1
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Hernandez Petzsche MR, Bürkle J, Hoffmann G, Zimmer C, Rühling S, Schwarting J, Wunderlich S, Maegerlein C, Boeckh-Behrens T, Kaczmarz S, Berndt-Mück M, Sollmann N. Cerebral blood flow from arterial spin labeling as an imaging biomarker of outcome after endovascular therapy for ischemic stroke. J Cereb Blood Flow Metab 2024:271678X241267066. [PMID: 39364671 DOI: 10.1177/0271678x241267066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Arterial spin labeling (ASL) is a contrast agent-free magnetic resonance imaging (MRI) technique to measure cerebral blood flow (CBF). We sought to investigate effects of CBF within the infarct on outcome and risk of hemorrhagic transformation (HT). In 111 patients (median age: 74 years, 50 men) who had undergone mechanical thrombectomy (MT) for ischemic stroke of the anterior circulation (median interval: 4 days between MT and MRI), post-stroke %CBF difference from pseudo-continuous ASL was calculated within the diffusion-weighted imaging (DWI)-positive infarct territory following lesion segmentation in relationship to the unaffected contralateral side. Functional independence was defined as a modified Rankin Scale (mRS) of 0-2 at 90 days post-stroke. %CBF difference, pre-stroke mRS, and infarct volume were independently associated with functional independence in a multivariate regression model. %CBF difference was comparable between patients with and without HT. A subcohort of 10 patients with decreased infarct-CBF despite expanded Treatment in Cerebral Infarction (eTICI) 2c or 3 recanalization was identified (likely related to the no-reflow phenomenon). Outcome was significantly worse in this group compared to the remaining cohort. In conclusion, ASL-derived %CBF difference from the DWI-positive infarct territory independently predicted functional independence, but %CBF difference was not significantly associated with an increased risk of HT.
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Affiliation(s)
- Moritz R Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johannes Bürkle
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gabriel Hoffmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Rühling
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Schwarting
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stefan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Philips GmbH Market DACH, Hamburg, Germany
| | - Maria Berndt-Mück
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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2
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Linninger AA, Ventimiglia T, Jamshidi M, Pascal Suisse M, Alaraj A, Lesage F, Li X, Schwartz DL, Rooney WD. Vascular synthesis based on hemodynamic efficiency principle recapitulates measured cerebral circulation properties in the human brain. J Cereb Blood Flow Metab 2024; 44:801-816. [PMID: 37988131 PMCID: PMC11197140 DOI: 10.1177/0271678x231214840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/20/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023]
Abstract
Quantifying anatomical and hemodynamical properties of the brain vasculature in vivo is difficult due to limited spatiotemporal resolution neuroimaging, variability between subjects, and bias between acquisition techniques. This work introduces a metabolically inspired vascular synthesis algorithm for creating a digital representation of the cortical blood supply in humans. Spatial organization and segment resistances of a cortical vascular network were generated. Cortical folding and macroscale arterial and venous vessels were reconstructed from anatomical MRI and MR angiography. The remaining network, including ensembles representing the parenchymal capillary bed, were synthesized following a mechanistic principle based on hydrodynamic efficiency of the cortical blood supply. We evaluated the digital model by comparing its simulated values with in vivo healthy human brain measurements of macrovessel blood velocity from phase contrast MRI and capillary bed transit times and bolus arrival times from dynamic susceptibility contrast. We find that measured and simulated values reasonably agree and that relevant neuroimaging observables can be recapitulated in silico. This work provides a basis for describing and testing quantitative aspects of the cerebrovascular circulation that are not directly observable. Future applications of such digital brains include the investigation of the organ-wide effects of simulated vascular and metabolic pathologies.
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Affiliation(s)
- Andreas A Linninger
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Thomas Ventimiglia
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Mohammad Jamshidi
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Mathieu Pascal Suisse
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Frédéric Lesage
- Department of Electrical Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Xin Li
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
| | - Daniel L Schwartz
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR, USA
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
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Zhang Y, Peng J, Zeng D, Xie Q, Li S, Bian Z, Wang Y, Zhang Y, Zhao Q, Zhang H, Liang Z, Lu H, Meng D, Ma J. Contrast-Medium Anisotropy-Aware Tensor Total Variation Model for Robust Cerebral Perfusion CT Reconstruction with Low-Dose Scans. IEEE TRANSACTIONS ON COMPUTATIONAL IMAGING 2020; 6:1375-1388. [PMID: 33313342 PMCID: PMC7731921 DOI: 10.1109/tci.2020.3023598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Perfusion computed tomography (PCT) is critical in detecting cerebral ischemic lesions. PCT examination with low-dose scans can effectively reduce radiation exposure to patients at the cost of degraded images with severe noise and artifacts. Tensor total variation (TTV) models are powerful tools that can encode the regional continuous structures underlying a PCT object. In a TTV model, the sparsity structures of the contrast-medium concentration (CMC) across PCT frames are assumed to be isotropic with identical and independent distribution. However, this assumption is inconsistent with practical PCT tasks wherein the sparsity has evident variations and correlations. Such modeling deviation hampers the performance of TTV-based PCT reconstructions. To address this issue, we developed a novel contrast-medium anisotropy-aware tensor total variation (CMAA-TTV) model to describe the intrinsic anisotropy sparsity of the CMC in PCT imaging tasks. Instead of directly on the difference matrices, the CMAA-TTV model characterizes sparsity on a low-rank subspace of the difference matrices which are calculated from the input data adaptively, thus naturally encoding the intrinsic variant and correlated anisotropy sparsity structures of the CMC. We further proposed a robust and efficient PCT reconstruction algorithm to improve low-dose PCT reconstruction performance using the CMAA-TTV model. Experimental studies using a digital brain perfusion phantom, patient data with low-dose simulation and clinical patient data were performed to validate the effectiveness of the presented algorithm. The results demonstrate that the CMAA-TTV algorithm can achieve noticeable improvements over state-of-the-art methods in low-dose PCT reconstruction tasks.
