Development of a nomogram model based on multimodal MRI quantitative parameters for risk prediction of poor prognosis in elderly patients with acute ischemic stroke after thrombolysis
CHEN Jun
CHEN Longhua
LU Yu
HAN Yan
Abstract：Objective To explore the value of a nomogram model constructed using multimodal magnetic resonance imaging(MRI)quantitative parameters combined with clinical indicators for the risk of poor prognosis in elderly patients with acute ischemic stroke(AIS)after intravenous thrombolysis.Methods A total of 105 elderly AIS patients who received intravenous thrombolysis with recombinant tissue-type plasminogen activator(rt-PA)in our hospital from January 2022 to January 2025 were recruited,and according to the score of modified Rankin Scale(mRS)at 3 months after thrombolysis,they were divided into a poor prognosis group(36 cases,mRS score≥3)and a good prognosis group(69 cases,mRS score<3).Clinical indicators including demographic data,underlying diseases,National Institutes of Health Stroke Scale(NIHSS)score at onset,rt-PA dose,and time from onset to thrombolysis,as well as multimodal MRI quantitative parameters[infarct volume,apparent diffusion coefficient(ADC)in the core region,cerebral microbleeds on susceptibility-weighted imaging,and mass effect)were collected.Univariate analysis was used to screen for differential indicators,and multivariate logistic regression analysis was applied to identify independent risk factors.A nomogram model was constructed,and internal validation was performed using Bootstrap to evaluate discriminative ability,calibration,and predictive efficacy.Results The poor prognosis group exhibited significantly higher NIHSS score at onset,larger infarct volume,more cerebral microbleeds,and larger proportion of mass effect,while obviously lower rt-PA dose and ADC in the core region when compared with the good prognosis group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that NIHSS score at onset(OR=1.685,95%CI:1.237-2.235,P<0.01),infarct volume(OR=1.090,95%CI:1.024-1.158,P<0.05),cerebral microbleeds(OR=1.581,95%CI:1.322-1.840,P<0.05),mass effect(OR=3.425,95%CI:2.590-4.260,P<0.01),rt-PA dose(OR=0.156,95%CI:0.044-0.657,P<0.01),and ADC value in the core region(OR=0.997,95%CI:0.995-0.999,P<0.01)were influencing factors for poor prognosis in elderly AIS patients after thrombolysis.The C-index of the constructed nomogram model was 0.838(95%CI:0.755-0.887).The AUC value,sensitivity,and specificity of the nomogram model for predicting the risk of poor prognosis in elderly AIS patients after thrombolysis were 0.822(95%CI:0.745-0.899),81.97%,and 68.42%,respectively(P<0.05).Conclusion The nomogram model constructed using multimodal MRI quantitative parameters and clinical indicators demonstrates good predictive efficacy for poor prognosis in elderly AIS patients after thrombolysis,providing a reference for clinical individualized prognosis assessment.
Keywords：brain infarctionnomogramsmultiparametric magnetic resonance imagingintravenous thrombolysis
Publication Date：2026-01-15
Online Publishing Date：2026-01-16(First online date of this platform, not the publication date of the document)
Pages：5( 93-97 )