  Brain parenchymal fraction (BPF) has been used as a surrogate measure of
global brain atrophy, and as a biomarker of brain reserve in studies evaluating
clinical outcomes after brain injury. Total brain volume at the time of injury
has recently been shown to influence functional outcomes, where larger brain
volumes are associated with better outcomes. Here, we assess if brain volume at
the time of ischemic stroke injury is a better biomarker of functional outcome
than BPF. Acute ischemic stroke cases at a single center between 2003 and 2011,
with MR neuroimaging obtained within 48 hours from presentation were eligible.
Functional outcomes represented by the modified Rankin Score (mRS) at 90 days
post admission (mRS<3 deemed a favorable outcome) were obtained via patient
interview or per chart review. Deep learning enabled automated segmentation
pipelines were used to calculate brain volume, intracranial volume (ICV), and
BPF on the acute neuroimaging data. Patient outcomes were modeled through
logistic regressions, and model comparison was conducted using the Bayes
Information Criterion (BIC). 467 patients with arterial ischemic stroke were
included in the analysis. Median age was 65.8 years, and 65.3% were male. In
both models, age and a larger stroke lesion volume were associated with worse
functional outcomes. Higher BPF and a larger brain volume were both associated
with favorable functional outcomes, however, comparison of both models
suggested that the brain volume model (BIC=501) explains the data better
compared to the BPF model (BIC=511). The extent of global brain atrophy has
been regarded as an important biomarker of post-stroke functional outcomes and
resilience to acute injury. Here, we demonstrate that a higher global brain
volume at the time of injury better explains favorable functional outcomes,
which can be directly clinically assessed.