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Affiliation(s)
- Yuanke Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China, and also with the School of Information Science and Engineering, Qufu Normal University, Rizhao 276826, China
| | - Jiangjun Peng
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, China
| | - Dong Zeng
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Qi Xie
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, China
| | - Sui Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Zhaoying Bian
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Yongbo Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
| | - Yong Zhang
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, China
| | - Qian Zhao
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, China
| | - Hao Zhang
- Department of Radiation Oncology, Stanford University, Stanford, CA 94305, USA
| | - Zhengrong Liang
- Departments of Radiology and Biomedical Engineering, State University of New York at Stony Brook, NY 11794, USA
| | - Hongbing Lu
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an 710032, China
| | - Deyu Meng
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an 710049, China
| | - Jianhua Ma
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China
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Langel C, Popovic KS. Infarct-core CT perfusion parameters in predicting post-thrombolysis hemorrhagic transformation of acute ischemic stroke. Radiol Oncol 2019; 53:25-30. [PMID: 30864425 PMCID: PMC6411018 DOI: 10.2478/raon-2018-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/11/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) is the method of choice in reperfusion treatment of patients with signs and symptoms of acute ischemic stroke (AIS) lasting less than 4.5 hours. Hemorrhagic transformation (HT) of acute ischemic stroke is a serious complication of IVT and occurs in 4.5-68.0% of clinical cases. The aim of our study was to determine the infarct core CT perfusion parameter (CTPP) most predictive of HT. PATIENTS AND METHODS Seventy-five patients with AIS who had undergone CT perfusion (CTP) imaging and were treated with IVT were enrolled in this retrospective study. Patients with and without HT after IVT were defined as cases and controls, respectively. Controls were found by matching for time from AIS symptom onset to IVT ± 0.5 h. The following CTPPs were measured: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), relative CBF (rCBF) and relative CBV (rCBV). Receiver operating characteristic analysis curves of significant CTPPs determined cut-off values that best predict HT. RESULTS There was a significant difference between cases and controls for CBF (p = 0.004), CBV (p = 0.009), rCBF (p < 0.001) and rCBV (p = 0.001). Receiver operating characteristic analysis revealed that rCBF < 4.5% of the contralateral mean (area under the curve = 0.736) allowed prediction of HT with a sensitivity of 71.0% and specificity of 52.5%. CONCLUSIONS CTP imaging has a considerable role in HT prediction, assisting in selection of patients that are likely to benefit from IVT. rCBF proved to have the highest HT predictive value.
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Affiliation(s)
- Crt Langel
- Novo Mesto General Hospital, Novo MestoSlovenia
| | - Katarina Surlan Popovic
- Institute of Radiology, University Medical Centre Ljubljana, LjubljanaSlovenia
- Assoc. Prof. Šurlan Popović Katarina, M.D., Ph.D., Institute of Radiology, University Medical Centre Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia. Phone: +386 1 522 85 30
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5
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Öman O, Mäkelä T, Salli E, Savolainen S, Kangasniemi M. 3D convolutional neural networks applied to CT angiography in the detection of acute ischemic stroke. Eur Radiol Exp 2019; 3:8. [PMID: 30758694 PMCID: PMC6374492 DOI: 10.1186/s41747-019-0085-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/04/2019] [Indexed: 12/23/2022] Open
Abstract
Background The aim of this study was to investigate the feasibility of ischemic stroke detection from computed tomography angiography source images (CTA-SI) using three-dimensional convolutional neural networks. Methods CTA-SI of 60 patients with a suspected acute ischemic stroke of the middle cerebral artery were randomly selected for this study; 30 patients were used in the neural network training, and the subsequent testing was performed using the remaining 30 patients. The training and testing were based on manually segmented lesions. Cerebral hemispheric comparison CTA and non-contrast computed tomography (NCCT) were studied as additional input features. Results All ischemic lesions in the testing data were correctly lateralized, and a high correspondence to manual segmentations was achieved. Patients with a diagnosed stroke had clinically relevant regions labeled infarcted with a 0.93 sensitivity and 0.82 specificity. The highest achieved voxel-wise area under receiver operating characteristic curve was 0.93, and the highest Dice similarity coefficient was 0.61. When cerebral hemispheric comparison was used as an input feature, the algorithm performance improved. Only a slight effect was seen when NCCT was included. Conclusion The results support the hypothesis that an acute ischemic stroke lesion can be detected with 3D convolutional neural network-based software from CTA-SI. Utilizing information from the contralateral hemisphere appears to be beneficial for reducing false positive findings.
