Distinct spatiotemporal patterns of white matter hyperintensity progression
White matter hyperintensity, a key imaging biomarker for brain health, has prognostic implications for stroke. Using a multicenter MRI dataset of 9179 stroke patients plus the UK Biobank (n = 36,210 low/high risk controls), we employ Subtype and Stage Inference modeling and identify three distinct white matter hyperintensity progression subtypes: fronto-parietal, radial, and temporo-occipital. Longitudinal validation confirms classification stability. The fronto-parietal subtype shows delayed onset and more hypertension, while the temporo-occipital subtype has more atrial fibrillation and coronary heart disease. The fronto-parietal and radial subtypes are linked to small vessel stroke, while the temporo-occipital subtype is linked to cardioembolism. The fronto-parietal subtype has higher 1-year ischemic stroke recurrence, while the temporo-occipital subtype shows a higher incidence of early neurological deterioration by symptomatic hemorrhagic transformation and worse 3-month outcomes. Beyond capturing progression, demographics, and vascular risks, and improving post-stroke outcome prediction, this subtyping-staging model also holds potential for stroke prediction.
Authors
- Hang‐Rai Kim (ORCID: https://orcid.org/0000-0003-4197-4541)
- Joanna Marguerite Wardlaw (ORCID: https://orcid.org/0000-0002-9812-6642)
- Kyung‐Ho Yu (ORCID: https://orcid.org/0000-0002-8997-5626)
- Dong‐Seok Gwak (ORCID: https://orcid.org/0000-0001-7850-0804)
- Hosung Kim (ORCID: https://orcid.org/0000-0002-2269-8644)
- Byung-Chul Lee
- Neda Jahanshad (ORCID: https://orcid.org/0000-0003-4401-8950)
- Mi Sun Oh (ORCID: https://orcid.org/0000-0002-6741-0464)
- Wi‐Sun Ryu (ORCID: https://orcid.org/0000-0002-2823-5253)
- Tai Hwan Park (ORCID: https://orcid.org/0000-0002-5148-1663)
- Keun‐Sik Hong (ORCID: https://orcid.org/0000-0002-4684-6111)
- Man‐Seok Park (ORCID: https://orcid.org/0000-0002-0637-5394)
- Soo Joo Lee (ORCID: https://orcid.org/0000-0001-8622-7000)
- Elizabeth Haddad (ORCID: https://orcid.org/0000-0002-7622-9085)
- Jae Guk Kim (ORCID: https://orcid.org/0000-0002-2446-4497)
- Moon‐Ku Han (ORCID: https://orcid.org/0000-0003-0166-387X)
- Hyerin Oh (ORCID: https://orcid.org/0000-0001-5179-2480)
- Gilsoon Park
- Dong‐Eog Kim (ORCID: https://orcid.org/0000-0002-9339-6539)
- Jae‐Kwan Cha (ORCID: https://orcid.org/0000-0002-1049-5196)
- Kang‐Ho Choi (ORCID: https://orcid.org/0000-0001-8851-2104)
- Philip M. Bath (ORCID: https://orcid.org/0000-0003-2734-5132)
- Sang‐Wuk Jeong (ORCID: https://orcid.org/0000-0002-5370-6846)
- Jong‐Moo Park (ORCID: https://orcid.org/0000-0002-4199-3024)
- Dawid Schellingerhout (ORCID: https://orcid.org/0000-0003-3659-435X)
- Kyusik Kang (ORCID: https://orcid.org/0000-0002-4021-4439)
- Jun Lee (ORCID: https://orcid.org/0000-0001-8643-0797)
- Yong‐Jin Cho (ORCID: https://orcid.org/0000-0002-7843-1148)
- Beom Joon Kim (ORCID: https://orcid.org/0000-0002-2719-3012)
- Dae‐Hyun Kim (ORCID: https://orcid.org/0000-0001-9761-7792)
- Joon‐Tae Kim (ORCID: https://orcid.org/0000-0003-4028-8339)
- Jinyong Chung (ORCID: https://orcid.org/0000-0001-9473-5152)
- Kyung‐Bok Lee (ORCID: https://orcid.org/0000-0003-1495-3462)
- Hee‐Joon Bae
- Sang-Soon Park
Institutions
- University of Southern California (US)
- The University of Texas MD Anderson Cancer Center (US)
- University of Nottingham (GB)
- Dongguk University (KR)
- Dong-A University Hospital (KR)
- Soonchunhyang University Hospital Seoul (KR)
- Seoul National University Bundang Hospital (KR)
- Seoul Medical Center (KR)
- Chonnam National University Hospital (KR)
- Dongguk University Ilsan Hospital (KR)
- The Catholic University of Korea Uijeongbu St. Mary's Hospital (KR)
- Inje University Ilsan Paik Hospital (KR)
- National Cancer Center (KR)
- Daejeon Eulji Medical Center, Eulji University (KR)
- UK Dementia Research Institute (GB)
- Yeungnam University Medical Center (KR)
- Hallym University Sacred Heart Hospital (KR)
- University of Edinburgh (GB)
Publication Details
- Journal
- Nature Communications
- Published
- 2025-10-24
- DOI
- https://doi.org/10.1038/s41467-025-64704-4
- Citations
- 1
- Primary Topic
- Acute Ischemic Stroke Management
- Type
- article
- Field-Weighted Citation Impact
- 1.35
Funders
- Alzheimer's Society
- National Institute for Health and Care Research
- National Research Foundation
- UK Dementia Research Institute
- National Institutes of Health
- Medical Research Council