1
|
Aoki J, Sakamoto Y, Suzuki K, Nishi Y, Kutsuna A, Takei Y, Sawada K, Kanamaru T, Abe A, Katano T, Takeshi Y, Nakagami T, Numao S, Kimura R, Suda S, Nishiyama Y, Kimura K. Fluid-Attenuated Inversion Recovery May Serve As a Tissue Clock in Patients Treated With Endovascular Thrombectomy. Stroke 2021; 52:2232-2240. [PMID: 33957776 DOI: 10.1161/strokeaha.120.033374] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Junya Aoki
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yuki Sakamoto
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yuji Nishi
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Akihito Kutsuna
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yukako Takei
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Kazutaka Sawada
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Takuya Kanamaru
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Arata Abe
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Takehiro Katano
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yuho Takeshi
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Toru Nakagami
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Shinichiro Numao
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Ryutaro Kimura
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Satoshi Suda
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School Graduate School of Medicine, Japan
| |
Collapse
|
2
|
Jakubicek S, Krebs S, Posekany A, Ferrari J, Szabo J, Siarnik P, Lang W, Sykora M. Modified DWI-FLAIR mismatch guided thrombolysis in unknown onset stroke. J Thromb Thrombolysis 2019; 47:167-173. [PMID: 30415393 DOI: 10.1007/s11239-018-1766-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
DWI-FLAIR mismatch has been recently proven to identify patients with unknown onset stroke (UOS) eligible for thrombolysis. However, this concept may exclude patients from thrombolysis who may eventually benefit as well. We aimed to examine the feasibility, safety and potential efficacy of thrombolysis in wake-up stroke (WUS) and UOS patients using a modified DWI-FLAIR mismatch allowing for partial FLAIR positivity. WUS/UOS patients fulfilling the modified DWI-FLAIR mismatch and treated with intravenous thrombolysis (IVT) were compared to propensity score matched WUS/UOS patients excluded from IVT due to FLAIR positivity. The primary endpoint was a symptomatic intracranial hemorrhage (SICH), the secondary endpoints were improvement of ≥ 4 in NIHSS score and mRS score at 3 months. 64 IVT-treated patients (median NIHSS 9) and 64 controls (median NIHSS 8) entered the analysis (p = 0.2). No significant difference in SICH was found between the IVT group and the controls (3.1% vs. 1.6%, p = 0.9). An improvement of ≥ 4 NIHSS points was more frequent in IVT patients as compared to controls (40.6% vs. 18.8%, p = 0.01). 23.4% of IVT patients achieved a mRS score of 0-1 at 3 months as compared to 18.8% of the controls (p = 0.8). SICH, improvement of NIHSS ≥ 4 and mRS 0-1 at 3 months were comparable in thrombolyzed patients with negative FLAIR images versus those thrombolyzed with partial positive FLAIR images (3% vs. 3%, p = 0.9; 40% vs. 41%, p = 0.9; 19% vs. 22%, p = 0.8). Our study signalizes that thrombolysis may be feasible in selected WUS/UOS patients with partial FLAIR signal positivity.
Collapse
Affiliation(s)
- Stanislava Jakubicek
- Department of Neurology, St. John's Hospital, Vienna, Austria.,Department of Neurology, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Stefan Krebs
- Department of Neurology, St. John's Hospital, Vienna, Austria
| | - Alexandra Posekany
- Danube University Krems, Dr. Karl Dorrek Straße 30, 3500, Krems, Austria.,Gesundheit Österreich GmbH/BIQG, Vienna, Austria
| | - Julia Ferrari
- Department of Neurology, St. John's Hospital, Vienna, Austria
| | - Jozef Szabo
- First Department of Neurology, Comenius University, Bratislava, Slovakia
| | - Pavel Siarnik
- First Department of Neurology, Comenius University, Bratislava, Slovakia
| | - Wilfried Lang
- Department of Neurology, St. John's Hospital, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Marek Sykora
- Department of Neurology, St. John's Hospital, Vienna, Austria. .,Medical Faculty, Sigmund Freud University, Vienna, Austria.
| |
Collapse
|
3
|
Sudre CH, Gomez Anson B, Davagnanam I, Schmitt A, Mendelson AF, Prados F, Smith L, Atkinson D, Hughes AD, Chaturvedi N, Cardoso MJ, Barkhof F, Jaeger HR, Ourselin S. Bullseye's representation of cerebral white matter hyperintensities. J Neuroradiol 2018; 45:114-122. [PMID: 29132940 PMCID: PMC5867449 DOI: 10.1016/j.neurad.2017.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 10/03/2017] [Accepted: 10/17/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Visual rating scales have limited capacities to depict the regional distribution of cerebral white matter hyperintensities (WMH). We present a regional-zonal volumetric analysis alongside a visualization tool to compare and deconstruct visual rating scales. MATERIALS AND METHODS 3D T1-weighted, T2-weighted spin-echo and FLAIR images were acquired on a 3T system, from 82 elderly participants in a population-based study. Images were automatically segmented for WMH. Lobar boundaries and distance to ventricular surface were used to define white matter regions. Regional-zonal WMH loads were displayed using bullseye plots. Four raters assessed all images applying three scales. Correlations between visual scales and regional WMH as well as inter and intra-rater variability were assessed. A multinomial ordinal regression model was used to predict scores based on regional volumes and global WMH burdens. RESULTS On average, the bullseye plot depicted a right-left symmetry in the distribution and concentration of damage in the periventricular zone, especially in frontal regions. WMH loads correlated well with the average visual rating scores (e.g. Kendall's tau [Volume, Scheltens]=0.59 CI=[0.53 0.62]). Local correlations allowed comparison of loading patterns between scales and between raters. Regional measurements had more predictive power than global WMH burden (e.g. frontal caps prediction with local features: ICC=0.67 CI=[0.53 0.77], global volume=0.50 CI=[0.32 0.65], intra-rater=0.44 CI=[0.23 0.60]). CONCLUSION Regional-zonal representation of WMH burden highlights similarities and differences between visual rating scales and raters. The bullseye infographic tool provides a simple visual representation of regional lesion load that can be used for rater calibration and training.