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Affiliation(s)
- Olli Öman
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340 (Haartmaninkatu 4), FI-00290, Helsinki, Finland.
| | - Teemu Mäkelä
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340 (Haartmaninkatu 4), FI-00290, Helsinki, Finland.,Department of Physics, University of Helsinki, P.O. Box 64, FI-00014, Helsinki, Finland
| | - Eero Salli
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340 (Haartmaninkatu 4), FI-00290, Helsinki, Finland
| | - Sauli Savolainen
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340 (Haartmaninkatu 4), FI-00290, Helsinki, Finland.,Department of Physics, University of Helsinki, P.O. Box 64, FI-00014, Helsinki, Finland
| | - Marko Kangasniemi
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340 (Haartmaninkatu 4), FI-00290, Helsinki, Finland
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6
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Abstract
Recent rapid advances in endovascular treatment for acute ischemic stroke highlight the crucial role of neuroimaging especially multimodal computed tomography (CT) including CT perfusion in stroke triage and management decisions. With an increasing focus on changes in cerebral physiology along with time-based matrices in clinical decisions for acute ischemic stroke, CT perfusion provides a rapid and practical modality for assessment and identification of salvageable tissue at risk and infarct core and provides a better understanding of the changes in cerebral physiology. Although there are challenges with the lack of standardization and accuracy of quantitative assessment, CT perfusion is evolving as a cornerstone for imaging-based strategies in the rapid management of acute ischemic stroke.
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Affiliation(s)
- Pradeep Krishnan
- *Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre †Diagnostic Imaging, The Hospital for Sick Children ‡Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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7
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Hage ZA, Alaraj A, Arnone GD, Charbel FT. Novel imaging approaches to cerebrovascular disease. Transl Res 2016; 175:54-75. [PMID: 27094991 DOI: 10.1016/j.trsl.2016.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 11/19/2022]
Abstract
Imaging techniques available to the physician treating neurovascular disease have substantially grown over the past several decades. New techniques as well as advances in imaging modalities continuously develop and provide an extensive array of modalities to diagnose, characterize, and understand neurovascular pathology. Modern noninvasive neurovascular imaging is generally based on computed tomography (CT), magnetic resonance (MR) imaging, or nuclear imaging and includes CT angiography, CT perfusion, xenon-enhanced CT, single-photon emission CT, positron emission tomography, magnetic resonance angiography, MR perfusion, functional magnetic resonance imaging with global and regional blood oxygen level dependent imaging, and magnetic resonance angiography with the use of the noninvasive optional vessel analysis software (River Forest, Ill). In addition to a brief overview of the technique, this review article discusses the clinical indications, advantages, and disadvantages of each of those modalities.
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Affiliation(s)
- Ziad A Hage
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Gregory D Arnone
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Ill, USA.
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8
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Wood RP, Khobragade P, Ying L, Snyder K, Wack D, Bednarek DR, Rudin S, Ionita CN. Initial testing of a 3D printed perfusion phantom using digital subtraction angiography. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2015; 9417. [PMID: 26633914 DOI: 10.1117/12.2081471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Perfusion imaging is the most applied modality for the assessment of acute stroke. Parameters such as Cerebral Blood Flow (CBF), Cerebral Blood volume (CBV) and Mean Transit Time (MTT) are used to distinguish the tissue infarct core and ischemic penumbra. Due to lack of standardization these parameters vary significantly between vendors and software even when provided with the same data set. There is a critical need to standardize the systems and make them more reliable. We have designed a uniform phantom to test and verify the perfusion systems. We implemented a flow loop with different flow rates (250, 300, 350 ml/min) and injected the same amount of contrast. The images of the phantom were acquired using a Digital Angiographic system. Since this phantom is uniform, projection images obtained using DSA is sufficient for initial validation. To validate the phantom we measured the contrast concentration at three regions of interest (arterial input, venous output, perfused area) and derived time density curves (TDC). We then calculated the maximum slope, area under the TDCs and flow. The maximum slope calculations were linearly increasing with increase in flow rate, the area under the curve decreases with increase in flow rate. There was 25% error between the calculated flow and measured flow. The derived TDCs were clinically relevant and the calculated flow, maximum slope and areas under the curve were sensitive to the measured flow. We have created a systematic way to calibrate existing perfusion systems and assess their reliability.
