The Skewness of a Histogram of White Matter Hyperintensity Is Associated with Symptomatic Stroke in Patients with CADASIL

Objective White matter hyperintensity (WMH) is the most prominent magnetic resonance imaging (MRI) feature of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), clinically characterized by recurrent ischemic stroke. This study aimed to explore the association between WMH and symptomatic stroke in patients with CADASIL by quantifying the volume and features extracted from histogram-segmented WMH. Methods Twenty-eight patients with CADASIL were retrospectively recruited. WMH was extracted from fluid-attenuated inversion recovery (FLAIR) images. A histogram analysis of WMH was performed using radiomics extension on a 3D slicer. We compared the histogram parameters between patients with and without symptomatic stroke. Results Thirteen patients had no symptoms, while 15 had previous symptomatic stroke. Their characteristics were similar, except for a higher frequency of males among stroke patients (73.3 vs. 15.4%, respectively). Among the histogram features, the skewness of the FLAIR intensity histogram was significantly lower in patients with stroke than in those without stroke (-0.179 vs. 0.210, respectively, p=0.0287), but there was no significant difference regarding any other histogram features or the WMH volume. According to a multiple logistic regression analysis, sex and skewness remained significant (odds ratio: 40.870 and 0.0119, p=0.0136 and 0.0473, respectively). Conclusion The skewness of the FLAIR WMH intensity histogram was significantly correlated with stroke in patients with CADASIL.