Collapse
Affiliation(s)
- C H Sudre
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - B Gomez Anson
- Santa Creu i Sant Pau Hospital, Universitat Autonòma Barcelona, 08041 Barcelona, Spain.
| | - I Davagnanam
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - A Schmitt
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK.
| | - A F Mendelson
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK.
| | - F Prados
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK.
| | - L Smith
- Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK.
| | - D Atkinson
- Centre for Medical Imaging, UCL Faculty of Medical Science, NW1 2PG London, UK.
| | - A D Hughes
- Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK.
| | - N Chaturvedi
- Cardiometabolic Phenotyping Group, UCL Institute of Cardiovascular Science, W1CE 6HX London, UK.
| | - M J Cardoso
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - F Barkhof
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - H R Jaeger
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, Queen Square, WCN1 3BG London, UK; Brain Repair and Rehabilitation, UCL Institute of Neurology, WC1N 3BG London, UK.
| | - S Ourselin
- Translational Imaging Group, CMIC, Department of Medical Physics and Biomedical Engineering, University College London, Room 8.04 8th floor Malet Place Engineering Building, 2, Malet Place, WC1E 7JE London, UK; Dementia Research Centre, UCL Institute of Neurology, WC1N 3BG London, UK.
| |
Collapse
|
4
|
|
5
|
Meisterernst J, Klinger-Gratz PP, Leidolt L, Lang MF, Schroth G, Mordasini P, Heldner MR, Mono ML, Kurmann R, Buehlmann M, Fischer U, Arnold M, Gralla J, Mattle HP, El-Koussy M, Jung S. Focal T2 and FLAIR hyperintensities within the infarcted area: A suitable marker for patient selection for treatment? PLoS One 2017; 12:e0185158. [PMID: 28957339 PMCID: PMC5619762 DOI: 10.1371/journal.pone.0185158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/07/2017] [Indexed: 12/03/2022] Open
Abstract
Background and purpose Some authors use FLAIR imaging to select patients for stroke treatment. However, the effect of hyperintensity on FLAIR images on outcome and bleeding has been addressed in only few studies with conflicting results. Methods 466 patients with anterior circulation strokes were included in this study. They all were examined with MRI before intravenous or endovascular treatment. Baseline data and 3 months outcome were recorded prospectively. Focal T2 and FLAIR hyperintensities within the ischemic lesion were evaluated by two raters, and the PROACT II classification was applied to assess bleeding complications on follow up imaging. Logistic regression analysis was used to determine predictors of bleeding complications and outcome and to analyze the influence of T2 or FLAIR hyperintensity on outcome. Results Focal hyperintensities were found in 142 of 307 (46.3%) patients with T2 weighted imaging and in 89 of 159 (56%) patients with FLAIR imaging. Hyperintensity in the basal ganglia, especially in the lentiform nucleus, on T2 weighted imaging was the only independent predictor of any bleeding after reperfusion treatment (33.8% in patients with vs. 18.2% in those without; p = 0.003) and there was a non-significant trend for more bleedings in patients with FLAIR hyperintensity within the basal ganglia (p = 0.069). However, there was no association of hyperintensity on T2 weighted or FLAIR images and symptomatic bleeding or worse outcome. Conclusion Our results question the assumption that T2 or FLAIR hyperintensities within the ischemic lesion should be used to exclude patients from reperfusion therapy, especially not from endovascular treatment.
Collapse
Affiliation(s)
- Julia Meisterernst
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Pascal P. Klinger-Gratz
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- Department of Radiology, University Hospital of Basel, University of Basel, Basel, Switzerland
| | - Lars Leidolt
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Matthias F. Lang
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gerhard Schroth
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Mirjam R. Heldner
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marie-Luise Mono
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Rebekka Kurmann
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Monika Buehlmann
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marwan El-Koussy
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- * E-mail:
| |
Collapse
|
6
|
Emergent vs. elective stenting of carotid stenosis with intraluminal carotid thrombus. J Neuroradiol 2017; 44:254-261. [DOI: 10.1016/j.neurad.2017.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/12/2017] [Accepted: 02/09/2017] [Indexed: 11/20/2022]
|
7
|
Temporal evolution of the signal intensity of hyper-acute ischemic lesions in a canine stroke model: influence of hyperintense acute reperfusion marker. Jpn J Radiol 2017; 35:161-167. [DOI: 10.1007/s11604-017-0615-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
|
8
|
Lucatelli P, Montisci R, Sanfilippo R, Sacconi B, Suri JS, Catalano C, Saba L. Is there an association between leukoaraiosis volume and diabetes? J Neuroradiol 2016; 43:273-9. [DOI: 10.1016/j.neurad.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
|