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Affiliation(s)
- Rachel P Wood
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY ; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
| | - Parag Khobragade
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY ; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
| | - Leslie Ying
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY
| | - Kenneth Snyder
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY ; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
| | - David Wack
- Department of Nuclear Medicine, State University of New York at Buffalo, Buffalo, NY
| | - Daniel R Bednarek
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY ; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
| | - Stephen Rudin
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY ; Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY ; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
| | - Ciprian N Ionita
- Department of Biomedical Engineering, State University of New York at Buffalo, Buffalo, NY ; Department of Neurosurgery, State University of New York at Buffalo, Buffalo, NY ; Toshiba Stroke and Vascular Research Center, State University of New York at Buffalo, Buffalo, NY
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9
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Delay-sensitive and delay-insensitive deconvolution perfusion-CT: similar ischemic core and penumbra volumes if appropriate threshold selected for each. Neuroradiology 2015; 57:573-81. [DOI: 10.1007/s00234-015-1507-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
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10
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Perfusion CT and acute stroke imaging: Foundations, applications, and literature review. J Neuroradiol 2015; 42:21-9. [DOI: 10.1016/j.neurad.2014.11.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
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11
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Hana T, Iwama J, Yokosako S, Yoshimura C, Arai N, Kuroi Y, Koseki H, Akiyama M, Hirota K, Ohbuchi H, Hagiwara S, Tani S, Sasahara A, Kasuya H. Sensitivity of CT perfusion for the diagnosis of cerebral infarction. THE JOURNAL OF MEDICAL INVESTIGATION 2014; 61:41-5. [DOI: 10.2152/jmi.61.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Taijun Hana
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Junya Iwama
- Department of Neurosurgery, Toho University Ohashi Medical Center
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Chika Yoshimura
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Naoyuki Arai
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Yasuhiro Kuroi
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Hirokazu Koseki
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Mami Akiyama
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Kengo Hirota
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Hidenori Ohbuchi
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Shinji Hagiwara
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Shigeru Tani
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Atsushi Sasahara
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Tokyo Women’s Medical University Medical Center East
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Neurologic complications of catheter ablation/defibrillators/pacemakers. HANDBOOK OF CLINICAL NEUROLOGY 2013. [PMID: 24365294 DOI: 10.1016/b978-0-7020-4086-3.00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Approaches to the management of patients with cardiac arrhythmias have significantly evolved over the last decade, with advancement in catheter ablation and device implantation techniques. As the techniques and tools evolve, so does our understanding of the possible complications from these procedures. The focus of this chapter is discussion of the neurologic complications involved with catheter ablation, pacemaker and defibrillation implantation, with the focus on timely diagnosis, and management strategies.
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13
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Menon BK, Demchuk AM. Computed Tomography Angiography in the Assessment of Patients With Stroke/TIA. Neurohospitalist 2013; 1:187-99. [PMID: 23983855 DOI: 10.1177/1941874411418523] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Rapid advance in medical technology has resulted in the availability of numerous tests and treatment strategies in the management of acute stroke. The increasingly evidence-based context of clinical medicine necessitates that clinicians use only appropriate tools to facilitate the diagnostic process and patient management. In this review, we seek to explore the use of computed tomography angiography (CTA) in the diagnosis and management of patients presenting with acute stroke (ischemic and hemorrhagic) or transient ischemic attack (TIA). We present evidence in favor of the use of CTA, highlight the disadvantages of this imaging modality, and present a heuristic model based on our experience at utilizing CTA for decision making in acute stroke and TIAs.
