Chronic stress, a pervasive feature of modern life, may now be visible on routine medical scans thanks to a new artificial intelligence tool. Researchers have developed a deep learning model capable of identifying a biomarker of chronic stress directly within standard CT scans, potentially opening doors to earlier risk assessment and preventative care. The findings, presented next week at the annual meeting of the Radiological Society of North America (RSNA), represent a significant step toward quantifying the often-invisible toll of long-term stress on the body.
The impact of chronic stress extends far beyond feelings of anxiety or overwhelm. According to the American Psychological Association, prolonged stress can contribute to a range of physical and mental health problems, including sleep disturbances, muscle pain, high blood pressure and a weakened immune system. Mounting evidence also links chronic stress to more serious conditions like heart disease, depression, and obesity. The APA provides extensive resources on understanding and managing stress.
The key to this new approach lies in analyzing the adrenal glands. Elena Ghotbi, M.D., a postdoctoral research fellow at Johns Hopkins University School of Medicine in Baltimore, Maryland, led the team that created and trained the AI. Their tool automatically calculates the size of the adrenal glands from existing chest CT scans – a procedure already performed on tens of millions of Americans each year. “Our approach leverages widely available imaging data and opens the door to large-scale evaluations of the biological impact of chronic stress across a range of conditions using existing chest CT scans,” Dr. Ghotbi explained.
Seeing Stress: How AI Measures Adrenal Gland Volume
The research team’s innovation isn’t simply measuring adrenal gland size, but creating an “Adrenal Volume Index” (AVI). AVI is calculated by dividing adrenal volume (in cubic centimeters) by a patient’s height squared (in meters squared). This standardization allows for comparison across individuals of different sizes. The AI was trained on data from the Multi-Ethnic Study of Atherosclerosis (MESA), a large, ongoing study that combines CT imaging with detailed health data, including stress questionnaires, cortisol measurements, and indicators of allostatic load – a measure of the cumulative physiological effects of stress.
“For the first time, You can ‘see’ the long-term burden of stress inside the body, using a scan that patients already get every day in hospitals across the country,” said Shadpour Demehri, M.D., professor of radiology at Johns Hopkins and senior author of the study. “Until now, we haven’t had a way to measure and quantify the cumulative effects of chronic stress, other than questionnaires, surrogate serum markers like chronic inflammation, and cortisol measurement, which is very cumbersome to obtain.” Unlike a single cortisol test, which provides a snapshot in time, the adrenal gland size offers a longer-term perspective on stress exposure.
Linking Adrenal Volume to Health Outcomes
The MESA study included data from 2,842 participants (average age 69.3, 51% women). Researchers found a strong correlation between higher AVI values and several indicators of stress and poor health. Specifically, individuals with larger adrenal glands, as measured by AVI, showed greater overall cortisol exposure, higher peak cortisol levels, and increased allostatic load. Those reporting higher levels of perceived stress also had higher AVI scores compared to those reporting lower stress levels.
Perhaps most significantly, the study linked AVI to cardiovascular risk. For every 1 cm3/m2 increase in AVI, the risk of heart failure and death increased. The team was able to correlate the AI-derived AVI with clinically relevant outcomes, including heart failure, using up to 10 years of follow-up data. “This is the very first imaging marker of chronic stress that has been validated and shown to have an independent impact on a cardiovascular outcome, namely, heart failure,” Dr. Ghotbi stated.
A New Era in Stress Measurement
Teresa E. Seeman, Ph.D., a professor of epidemiology at UCLA and a leading researcher in stress and health, emphasized the importance of this work. “For over three decades, we’ve known that chronic stress can wear down the body across multiple systems,” she said. “What makes this work so exciting is that it links a routinely obtained imaging feature, adrenal volume, with validated biological and psychological measures of stress and shows that it independently predicts a major clinical outcome. It’s a true step forward in operationalizing the cumulative impact of stress on health.”
Dr. Demehri highlighted the practicality of this biomarker. “The key significance of this work is that this biomarker is obtainable from CTs that are performed widely in the United States for various reasons,” he explained. “Secondly, it is a physiologically sound measure of adrenal volume, which is part of the chronic stress physiologic cascade.” The researchers believe this imaging biomarker could be applied to a wide range of stress-related diseases, particularly in middle-aged and older adults.
The potential applications of this technology extend beyond cardiovascular risk assessment. Researchers suggest it could be used to monitor the effectiveness of stress-reduction interventions and to identify individuals who might benefit from preventative care. Further research is needed to determine the optimal AVI thresholds for identifying individuals at risk and to explore the biomarker’s utility in other stress-related conditions.
The research team will present their findings at the Radiological Society of North America (RSNA) annual meeting in Chicago next week. The RSNA meeting is a major event for radiologists and medical imaging professionals. The next step will involve validating these findings in larger and more diverse populations and exploring the potential for integrating AVI into routine clinical practice.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
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