{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:33:14Z","timestamp":1757313194405,"version":"3.40.5"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T00:00:00Z","timestamp":1688428800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Leukoaraiosis and other brain MRI\u2010assessed parameters were shown to be associated with recurrent stroke in this population. We aimed to develop an MRI\u2010based predictive tool for risk stratification of ESUS patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively assessed consecutive patients who were diagnosed with ESUS and underwent brain MRI and performed a multivariable analysis with the outcome of recurrent stroke\/TIA. Based on the coefficient of each covariate, we generated an integer\u2010based point scoring system. The discrimination and calibration of the score were assessed using the area under the receiver operator characteristic curve, net reclassification improvement, integrated discrimination improvement, calibration curve, and decision curve analysis. Also, we compared the new score with a previously published score (ALM score).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 176 patients followed for an overall period of 902.3 patient\u2010years (median of 74\u2009months), there were 39 recurrent ischemic stroke\/TIAs (4.32 per 100 patient\u2010years). Fazekas score (HR: 1.26, 95% CI: 1.03\u20131.54), enlarged perivascular space (EPVS) (HR: 2.76, 95% CI: 1.12\u20136.17), NIHSS at admission (HR: 1.11, 95% CI: 1.02\u20131.18), and infarct subtypes (HR: 2.88, 95% CI: 1.34\u20136.17) were associated with recurrent stroke\/TIA. Accordingly, a score (FENS score) was developed with AUC\u2010ROC values of 0.863, 0.788, and 0.858 for 1, 3, and 5\u2009years, respectively. These were significantly better than the AUC\u2010ROC of ALM score (0.635, 0.695, and 0.705, respectively). The FENS score exhibited better calibration and discrimination ability than the ALM score (Hosmer\u2013Lemeshow test <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>: 4.402, <jats:italic>p<\/jats:italic>\u2009=\u20090.819).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The MRI\u2010based FENS score can provide excellent predictive performance for recurrent stroke\/TIA and may assist in risk stratification of ESUS patients.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.51843","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T08:38:14Z","timestamp":1688459894000},"page":"1533-1543","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["<scp>MRI<\/scp>\u2010based risk stratification for recurrent ischemic stroke in embolic stroke of undetermined source"],"prefix":"10.1002","volume":"10","author":[{"given":"Quan\u2010Ying","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurology General Hospital of Northern Theater Command  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying\u2010Jie","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Neurology General Hospital of Northern Theater Command  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiao\u2010Qiu","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology General Hospital of Northern Theater Command  Shenyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin\u2010Hong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology General Hospital of Northern Theater Command  Shenyang 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