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Affiliation(s)
- Bijoy K Menon
- Department of Clinical Neurosciences, University of Calgary, Calgary Stroke Program, Calgary, Canada
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14
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Kamalian S, Kamalian S, Pomerantz SR, Tanpitukpongse TP, Gupta R, Romero JM, Katz DS. Role of cardiac and extracranial vascular CT in the evaluation/management of cerebral ischemia and stroke. Emerg Radiol 2013; 20:417-28. [DOI: 10.1007/s10140-013-1116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/03/2013] [Indexed: 01/09/2023]
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15
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Calleja AI, Cortijo E, García-Bermejo P, Gómez RD, Pérez-Fernández S, Del Monte JM, Muñoz MF, Fernández-Herranz R, Arenillas JF. Collateral circulation on perfusion-computed tomography-source images predicts the response to stroke intravenous thrombolysis. Eur J Neurol 2012; 20:795-802. [PMID: 23278976 DOI: 10.1111/ene.12063] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 11/01/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Perfusion-computed tomography-source images (PCT-SI) may allow a dynamic assessment of leptomeningeal collateral arteries (LMC) filling and emptying in middle cerebral artery (MCA) ischaemic stroke. We described a regional LMC scale on PCT-SI and hypothesized that a higher collateral score would predict a better response to intravenous (iv) thrombolysis. METHODS We studied consecutive ischaemic stroke patients with an acute MCA occlusion documented by transcranial Doppler/transcranial color-coded duplex, treated with iv thrombolysis who underwent PCT prior to treatment. Readers evaluated PCT-SI in a blinded fashion to assess LMC within the hypoperfused MCA territory. LMC scored as follows: 0, absence of vessels; 1, collateral supply filling ≤ 50%; 2, between> 50% and < 100%; 3, equal or more prominent when compared with the unaffected hemisphere. The scale was divided into good (scores 2-3) vs. poor (scores 0-1) collaterals. The predetermined primary end-point was a good 3-month functional outcome, while early neurological recovery, transcranial duplex-assessed 24-h MCA recanalization, 24-h hypodensity volume and hemorrhagic transformation were considered secondary end-points. RESULTS Fifty-four patients were included (55.5% women, median NIHSS 10), and 4-13-23-14 patients had LMC score (LMCs) of 0-1-2-3, respectively. The probability of a good long-term outcome augmented gradually with increasing LMCs: (0) 0%; (1) 15.4%; (2) 65.2%; (3) 64.3%, P = 0.004. Good-LMCs was independently associated with a good outcome [OR 21.02 (95% CI 2.23-197.75), P = 0.008]. Patients with good LMCs had better early neurological recovery (P = 0.001), smaller hypodensity volumes (P < 0.001) and a clear trend towards a higher recanalization rate. CONCLUSIONS A higher degree of LMC assessed by PCT-SI predicts good response to iv thrombolysis in MCA ischaemic stroke patients.
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Affiliation(s)
- A I Calleja
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Valladolid, Spain.
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Abstract
Computed tomographic perfusion (CTP) imaging is an advanced modality that provides important information about capillary-level hemodynamics of the brain parenchyma. CTP can aid in diagnosis, management, and prognosis of acute stroke patients by clarifying acute cerebral physiology and hemodynamic status, including distinguishing severely hypoperfused but potentially salvageable tissue from both tissue likely to be irreversibly infarcted ("core") and hypoperfused but metabolically stable tissue ("benign oligemia"). A qualitative estimate of the presence and degree of ischemia is typically required for guiding clinical management. Radiation dose issues with CTP imaging, a topic of much current concern, are also addressed in this review.
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Affiliation(s)
- Angelos A Konstas
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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17
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Menon BK, Smith EE, Modi J, Patel SK, Bhatia R, Watson TWJ, Hill MD, Demchuk AM, Goyal M. Regional leptomeningeal score on CT angiography predicts clinical and imaging outcomes in patients with acute anterior circulation occlusions. AJNR Am J Neuroradiol 2011; 32:1640-5. [PMID: 21799045 DOI: 10.3174/ajnr.a2564] [Citation(s) in RCA: 254] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The regional leptomeningeal score is a strong and reliable imaging predictor of good clinical outcomes in acute anterior circulation ischemic strokes and can therefore be used for imaging based patient selection. Efforts to determine biological determinants of collateral status are needed if techniques to alter collateral behavior and extend time windows are to succeed. MATERIALS AND METHODS This was a retrospective Institutional Review Board-approved study of patients with acute ischemic stroke and M1 middle cerebral artery+/- intracranial internal carotid artery occlusion at our center from 2003 to 2009. The rLMC score is based on scoring pial and lenticulostriate arteries (0, no; 1, less; 2, equal or more prominent compared with matching region in opposite hemisphere) in 6 ASPECTS regions (M1-6) plus anterior cerebral artery region and basal ganglia. Pial arteries in the Sylvian sulcus are scored 0, 2, or 4. Good clinical outcome was defined as mRS ≤ 2 at 90 days. RESULTS The analysis included 138 patients: 37.6% had a good (17-20), 40.5% a medium (11-16), and 21.7% a poor (0-10) rLMC score. Interrater reliability was high, with an intraclass correlation coefficient of 0.87 (95% CI, 0.77%-0.95%). On univariate analysis, no single vascular risk factor was associated with the presence of poor rLMCs (P ≥ .20 for all comparisons). In multivariable analysis, the rLMC score (good versus poor: OR, 16.7; 95% CI, 2.9%-97.4%; medium versus poor: OR, 9.2, 95% CI, 1.7%-50.6%), age (< 80 years), baseline ASPECTS (≥ 8), and clot burden score (≥ 8) were independent predictors of good clinical outcome. CONCLUSIONS The rLMC score is a strong imaging parameter on CT angiography for predicting clinical outcomes in patients with acute ischemic strokes.
