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Wang X, Shu X, He P, Cai Y, Geng Y, Hu X, Sun Y, Xiao H, Zheng W, Song Y, Xue Y, Jiang R. Ultra-high b-value DWI accurately identifies isocitrate dehydrogenase genotypes and tumor subtypes of adult-type diffuse gliomas. Eur Radiol 2024; 34:6751-6762. [PMID: 38528135 DOI: 10.1007/s00330-024-10708-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/08/2024] [Accepted: 02/23/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To distinguish isocitrate dehydrogenase (IDH) genotypes and tumor subtypes of adult-type diffuse gliomas based on the fifth edition of the World Health Organization classification of central nervous system tumors (WHO CNS5) in 2021 using standard, high, and ultra-high b-value diffusion-weighted imaging (DWI). MATERIALS AND METHODS This prospective study enrolled 70 patients with adult-type diffuse gliomas who underwent multiple b-value DWI. Apparent diffusion coefficient (ADC) values including ADCb500/b1000, ADCb500/b2000, ADCb500/b3000, ADCb500/b4000, ADCb500/b6000, ADCb500/b8000, and ADCb500/b10000 in tumor parenchyma (TP) and contralateral normal-appearing white matter (NAWM) were calculated. The ADC ratios of TP/NAWM were assessed for correlations with IDH genotypes, tumor subtypes, and Ki-67 status; diagnostic performances were compared. RESULTS All ADCs were significantly higher in IDH mutant gliomas than in IDH wild-type gliomas (p < 0.01 for all); ADCb500/b8000 had the highest area under the curve (AUC) of 0.866. All ADCs were significantly lower in glioblastoma than in astrocytoma (p < 0.01 for all). ADCs other than ADCb500/b1000 were significantly lower in glioblastoma than in oligodendroglioma (p < 0.05 for all). ADCb500/b8000 and ADCb500/b10000 were significantly higher in oligodendroglioma than in astrocytoma (p = 0.034 and 0.023). The highest AUCs were 0.818 for ADCb500/b6000 when distinguishing glioblastoma from astrocytoma, 0.979 for ADCb500/b8000 and ADCb500/b10000 when distinguishing glioblastoma from oligodendroglioma, and 0.773 for ADCb500/b10000 when distinguishing astrocytoma from oligodendroglioma. Additionally, all ADCs were negatively correlated with Ki-67 status (p < 0.05 for all). CONCLUSION Ultra-high b-value DWI can reliably separate IDH genotypes and tumor subtypes of adult-type diffuse gliomas using WHO CNS5 criteria. CLINICAL RELEVANCE STATEMENT Ultra-high b-value diffusion-weighted imaging can accurately distinguish isocitrate dehydrogenase genotypes and tumor subtypes of adult-type diffuse gliomas, which may facilitate personalized treatment and prognostic assessment for patients with glioma. KEY POINTS • Ultra-high b-value diffusion-weighted imaging can accurately distinguish subtle differences in water diffusion among biological tissues. • Ultra-high b-value diffusion-weighted imaging can reliably separate isocitrate dehydrogenase genotypes and tumor subtypes of adult-type diffuse gliomas. • Compared with standard b-value diffusion-weighted imaging, high and ultra-high b-value diffusion-weighted imaging demonstrate better diagnostic performances.
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Affiliation(s)
- Xueqin Wang
- Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
- School of Medical Imaging, Fujian Medical University, Fuzhou, 350004, China
| | - Xinru Shu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, 350004, China
| | - Pingping He
- School of Medical Imaging, Fujian Medical University, Fuzhou, 350004, China
| | - Yiting Cai
- School of Medical Imaging, Fujian Medical University, Fuzhou, 350004, China
| | - Yingqian Geng
- Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Xiaomei Hu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, 350001, China
| | - Yifan Sun
- Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Huinan Xiao
- Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Wanyi Zheng
- Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yang Song
- MR Scientific Marketing, Siemens Healthcare, Shanghai, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, NO.29 Xinquan Road, Fuzhou, 350001, Fujian, People's Republic of China.
- School of Medical Technology and Engineering, Fujian Medical University, Fuzhou, 350004, China.
