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Figure 2. Kaplan-Mayer curve for CMI accumulation over time from cancer diagnosis: lung cancer group versus non-lung
cancer control group.
risk is almost doubled in LC patients relative to the general
population,16,17 efforts should be directed to identify subpopulations
who might benefit from anticoagulation.
Therefore, looking for biomarkers such as non-symptomatic
CMI on routine imaging might help in developing
tailored treatment for primary stroke prevention.
A notable strength of our study is a large population-based
cohort, with a control group of NLC patients. In addition,
MRI readers were either neurologists or neuroradiologists,
with high inter-rater reliability (ICC = 0.89). Moreover, all
positive CMIs underwent a second review by an experienced
neuroradiologist and vascular neurologist to reach a
consensus.
Some limitations should be recognized. First, this is a
retrospective cohort study. Second, we did not have data for
cancer staging at time of MRI. Moreover, as scans were
performed up to 5 years following cancer diagnosis, some
LC patients may have undergone remission. The latter,
however, may enhance our findings, as the real CMI incidence
among active LC patients is probably higher. Third,
as in other MRI-based retrospective studies, different protocols,
scans, and MRI machines were used. Fourth, we did
not have pathological correlation with DWI lesions to confirm
CMI presence; however, previous radiological-pathological
studies confirmed this correlation.28 And finally,
although CMI are defined as non-symptomatic lesions, we
did not have access to clinical indications for all imaging;
therefore, it is possible that some of the lesions were symptomatic.
The latter is unlikely, however, due to the lesions'
small size.
Conclusion
CMIs are common findings in cancer patients relative to
general population and especially in LC patients. Therefore,
they might serve as a marker for occult brain ischemia, cognitive
decline, and CRS risk, a matter for future studies.
Whether CMI presence should be considered an indication
for anticoagulant treatment as primary CRS prevention is a
question for future large prospective clinical studies.
Author contributions
J.N. MD contributed to study design, data collection, data analysis,
and writing of the paper. R.B. MD contributed to study design
and writing of the paper. R.E. MD contributed to data collection
and data review. K.P. MD contributed to data collection. A.T. MD
contributed to data collection. M.A. MD contributed to data collection.
V.H. MD contributed to data collection. W.S. MD, MPH
contributed to data analysis and provided critical review of the
manuscript. S.B. MD contributed to data analysis. G.R. MD provided
the critical review of the manuscript. A.L. MD provided the
critical review of the manuscript. E.A. MD, MSc contributed to
study design, data analysis, provided critical review of the manuscript,
and writing of the paper.
International Journal of Stroke, 19(4)

WSO - April 2024

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