To investigate the relationship between radiomics derived brain age and Patient Reported Outcome Measures (PROMs) in acute ischemic stroke (AIS) patients.

Radiomics-derived brain age provides an objective, quantitative evaluation of brain health leveraging features of neuroimaging imperceptible to the human eye. Brain Age Gap (BAG) measures the difference between biological brain age and chronological brain age. A higher BAG has been associated with worse functional outcome as measured by the clinician-rated modified Rankin Scale (mRS). Considering the growing emphasis placed on patient reported outcomes, the association between BAG and PROMs remains to be evaluated.

Patients with AIS, T2-FLAIR MRI imaging, and PROMs from the COAST cohort (single center, 2017-2020) had BAG calculated using our previously developed radiomics-based pipeline. Outcomes were defined by global mental (T_Mental) and physical (T_Physical) scores based on responses to the PROMIS Global Health questionnaire (Range: 0-100). The association between poor outcome (T-score <50) and BAG was modeled using logistic regression adjusting for age, sex, and NIHSS score.

A total of 132 patients were analyzed (41% Female; median (IQR): Age 64 (57-71), NIHSS 2 (1-5), T_Mental 48.3 (43.5-53.3), T_Physical 47.7 (42.3-54.1)) with 75 and 76 patients having poor outcomes for T_Mental and T_Physical, respectively. Higher BAG was associated with worse T_Mental (aOR=1.71, 95%CI=1.17-2.58, p<0.01), but had no statistically significant impact on T_Physical scores (aOR=1.20, 95%CI=0.82-1.78, p=0.35).

Patients with a larger positive BAG —reflecting older appearing brains— reported worse mental, but not physical, health outcomes after AIS. Our results support the inclusion of brain age in clinical prognostication and future research into patient-centered outcomes after AIS.