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Förster A, Ramos A, Wenz H, Groden C, Alonso A. Computed diffusion-weighted imaging in patients with transient neurovascular symptoms with and without ischemic infarction. J Neuroradiol 2024; 51:1-4. [PMID: 36868372 DOI: 10.1016/j.neurad.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/25/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Detection of ischemic lesions in patients with transient neurovascular symptoms is relevant for the estimation of the risk of a subsequent stroke and etiological classification. To improve detection rates, different technical approaches have been used, such as diffusion-weighted imaging (DWI) with high b-values or higher magnetic field strength. Here, we sought to investigate the value of computed DWI (cDWI) with high b-values in these patients. METHODS From an MRI report database we identified patients with transient neurovascular symptoms who underwent repeated MRI including DWI. cDWI was calculated with a monoexponential model with high b-values (2000, 3000, and 4000 s/mm2) and compared to the routinely used standard DWI with regard to presence of ischemic lesions and lesion detectability. RESULT Overall 33 patients with transient neurovascular symptoms (71 [IQR 57-83.5] years; 21 [63.6%] male) were included. On DWI, acute ischemic lesions were observed in 22 (78.6%). Acute ischemic lesions were observed in 17 (51.5%) patients on initial DWI, and in 26 (78.8%) patients on follow-up DWI. Lesion detectability was rated significantly better on cDWI at 2000s/mm2 compared to standard DWI. In 2 (9.1%) patients, cDWI at 2000s/mm2 revealed an acute ischemic lesion proven on follow-up standard DWI which was not detected with certainty on the initial standard DWI. CONCLUSION cDWI might be a valuable addition to routinely acquired standard DWI in patients with transient neurovascular symptoms since its use might result in improved ischemic lesion detection. A b-value of 2000s/mm2 seems most promising for clinical practice.
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Affiliation(s)
- A Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Ana Ramos
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - H Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - C Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - A Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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Shibasaki J, Niwa T, Piedvache A, Tomiyasu M, Morisaki N, Fujii Y, Toyoshima K, Aida N. Comparison of Predictive Values of Magnetic Resonance Biomarkers Based on Scan Timing in Neonatal Encephalopathy Following Therapeutic Hypothermia. J Pediatr 2021; 239:101-109.e4. [PMID: 34391766 DOI: 10.1016/j.jpeds.2021.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the optimal quantitative magnetic resonance (MR) biomarker in neonatal encephalopathy following therapeutic hypothermia based on scan timing. STUDY DESIGN This retrospective study included 98 neonates (35-41 weeks of gestation) with neonatal encephalopathy, who underwent therapeutic hypothermia; diffusion-weighted imaging and proton MR spectroscopy were performed at 24-96 hours (n = 56) and 7-14 days (n = 92) after birth, respectively, to estimate apparent diffusion coefficient (ADC) values, N-acetylaspartate and N-acetylaspartylglutamate (tNAA), lactate, and choline concentrations, and lactate/tNAA, tNAA/choline ratios in the deep gray matter. Adverse outcomes included death or neurodevelopmental impairment at 18-22 months of age. We used receiver operating characteristic curves to examine the prognostic accuracy of each MR biomarker. RESULTS Deep gray matter tNAA concentrations showed the best prognostic value, with an area under the curve (AUC) of 0.97 and 1.00 at 24-96 hours and 7-14 days after birth, respectively. At 24-96 hours of age, ADC values, lactate concentrations, and lactate/tNAA ratios showed prognostic value with AUCs of 0.90, 0.95, and 0.97, respectively. At 7-14 days of age, the AUCs of ADC values, lactate, and lactate/tNAA ratios were 0.61, 0.67, and 0.80, respectively; these were lower than those at 24-96 hours of age. CONCLUSIONS During the first 2 weeks of life, the deep gray matter tNAA concentration was the most accurate quantitative MR biomarker. Although ADC values, lactate levels, and lactate/tNAA ratios also showed high prognostic value during 24-96 hours of life, only tNAA retained high prognostic value in the second week of life.