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Affiliation(s)
- B K Menon
- Department of Clinical Neuroscience, University of Calgary, Calgary, Alberta, Canada
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18
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Bhatia R, Bal SS, Shobha N, Menon BK, Tymchuk S, Puetz V, Dzialowski I, Coutts SB, Goyal M, Barber PA, Watson T, Smith EE, Demchuk AM. CT Angiographic Source Images Predict Outcome and Final Infarct Volume Better Than Noncontrast CT in Proximal Vascular Occlusions. Stroke 2011; 42:1575-80. [DOI: 10.1161/strokeaha.110.603936] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Alberta Stroke Programme Early CT Score (ASPECTS) is widely used for assessment of early ischemic changes in acute stroke. We hypothesized that CT angiography source image (CTA-SI) ASPECTS correlates better with baseline National Institutes of Health Stroke Scale score, final ASPECTS and neurological outcomes when compared with noncontrast CT ASPECTS.
Methods—
We studied patients presenting with acute ischemic stroke and identified proximal arterial occlusions (internal carotid artery, middle cerebral artery M1, and proximal middle cerebral artery M2) from the Calgary CT Angiography database. CT scans were independently read by 3 observers for baseline noncontrast CT ASPECTS, CT angiography source image ASPECTS, and follow-up ASPECTS. Details of demographics and risk factors were noted. A modified Rankin Scale score ≤2 at 3 months was considered a favorable outcome.
Results—
We identified 261 patients with proximal occlusions for analysis. We found a better correlation between CT angiography source image ASPECTS and follow-up ASPECTS (Spearman correlation coefficient
r
=0.65; 95% CI, 0.58 to 0.72;
P
<0.001) than between noncontrast CT ASPECTS and follow-up CT ASPECTS (
r
=0.46; 95% CI, 0.36 to 0.55;
P
<0.001). CT angiography source image ASPECTS correlated better with baseline National Institutes of Health Stroke Scale and 24-hour National Institutes of Health Stroke Scale when compared with noncontrast CT ASPECTS (
P
<0.001). In an adjusted model including both CT angiography source image ASPECTS and noncontrast CT ASPECTS, CT angiography source image ASPECTS was associated with good outcome (OR, 2.30; 95%, CI, 1.16 to 4.53), whereas noncontrast CT ASPECTS was not (OR, 1.54; 95% CI, 0.84 to 2.82). Among imaging parameters, CT angiography source image ASPECTS was the only independent predictor of good outcome (OR, 2.29; 95% CI, 1.16 to 4.53).
Conclusions—
CT angiography source image ASPECTS correlates better with baseline stroke severity, is a better predictor of final infarct extension, and independently predicts neurological outcome than noncontrast CT ASPECTS.
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Affiliation(s)
- Rohit Bhatia
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Simerpreet S. Bal
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Nandavar Shobha
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Bijoy K. Menon
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Sarah Tymchuk
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Volker Puetz
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Imanuel Dzialowski
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Shelagh B. Coutts
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Mayank Goyal
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Philip A. Barber
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Tim Watson
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Eric E. Smith
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
| | - Andrew M. Demchuk
- From the Department of Neurology (R.B.), All India Institute of Medical Sciences, New Delhi, India; the Departments of Clinical Neurosciences (S.S.B., B.K.M., S.T., S.B.C., M.G., P.A.B., T.W., E.E.S., A.M.D.), and Radiology (S.B.C., E.E.S., A.M.D.), University of Calgary, Calgary, Alberta, Canada; Bangalore Neuro Centre (N.S.), Kanva Diagnostic Centre, Vagus Super Speciality Hospital, Manipal Northside Hospital, Bhagwan Mahaveer Jain Hospital, Bangalore, India; and the Department of Neurology (V.P.,
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Kamalian S, Kamalian S, Maas MB, Goldmacher GV, Payabvash S, Akbar A, Schaefer PW, Furie KL, Gonzalez RG, Lev MH. CT cerebral blood flow maps optimally correlate with admission diffusion-weighted imaging in acute stroke but thresholds vary by postprocessing platform. Stroke 2011; 42:1923-8. [PMID: 21546490 DOI: 10.1161/strokeaha.110.610618] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Admission infarct core lesion size is an important determinant of management and outcome in acute (<9 hours) stroke. Our purposes were to: (1) determine the optimal CT perfusion parameter to define infarct core using various postprocessing platforms; and (2) establish the degree of variability in threshold values between these different platforms. METHODS We evaluated 48 consecutive cases with vessel occlusion and admission CT perfusion and diffusion-weighted imaging within 3 hours of each other. CT perfusion was acquired with a "second-generation" 66-second biphasic cine protocol and postprocessed using "standard" (from 2 vendors, "A-std" and "B-std") and "delay-corrected" (from 1 vendor, "A-dc") commercial software. Receiver operating characteristic curve analysis was performed comparing each CT perfusion parameter-both absolute and normalized to the contralateral uninvolved hemisphere-between infarcted and noninfarcted regions as defined by coregistered diffusion-weighted imaging. RESULTS Cerebral blood flow had the highest accuracy (receiver operating characteristic area under the curve) for all 3 platforms (P<0.01). The maximal areas under the curve for each parameter were: absolute cerebral blood flow 0.88, cerebral blood volume 0.81, and mean transit time 0.82 and relative Cerebral blood flow 0.88, cerebral blood volume 0.83, and mean transit time 0.82. Optimal receiver operating characteristic operating point thresholds varied significantly between different platforms (Friedman test, P<0.01). CONCLUSIONS Admission absolute and normalized "second-generation" cine acquired CT cerebral blood flow lesion volumes correlate more closely with diffusion-weighted imaging-defined infarct core than do those of CT cerebral blood volume or mean transit time. Although limited availability of diffusion-weighted imaging for some patients creates impetus to develop alternative methods of estimating core, the marked variability in quantification among different postprocessing software limits generalizability of parameter map thresholds between platforms.
