 h of admission, and the ALPS index was calculated in the hemisphere ipsilateral to the occlusion (ipsilesional ALPS). Favorable outcome at 90 days was defined as modified Rankin Scale (mRS) 0–2. Multivariable logistic regression identified independent predictors, with covariates (admission National Institutes of Health Stroke Scale [NIHSS] score, LDL cholesterol, and smoking status) prespecified on clinical grounds rather than selected by univariate screening. Incremental discriminative value was assessed by comparing nested models using receiver operating characteristic (ROC) analysis and the likelihood-ratio test (LRT), which is preferable to DeLong’s test for nested models. Calibration (Hosmer–Lemeshow test, Nagelkerke R2) and internal validation with 1,000 bootstrap resamples (optimism-corrected AUC) were performed.
Interpretation: Lower admission NIHSS score [adjusted odds ratio (aOR) per 1-point increase: 0.890, 95% CI: 0.813–0.976; p = 0.013] and lower LDL cholesterol (aOR per 1 mmol/L: 0.660, 95% CI: 0.472–0.923; p = 0.015) were independently associated with favorable outcome, whereas the ipsilesional ALPS index showed a directionally consistent, non-significant association (aOR per 0.1-unit increase: 1.525, 95% CI: 0.948–2.454; p = 0.082). Adding the ALPS index to a base model containing NIHSS and LDL yielded a modest but significant improvement in discrimination (AUC 0.681 to 0.699; ΔAUC = 0.018; LRT p = 0.042); calibration was adequate (Hosmer–Lemeshow p = 0.31 and 0.28), and the gain persisted after bootstrap optimism correction (ΔAUC = 0.013).
Conclusion: In this exploratory cohort, the ipsilesional ALPS index showed a consistent directional association with 90-day functional outcome and provided a modest but significant incremental improvement in discrimination beyond NIHSS and LDL cholesterol; the magnitude of this gain is small and requires external validation.
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BibTeX
@article{shen2026ipsilesional,
title = {{The ipsilesional DTI-ALPS index provides modest incremental prognostic value beyond clinical models for 90-day outcome in patients with acute MCA occlusion treated with intravenous thrombolysis: a prospective exploratory cohort study}},
author = {Lu Shen and Bo Ye and Jingye Lu and Chengying Yin and Huiqun Lu and Xiaojie Xu and Beijia Qin and Caixia Xu and Peng Yu},
journal = {Frontiers in aging neuroscience},
year = {2026},
month = oct,
doi = {10.3389/fnagi.2026.1917297},
url = {https://europepmc.org/article/PMC/PMC13719295},
note = {CC BY},
}
RIS
TY - JOUR
TI - The ipsilesional DTI-ALPS index provides modest incremental prognostic value beyond clinical models for 90-day outcome in patients with acute MCA occlusion treated with intravenous thrombolysis: a prospective exploratory cohort study
AU - Lu Shen
AU - Bo Ye
AU - Jingye Lu
AU - Chengying Yin
AU - Huiqun Lu
AU - Xiaojie Xu
AU - Beijia Qin
AU - Caixia Xu
AU - Peng Yu
PY - 2026
DA - 2026/10/16
JO - Frontiers in aging neuroscience
DO - 10.3389/fnagi.2026.1917297
UR - https://europepmc.org/article/PMC/PMC13719295
AB - Background and purpose: Impaired perivascular fluid dynamics may contribute to secondary brain injury after acute ischemic stroke, yet its prognostic relevance remains uncertain. We investigated whether the Diffusion Tensor Image Analysis along the Perivascular Space (ALPS) index—a quantitative MRI marker of perivascular fluid dynamics—provides incremental predictive value for long-term functional outcomes in patients with acute middle cerebral artery occlusion (MCAO) treated with intravenous thrombolysis. Methods: In this prospective observational cohort study, 128 patients underwent multimodal brain MRI within 24 h of admission, and the ALPS index was calculated in the hemisphere ipsilateral to the occlusion (ipsilesional ALPS). Favorable outcome at 90 days was defined as modified Rankin Scale (mRS) 0–2. Multivariable logistic regression identified independent predictors, with covariates (admission National Institutes of Health Stroke Scale [NIHSS] score, LDL cholesterol, and smoking status) prespecified on clinical grounds rather than selected by univariate screening. Incremental discriminative value was assessed by comparing nested models using receiver operating characteristic (ROC) analysis and the likelihood-ratio test (LRT), which is preferable to DeLong’s test for nested models. Calibration (Hosmer–Lemeshow test, Nagelkerke R2) and internal validation with 1,000 bootstrap resamples (optimism-corrected AUC) were performed. Interpretation: Lower admission NIHSS score [adjusted odds ratio (aOR) per 1-point increase: 0.890, 95% CI: 0.813–0.976; p = 0.013] and lower LDL cholesterol (aOR per 1 mmol/L: 0.660, 95% CI: 0.472–0.923; p = 0.015) were independently associated with favorable outcome, whereas the ipsilesional ALPS index showed a directionally consistent, non-significant association (aOR per 0.1-unit increase: 1.525, 95% CI: 0.948–2.454; p = 0.082). Adding the ALPS index to a base model containing NIHSS and LDL yielded a modest but significant improvement in discrimination (AUC 0.681 to 0.699; ΔAUC = 0.018; LRT p = 0.042); calibration was adequate (Hosmer–Lemeshow p = 0.31 and 0.28), and the gain persisted after bootstrap optimism correction (ΔAUC = 0.013). Conclusion: In this exploratory cohort, the ipsilesional ALPS index showed a consistent directional association with 90-day functional outcome and provided a modest but significant incremental improvement in discrimination beyond NIHSS and LDL cholesterol; the magnitude of this gain is small and requires external validation.
SN - 1663-4365
ER -