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Affiliation(s)
- Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Tetsu Niwa
- Department of Radiology, Tokai University School of Medicine, Isehara, Japan; Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan.
| | - Aurélie Piedvache
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Moyoko Tomiyasu
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan; Department of Molecular Imaging and Theranostics, National Institute for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Naho Morisaki
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yuta Fujii
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Katsuaki Toyoshima
- Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Noriko Aida
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
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Huang X, Xu X, Sun Y, Cai G, Jiang R, Chen J, Xue Y. Ultra-high b value DWI in distinguishing fresh gray matter ischemic lesions from white matter ones: a comparative study with routine and high b value DWI. Quant Imaging Med Surg 2021; 11:4583-4593. [PMID: 34737925 DOI: 10.21037/qims-20-1241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 05/28/2021] [Indexed: 11/06/2022]
Abstract
Background Fresh ischemic lesions (FILs) can occur in both the brain's gray matter (GM) and white matter (WM), with each location signifying a different prognosis for patients. This study aims to investigate the application of ultra-high b value diffusion-weighted imaging (DWI) in distinguishing FILs in these two areas via a comparative study with routine and high b value DWI. Methods Multiple b value DWI (b=0, 500, 1,000, 2,000, 4,000, 6,000, 8,000, 10,000 s/mm2) was performed on 47 patients with suspected acute ischemic stroke (AIS). Apparent diffusion coefficient (ADC) maps, including ADC500, ADC1,000, ADC2,000, ADC4,000, ADC6,000, ADC8,000, and ADC10,000, were calculated, and the mean ADC value of the FILs in the GM and WM on each map was obtained by referring to the structural magnetic resonance imaging (MRI). ADC value differences of the FILs in the GM and WM were compared using Mann-Whitney U tests, and receiver operating characteristic (ROC) curves evaluated the diagnostic efficiency of each ADC value in distinguishing FILs in the two areas. Results In the enrolled 34 patients, 145 FILs were identified, of which 42 involved the GM, 87 the WM, and 16 both the GM and WM. A total of 161 regions were delineated, 58 in the GM and 103 in the WM. The values of FILs in the WM on ADC2,000, ADC4,000, ADC6,000, ADC8,000, and ADC10,000 maps were significantly lower than those in the GM (P=0.007, P<0.001, P<0.001, P<0.001 and P<0.001, respectively), while no significant differences were found on ADC500 and ADC1,000 maps (P=0.427 and P=0.225, respectively). ROC curves demonstrated that the area under the curve (AUC) paralleled the increasing b value, ascending from ADC500 to ADC10,000 (0.538, 0.558, 0.629, 0.766, 0.827, 0.859, 0.872, in that order). Conclusions Ultra-high b value DWI is extremely sensitive to the slight diffusion difference between FILs in the GM and the WM. Its sensitivity parallels the increasing b value, indicating its clinical advantage in identifying the microstructure of FILs.
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Affiliation(s)
- Xinming Huang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xue Xu
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yifan Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rifeng Jiang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianhua Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
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Faust O, En Wei Koh J, Jahmunah V, Sabut S, Ciaccio EJ, Majid A, Ali A, Lip GYH, Acharya UR. Fusion of Higher Order Spectra and Texture Extraction Methods for Automated Stroke Severity Classification with MRI Images. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8059. [PMID: 34360349 PMCID: PMC8345794 DOI: 10.3390/ijerph18158059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022]
Abstract
This paper presents a scientific foundation for automated stroke severity classification. We have constructed and assessed a system which extracts diagnostically relevant information from Magnetic Resonance Imaging (MRI) images. The design was based on 267 images that show the brain from individual subjects after stroke. They were labeled as either Lacunar Syndrome (LACS), Partial Anterior Circulation Syndrome (PACS), or Total Anterior Circulation Stroke (TACS). The labels indicate different physiological processes which manifest themselves in distinct image texture. The processing system was tasked with extracting texture information that could be used to classify a brain MRI image from a stroke survivor into either LACS, PACS, or TACS. We analyzed 6475 features that were obtained with Gray-Level Run Length Matrix (GLRLM), Higher Order Spectra (HOS), as well as a combination of Discrete Wavelet Transform (DWT) and Gray-Level Co-occurrence Matrix (GLCM) methods. The resulting features were ranked based on the p-value extracted with the Analysis Of Variance (ANOVA) algorithm. The ranked features were used to train and test four types of Support Vector Machine (SVM) classification algorithms according to the rules of 10-fold cross-validation. We found that SVM with Radial Basis Function (RBF) kernel achieves: Accuracy (ACC) = 93.62%, Specificity (SPE) = 95.91%, Sensitivity (SEN) = 92.44%, and Dice-score = 0.95. These results indicate that computer aided stroke severity diagnosis support is possible. Such systems might lead to progress in stroke diagnosis by enabling healthcare professionals to improve diagnosis and management of stroke patients with the same resources.