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Affiliation(s)
- Shahmir Kamalian
- Department of Radiology, Massachusetts General Hospital, Gray B285, 55 Fruit Street, Boston, MA 02114, USA
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20
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Arterial input function placement for accurate CT perfusion map construction in acute stroke. AJR Am J Roentgenol 2010; 194:1330-6. [PMID: 20410422 DOI: 10.2214/ajr.09.2845] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the effect of varying arterial input function (AIF) placement on the qualitative and quantitative CT perfusion parameters. MATERIALS AND METHODS Retrospective analysis of CT perfusion data was performed on 14 acute stroke patients with a proximal middle cerebral artery (MCA) clot. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) maps were constructed using a systematic method by varying only the AIF placement in four positions relative to the MCA clot including proximal and distal to the clot in the ipsilateral and contralateral hemispheres. Two postprocessing software programs were used to evaluate the effect of AIF placement on perfusion parameters using a delay-insensitive deconvolution method compared with a standard deconvolution method. RESULTS One hundred sixty-eight CT perfusion maps were constructed for each software package. Both software programs generated a mean CBF at the infarct core of < 12 mL/100 g/min and a mean CBV of < 2 mL/100 g for AIF placement proximal to the clot in the ipsilateral hemisphere and proximal and distal to the clot in the contralateral hemisphere. For AIF placement distal to the clot in the ipsilateral hemisphere, the mean CBF significantly increased to 17.3 mL/100 g/min with delay-insensitive software and to 19.4 mL/100 g/min with standard software (p < 0.05). The mean MTT was significantly decreased for this AIF position. Furthermore, this AIF position yielded qualitatively different parametric maps, being most pronounced with MTT and CBF. Overall, CBV was least affected by AIF location. CONCLUSION For postprocessing of accurate quantitative CT perfusion maps, laterality of the AIF location is less important than avoiding AIF placement distal to the clot as detected on CT angiography. This pitfall is less severe with deconvolution-based software programs using a delay-insensitive technique than with those using a standard deconvolution method.
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21
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Mukherjee S, Raghavan P, Phillips CD. Computed Tomography Perfusion: Acute Stroke and Beyond. Semin Roentgenol 2010; 45:116-25. [DOI: 10.1053/j.ro.2009.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Konstas AA, Goldmakher GV, Lee TY, Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol 2009; 30:885-92. [PMID: 19299489 DOI: 10.3174/ajnr.a1492] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CT perfusion (CTP) is a functional imaging technique that provides important information about capillary-level hemodynamics of the brain parenchyma and is a natural complement to the strengths of unenhanced CT and CT angiography in the evaluation of acute stroke, vasospasm, and other neurovascular disorders. CTP is critical in determining the extent of irreversibly infarcted brain tissue (infarct "core") and the severely ischemic but potentially salvageable tissue ("penumbra"). This is achieved by generating parametric maps of cerebral blood flow, cerebral blood volume, and mean transit time.
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Affiliation(s)
- A A Konstas
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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23
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Konstas AA, Goldmakher GV, Lee TY, Lev MH. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 1: Theoretic basis. AJNR Am J Neuroradiol 2009; 30:662-8. [PMID: 19270105 DOI: 10.3174/ajnr.a1487] [Citation(s) in RCA: 188] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
CT perfusion (CTP) is a functional imaging technique that provides important information about capillary-level hemodynamics of the brain parenchyma and is a natural complement to the strengths of unenhanced CT and CT angiography in the evaluation of acute stroke, vasospasm, and other neurovascular disorders. CTP is critical in determining the extent of irreversibly infarcted brain tissue (infarct "core") and the severely ischemic but potentially salvageable tissue ("penumbra"). This is achieved by generating parametric maps of cerebral blood flow, cerebral blood volume, and mean transit time.