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Affiliation(s)
- Oliver Faust
- Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Joel En Wei Koh
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
| | - Vicnesh Jahmunah
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
| | - Sukant Sabut
- School of Electronics Engineering, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha 751024, India;
| | - Edward J. Ciaccio
- Department of Medicine-Cardiology, Columbia University, New York, NY 10027, USA;
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield S10 2HQ, UK;
| | - Ali Ali
- Sheffield Teaching Hospitals NIHR Biomedical Research Centre, Sheffield S10 2JF, UK;
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L69 7TX, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - U. Rajendra Acharya
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
- School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, Singapore 599494, Singapore
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto 860-8555, Japan
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Sartoretti T, Sartoretti E, Wyss M, Mannil M, van Smoorenburg L, Eichenberger B, Reischauer C, Alfieri A, Binkert C, Sartoretti-Schefer S. Diffusion-weighted MRI of ischemic stroke at 3T: Value of synthetic b-values. Br J Radiol 2021; 94:20200869. [PMID: 33596102 DOI: 10.1259/bjr.20200869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Diffusion-weighted imaging (DWI) plays a crucial role in the diagnosis of ischemic stroke. We assessed the value of computed and acquired high b-value DWI in comparison with conventional b = 1000 s mm-2 DWI for ischemic stroke at 3T. METHODS We included 36 patients with acute ischemic stroke who presented with diffusion abnormalities on DWI performed within 24 h of symptom onset. B-values of 0, 500, 1000 and 2000 s mm-2 were acquired. Synthetic images with b-values of 1000, 1500, 2000 and 2500 s mm-2 were computed. Two readers compared synthetic (syn) and acquired (acq) b = 2000 s mm-2 images with acquired b = 1000 s mm-2 images in terms of lesion detection rate, image quality, presence of uncertain hyperintensities and lesion conspicuity. Readers also selected their preferred b-value. Contrast ratio (CR) measurements were performed. Non-parametrical statistical tests and weighted Cohens' κ tests were computed. RESULTS Syn1000 and syn1500 matched acq1000 images in terms of lesion detection rate, image quality and presence of uncertain hyperintensities but presented with significantly improved lesion conspicuity (p < 0.01) and were frequently selected as preferred b-values. Acq2000 images exhibited a similar lesion detection rate and improved lesion conspicuity (p < 0.01) but worse image quality (p < 0.01) than acq1000 images. Syn2000 and syn2500 images performed significantly worse (p < 0.01) than acq1000 images in most or all categories. CR significantly increased with increasing b-values. CONCLUSION Synthetic images at b = 1000 and 1500 s mm-2 and acquired DWI images at b = 2000 s mm-2 may be of clinical value due to improved lesion conspicuity. ADVANCES IN KNOWLEDGE Synthetic b-values enable improved lesion conspicuity for DWI of ischemic stroke.
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Affiliation(s)
- Thomas Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Elisabeth Sartoretti
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Michael Wyss
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland.,Philips Healthsystems, Zürich, Switzerland
| | - Manoj Mannil
- Institute of Neuroradiology, Kantonsspital Aarau, Aarau, Switzerland
| | | | | | - Carolin Reischauer
- Department of Medicine, University of Fribourg, Fribourg, Switzerland.,Department of Radiology, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland
| | - Alex Alfieri
- Department of Neurosurgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Christoph Binkert
- Institute of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland
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7
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Ablefoni M, Ullrich S, Surov A, Hoffmann KT, Meyer HJ. Diagnostic benefit of high b-value computed diffusion-weighted imaging in acute brainstem infarction. J Neuroradiol 2020; 49:47-52. [PMID: 32987036 DOI: 10.1016/j.neurad.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/03/2020] [Accepted: 09/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Diffusion-weighted imaging (DWI) is a cornerstone in diagnostic of ischemic stroke. The aim of this study was to investigate the usefulness of high-b-value computed DWI (c-DWI) in comparison to standard DWI in patients with acute brainstem infarction. MATERIALS AND METHODS 56 patients with acute brainstem infarction were retrospectively analysed by two readers. DWI was obtained with the b-values 0, 500 and 1000 s/mm² on either a 1.5 or 3 T magnetic resonance imaging (MRI) scanner. c-DWI was calculated with a monoexponential model with high b-values 2000, 3000, 4000 and 5000 s/mm². All c-DWI series with high-b-values were compared to the standard DWI sequence at b-value of 1000 s/mm² in terms of image artifacts, lesion extent and contrast. RESULTS There was no statistically significant difference between 1.5 and 3 T MRI regarding the measured ischemic lesion size. There were no statistically significant differences between the ischemic lesion sizes on DWI at b-values of 1000 s/mm² and on c-DWI at higher b-values. Overall, the contrast between the lesion and the surrounding normal areas improved with increasing b-value on the isotropic DWIs: maximum at b = 5000, followed by that at b 2000 and b 1000 s/mm², in order. The best relation between artifacts and lesion contrast was identified for b 2000 s/mm². CONCLUSION High b-value DWI derived from c-DWI has a higher visibility for ischemic brainstem lesions compared to standard DWI without additional time cost. The b-2000 image is recommended to use in clinical routine, higher b-value images lead to more imaging artifacts, which might result in misdiagnosis.
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Affiliation(s)
- Maxime Ablefoni
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany.
| | - Sebastian Ullrich
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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8
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Ter Telgte A, Wiegertjes K, Gesierich B, Marques JP, Huebner M, de Klerk JJ, Schreuder FHBM, Araque Caballero MA, Kuijf HJ, Norris DG, Klijn CJM, Dichgans M, Tuladhar AM, Duering M, de Leeuw FE. Contribution of acute infarcts to cerebral small vessel disease progression. Ann Neurol 2019; 86:582-592. [PMID: 31340067 PMCID: PMC6771732 DOI: 10.1002/ana.25556] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 01/02/2023]
Abstract
Objective To determine the contribution of acute infarcts, evidenced by diffusion‐weighted imaging positive (DWI+) lesions, to progression of white matter hyperintensities (WMH) and other cerebral small vessel disease (SVD) markers. Methods We performed monthly 3T magnetic resonance imaging (MRI) for 10 consecutive months in 54 elderly individuals with SVD. MRI included high‐resolution multishell DWI, and 3‐dimensional fluid‐attenuated inversion recovery, T1, and susceptibility‐weighted imaging. We determined DWI+ lesion evolution, WMH progression rate (ml/mo), and number of incident lacunes and microbleeds, and calculated for each marker the proportion of progression explained by DWI+ lesions. Results We identified 39 DWI+ lesions on 21 of 472 DWI scans in 9 of 54 subjects. Of the 36 DWI+ lesions with follow‐up MRI, 2 evolved into WMH, 4 evolved into a lacune (3 with cavity <3mm), 3 evolved into a microbleed, and 27 were not detectable on follow‐up. WMH volume increased at a median rate of 0.027 ml/mo (interquartile range = 0.005–0.073), but was not significantly higher in subjects with DWI+ lesions compared to those without (p = 0.195). Of the 2 DWI+ lesions evolving into WMH on follow‐up, one explained 23% of the total WMH volume increase in one subject, whereas the WMH regressed in the other subject. DWI+ lesions preceded 4 of 5 incident lacunes and 3 of 10 incident microbleeds. Interpretation DWI+ lesions explain only a small proportion of the total WMH progression. Hence, WMH progression seems to be mostly driven by factors other than acute infarcts. DWI+ lesions explain the majority of incident lacunes and small cavities, and almost one‐third of incident microbleeds, confirming that WMH, lacunes, and microbleeds, although heterogeneous on MRI, can have a common initial appearance on MRI. ANN NEUROL 2019;86:582–592
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Affiliation(s)
- Annemieke Ter Telgte
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kim Wiegertjes
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Benno Gesierich
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Mathias Huebner
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Jabke J de Klerk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Floris H B M Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Miguel A Araque Caballero