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Affiliation(s)
- A A Konstas
- Department of Radiology, Massachusetts General Hospital, Boston, Mass. 02114, USA.
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Hakimelahi R, González RG. Neuroimaging of ischemic stroke with CT and MRI: advancing towards physiology-based diagnosis and therapy. Expert Rev Cardiovasc Ther 2009; 7:29-48. [PMID: 19105765 DOI: 10.1586/14779072.7.1.29] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Acute ischemic stroke is the third leading cause of death and the major cause of significant disability in adults in the USA and Europe. The number of patients who are actually treated for acute ischemic stroke is disappointingly low, despite availability of effective treatments. A major obstacle is the short window of time following stroke in which therapies are effective. Modern imaging is able to identify the ischemic penumbra, a key concept in stroke physiology. Evidence is accumulating that identification of a penumbra enhances patient management, resulting in significantly improved outcomes. Moreover, unexpectedly large proportions of patients have a substantial ischemic penumbra beyond the traditional time window and are suitable for therapy. The widespread availability of modern MRI and computed tomography systems presents new opportunities to use physiology to guide ischemic stroke therapy in individual patients. This article suggests an evidence-based alternative to contemporary acute ischemic stroke therapy.
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Affiliation(s)
- Reza Hakimelahi
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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25
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Silvennoinen HM, Hamberg LM, Valanne L, Hunter GJ. Increasing contrast agent concentration improves enhancement in first-pass CT perfusion. AJNR Am J Neuroradiol 2007; 28:1299-303. [PMID: 17698531 PMCID: PMC7977633 DOI: 10.3174/ajnr.a0574] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate whether increasing iodine concentration, at a constant total iodine dose, resulted in better brain tissue opacification in patients with acute stroke symptoms during their evaluation by first-pass CT perfusion (CTP). MATERIALS AND METHODS One hundred two patients presenting to the emergency department within 3 hours of onset of acute stroke symptoms underwent CTP scanning. Three different concentrations of iodinated nonionic contrast material were used (300, 350, or 400 mg/mL). Total iodine dose (15 g) and injection rate (7 mL/s) were kept constant. There were 25, 53, and 19 patients in the different concentration groups, respectively; 5 patients were excluded due to uncorrectable motion artifacts. CTP scanning was performed at the level of the putamen, and data were analyzed by determining peak opacification for normal gray and white matter, arterial input, and venous output. Mean and SD values were calculated, and 3 concentration groups, stratified by region-of-interest location, were compared by using a single-tailed unpaired t test. RESULTS Monotonic increasing peak opacification was observed in all region-of-interest locations. Statistically significant differences were observed between the 300 and 350 mg/mL, 300 and 400 mg/mL, as well as the 350 and 400 mg/mL groups (P<.01) in white matter, gray matter, and the arterial input. Statistical significance was seen in the venous output group between the 300 and 400 mg/mL (P<.005) and 350 and 400 mg/mL (P<.007) groups, but not between the 300 and 350 mg/mL (P=.2) groups. CONCLUSION Increasing contrast concentration improves peak opacification of tissue, suggesting that CTP evaluation of patients with acute stroke is better performed with the highest available concentration contrast agent.
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Affiliation(s)
- H M Silvennoinen
- Department of Radiology-Neuroradiology, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
Due to its widespread availability, computer tomography (CT) scanning continues to be the primary initial imaging modality for assessment of patients with suspected acute stroke. It serves as a screening tool for other structural lesions which can mimic stroke and evaluates for possible hemorrhage prior to potential thrombolytic therapy. Findings seen on the initial CT may also serve as prognostic indicators of patient outcome helping with management decisions. As well, follow-up imaging in the subacute stages of infarct is also valuable for assessment of potential complications such as infarct extension, hemorrhagic transformation (and/or intracranial hemorrhage), and cerebral edema.
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Affiliation(s)
- Bao-Tram Nguyen
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Boston, MA 02139, USA.
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Hana T, Iwama J, Yokosako S, Yoshimura C, Arai N, Kuroi Y, Koseki H, Akiyama M, Hirota K, Ohbuchi H, Hagiwara S, Tani S, Sasahara A, Kasuya H. <b>Sensitivity of CT perfusion for the diagnosis of cerebral </b><b>infarction </b>. THE JOURNAL OF MEDICAL INVESTIGATION 2000. [DOI: 10.2152/jmi.40.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Taijun Hana
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Junya Iwama
- Department of Neurosurgery, Toho University Ohashi Medical Center
| | - Suguru Yokosako
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Chika Yoshimura
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Naoyuki Arai
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Yasuhiro Kuroi
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Hirokazu Koseki
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Mami Akiyama
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Kengo Hirota
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Hidenori Ohbuchi
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Shinji Hagiwara
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Shigeru Tani
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Atsushi Sasahara
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
| | - Hidetoshi Kasuya
- Department of Neurosurgery, Tokyo Women's Medical University Medical Center East
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