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE Munich), Munich, Germany
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Catharina J M Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE Munich), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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Liu C, Zhang S, Yao Y, Su C, Wang Z, Wang M, Zhu W. Associations Between Diffusion Dynamics and Functional Outcome in Acute and Early Subacute Ischemic Stroke. Clin Neuroradiol 2019; 30:517-524. [PMID: 31399748 DOI: 10.1007/s00062-019-00812-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The current study aimed to investigate the associations between diffusion dynamics of ischemic lesions and clinical functional outcome of acute and early subacute stroke. MATERIAL AND METHODS A total of 80 patients with first ever infarcts in the territory of the middle cerebral artery underwent multi-b-values diffusion-weighted imaging and diffusion kurtosis imaging. Multiple diffusion parameters were generated in postprocessing using different diffusion models. Long-term functional outcome was evaluated with modified Rankin scale (mRS) at 6 months post-stroke. Good functional outcome was defined as mRS score ≤ 2 and poor functional outcome was defined as mRS score ≥ 3. Univariate analysis was used to compare the diffusion parameters and clinical features between patients with poor and good functional outcome. Significant parameters were further analyzed for correlations with functional outcome using partial correlation. RESULTS In univariate analyses, standard-b-values apparent diffusion coefficient (ADCst) ratio and fractional anisotropy (FA) ratio of acute stroke, ADCst ratio and mean kurtosis (MK) ratio of early subacute stroke were statistically different between patients with poor outcome and good outcome (P < 0.05). When the potential confounding factor of lesion volume was controlled, only FA ratio of acute stroke, ADCst ratio and MK ratio of early subacute stroke remained correlated with the functional outcome (P < 0.05). CONCLUSION Diffusion dynamics are correlated with the clinical functional outcome of ischemic stroke. This correlation is independent of the effect of lesion volume and is specific to the time period between symptom onset and imaging. More effort is needed to further investigate the predictive value of diffusion-weighted imaging.
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Affiliation(s)
- Chengxia Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Yihao Yao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Changliang Su
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Zhenxiong Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Minghuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030, Wuhan, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China.
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10
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Hori M, Irie R, Suzuki M, Aoki S. Teaching Neuroimages: Obscured Cerebral Infarction on MRI. Clin Neuroradiol 2017; 27:519-520. [PMID: 28314911 PMCID: PMC5858466 DOI: 10.1007/s00062-017-0576-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan.
| | - Ryusuke Irie
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan.,Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Michimasa Suzuki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Tokyo, Japan
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11
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Characteristic CT and MR imaging findings of cerebral paragonimiasis. J Neuroradiol 2016; 43:200-6. [DOI: 10.1016/j.neurad.2014.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/05/2014] [Accepted: 10/29/2014] [Indexed: 11/19/2022]
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12
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Cheng Q, Xu X, Zu Q, Lu S, Yu J, Liu X, Wang B, Shi H, Teng G, Liu S. High b value DWI in evaluation of the hyperacute cerebral ischemia at 3T: A comparative study in an embolic canine stroke model. Exp Ther Med 2016; 12:951-956. [PMID: 27446301 PMCID: PMC4950572 DOI: 10.3892/etm.2016.3403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/05/2016] [Indexed: 01/23/2023] Open
Abstract
Previous studies have indicated that the temporal change of relative diffusion weighted imaging (rDWI) signal intensity may help to determine the onset time of a stroke. Furthermore, several studies have indicated that high b value DWI offered improved detection rates for hyper-acute ischemic lesions compared with standard b value DWI. However, the temporal changes of the rDWI on high b value DWI remain unclear. Therefore, based on our embolic canine stroke model, we evaluated the temporal evolution of rDWI on high b value DWI, and further compared its diagnostic value in predicting the onset time of ischemic stroke with rDWI on standard b value DWI. Twelve canine MCAO models were established, and DWI was performed at 1, 2, 3, 4, 5 and 6 h after MCAO, with 3 b values of 1,000, 2,000 and 3,000. High b value DWI detected all ischemic lesions after 1 h, while standard b value did not detect the ischemic lesions in one dog at 1 h. With all three of the tested b values, rDWIs increased continuously within 6 h, while relative apparent diffusion coefficient (rADC) values rapidly decreased in 1 h, then became relatively stable. The area under the curve values for rDWI with b value of 1,000, 2,000 and 3,000, in predicting ischemic lesions within 3 h were 0.897, 0.929 and 0.938, while for rADC were 0.645, 0.583 and 0.599, respectively. Therefore, the results indicated that the rDWI was helpful in aging hyper-acute ischemic stroke, while rADC appeared not to be. High b value DWI had a higher detection rate for ischemic lesions and better predictive efficacy in determining the onset time of hyper-acute stroke.
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Affiliation(s)
- Qiguang Cheng
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiaoquan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Qingquan Zu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Shanshan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jing Yu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xinglong Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Bin Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Haibin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Gaojun Teng
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu 210029, P.R. China
| | - Sheng Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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13
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Utility of High-b-Value Diffusion-Weighted Magnetic Resonance Imaging in Evaluating Reversible Medial Longitudinal Fasciculus Syndrome Caused by Acute Brainstem Ischemia. J Stroke Cerebrovasc Dis 2015; 24:e157-9. [PMID: 25836632 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 03/03/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Medial longitudinal fasciculus (MLF) syndrome refers to a gaze disorder characterized by impaired adduction on the ipsilateral side to the injured MLF, with dissociated nystagmus of the contralateral abducting eye. The most common cause of the MLF syndrome is ischemic stroke. However, acute ischemic change in the MLF may be undetectable even on diffusion-weighted magnetic resonance imaging (DW-MRI) partly because of its small size and specific brainstem location. CASE REPORT Herein, we present the first reported case of MLF syndrome in which, compared with the standard-b-value DWI, a higher b-value DWI revealed more clearly a small infarction in the dorsal pons in the acute stage. CONCLUSIONS We suggest that high-b-value DWI can be a useful diagnostic method for patients with MLF syndrome caused by possible brainstem ischemia and thus supportive for deciding the optimal treatment for such patients.
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14
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15
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Affiliation(s)
- Karl-Olof Lövblad
- Service neuro-diagnostique et neuro-interventionnel, département DISIM, hôpitaux universitaires de Genève, 1211 Geneva, Switzerland.
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16
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Amarteifio E, Essig M, Böckler D, Attigah N, Schuster L, Demirel S. Comparison of gadofosveset (Vasovist(®)) with gadobenate dimeglumine (Multihance(®))-enhanced MR angiography for high-grade carotid artery stenosis. J Neuroradiol 2014; 42:236-44. [PMID: 24996569 DOI: 10.1016/j.neurad.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/16/2014] [Accepted: 03/19/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To prove superiority of blood pool contrast agent gadofosveset over conventional contrast agent gadobenate dimeglumine for assessment of stenotic internal carotid artery (ICA). METHODS Eleven patients with high-grade ICA stenosis (≥75%), confirmed by duplex sonography, underwent MR angiography (MRA) with gadofosveset and gadobenate dimeglumine. RESULTS Agreement in stenosis grade was reached in 7 of 10 stenotic ICAs. In two ICAs, gadobenate dimeglumine led to underestimation of stenosis grade. There was a significant difference in signal intensity (pre-/post-stenotic segments), showing higher values for gadofosveset (P<0.01; P<0.05). Impression of contrast intensity with gadofosveset was better in 8 ICAs and only in 1 ICA with gadobenate dimeglumine (P<0.05). CONCLUSION Gadofosveset-enhanced MR angiography may be superior for assessment of high-grade ICA stenosis compared with gadobenate dimeglumine MR angiography.
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Affiliation(s)
- E Amarteifio
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany; Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - M Essig
- Department of Radiology, University of Manitoba, GA216-820 Sherbrook Street, MB R3T 2N2 Manitoba, Winnipeg, Canada
| | - D Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - N Attigah
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - L Schuster
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - S Demirel
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, INF 110, 69120 Heidelberg, Germany.
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17
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Future directions for endovascular management of patients with acute ischemic stroke. J Neuroradiol 2014; 41:151-2. [DOI: 10.1016/j.neurad.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Automatic detection and quantification of acute cerebral infarct by fuzzy clustering and histographic characterization on diffusion weighted MR imaging and apparent diffusion coefficient map. BIOMED RESEARCH INTERNATIONAL 2014; 2014:963032. [PMID: 24738080 PMCID: PMC3971548 DOI: 10.1155/2014/963032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/31/2013] [Accepted: 01/09/2014] [Indexed: 12/16/2022]
Abstract
Determination of the volumes of acute cerebral infarct in the magnetic resonance imaging harbors prognostic values. However, semiautomatic method of segmentation is time-consuming and with high interrater variability. Using diffusion weighted imaging and apparent diffusion coefficient map from patients with acute infarction in 10 days, we aimed to develop a fully automatic algorithm to measure infarct volume. It includes an unsupervised classification with fuzzy C-means clustering determination of the histographic distribution, defining self-adjusted intensity thresholds. The proposed method attained high agreement with the semiautomatic method, with similarity index 89.9 ± 6.5%, in detecting cerebral infarct lesions from 22 acute stroke patients. We demonstrated the accuracy of the proposed computer-assisted prompt segmentation method, which appeared promising to replace the laborious, time-consuming, and operator-dependent semiautomatic segmentation.
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19
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Bivard A, Levi C, Krishnamurthy V, Hislop-Jambrich J, Salazar P, Jackson B, Davis S, Parsons M. Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion. J Neuroradiol 2014; 41:307-15. [PMID: 24433950 DOI: 10.1016/j.neurad.2013.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/25/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to identify and validate whole brain perfusion computed tomography (CTP) thresholds for ischemic core and salvageable penumbra in acute stroke patients and develop a probability based model to increase the accuracy of tissue pathophysiology measurements. METHODS One hundred and eighty-three patients underwent multimodal stroke CT using a 320-slice scanner within 6hours of acute stroke onset, followed by 24hour MRI that included diffusion weighted imaging (DWI) and dynamic susceptibility weighted perfusion imaging (PWI). Coregistered acute CTP and 24hour DWI was used to identify the optimum single perfusion parameter thresholds to define penumbra (in patients without reperfusion), and ischemic core (in patients with reperfusion), using a pixel based receiver operator curve analysis. Then, these results were used to develop a sigma curve fitted probability based model incorporating multiple perfusion parameter thresholds. RESULTS For single perfusion thresholds, a time to peak (TTP) of +5seconds best defined the penumbra (area under the curve, AUC 0.79 CI 0.74-0.83) while a cerebral blood flow (CBF) of < 50% best defined the acute ischemic core (AUC 0.73, CI 0.69-0.77). The probability model was more accurate at detecting the ischemic core (AUC 0.80 SD 0.75-0.83) and penumbra (0.85 SD 0.83-0.87) and was significantly closer in volume to the corresponding reference DWI (P=0.031). CONCLUSIONS Whole brain CTP can accurately identify penumbra and ischemic core using similar thresholds to previously validated 16 or 64 slice CTP. Additionally, a novel probability based model was closer to defining the ischemic core and penumbra than single thresholds.
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Affiliation(s)
- A Bivard
- Melbourne Brain Centre, Flory Neuroscience Institute, University of Melbourne, Melbourne, Australia.
| | - C Levi
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
| | - V Krishnamurthy
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
| | | | - P Salazar
- Vital Images, Minneapolis, United States
| | - B Jackson
- Vital Images, Minneapolis, United States
| | - S Davis
- Melbourne Brain Centre, Flory Neuroscience Institute, University of Melbourne, Melbourne, Australia
| | - M Parsons
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, Australia.
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Raoult H, Eugène F, Ferré JC, Gentric JC, Ronzière T, Stamm A, Gauvrit JY. Prognostic factors for outcomes after mechanical thrombectomy with solitaire stent. J Neuroradiol 2013; 40:252-9. [DOI: 10.1016/j.neurad.2013.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 03/27/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
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