1
|
Cheng Y, Wan S, Wu W, Chen F, Jiang J, Cai D, Bao Z, Li Y, Zhang L. Computed Tomography Angiography-Based Thrombus Radiomics for Predicting the Time Since Stroke Onset. Acad Radiol 2023; 30:2469-2476. [PMID: 36697269 DOI: 10.1016/j.acra.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 12/11/2022] [Accepted: 12/18/2022] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES The measurement of the time since stroke onset (TSS) is crucial for decision-making in the treatment of acute ischemic stroke (AIS). This study assessed the utility of computed tomography angiography (CTA) radiomics features (RFs) to estimate TSS. MATERIALS AND METHODS A total of 221 patients with AIS were enrolled in this retrospective study and were divided into a training group (n = 154) and a test group (n = 67). Thrombi in CTA images were manually outlined using ITK-SNAP. Images were aligned, normalized, and pre-processed to extract RFs. The TSS was calculated as the time from stroke onset to CTA completion. The patients were classified into two groups according to estimated TSS: ≤4.5 and >4.5 hours. A total of 944 RFs were extracted from CTA images. Clinical factors associated with TSS were identified using multivariate logistic regression, and a combined model (clinical data and RFs) was constructed. The predictive value of the models was assessed by the area under the receiver operating characteristic curve (AUC). The performance of the models was compared using the DeLong test, and clinical utility was evaluated by decision curve analysis. RESULTS The AUC of the radiomics model was 0.803 (95% confidence interval [CI]: 0.733-0.873) and 0.803 (95% CI: 0.698-0.908) in the training and test cohorts, respectively. The AUC of the combined model (containing data on age, diabetes, and atrial fibrillation) in the training and test sets was 0.813 (95% CI: 0.750-0.889) and 0.803 (95% CI: 0.699-0.907), respectively. The DeLong test showed no significant difference between the radiomics and combined models. Decision curve analysis showed that both models had clinical utility. CONCLUSION CTA-based thrombus radiomics can estimate TSS in patients with AIS. The addition of clinical data to the model does not improve predictive performance.
Collapse
Affiliation(s)
- Yue Cheng
- Department of Radiology, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, Jiangsu, China; Department of Radiology, Wuxi NO.2 People's Hospital, Affiliated Wuxi Clinical College of Nantong University, Wuxi, China
| | - Sunli Wan
- Department of Radiology, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, Jiangsu, China
| | - Wenjuan Wu
- Department of Radiology, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, Jiangsu, China
| | - Fangming Chen
- Department of Radiology, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, Jiangsu, China
| | - Jingxuan Jiang
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongmei Cai
- Department of Radiology, Xishan People's Hospital of Wuxi, Wuxi, China
| | - Zhongyuan Bao
- Department of Radiology, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, Jiangsu, China
| | - Yuehua Li
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Radiology, Wuxi No.2 People's Hospital, Jiangnan University Medical Center, 68 Zhongshan Road, Wuxi, Jiangsu, China.
| |
Collapse
|
2
|
Liu S, Chen T, Wu W. Predictive value of whole-brain CT perfusion combined with ABCD3 score for short-term secondary cerebral infarction after TIA. Front Neurol 2023; 14:1244014. [PMID: 37745657 PMCID: PMC10513042 DOI: 10.3389/fneur.2023.1244014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To investigate the predictive value of Whole Brain CT Perfusion (WB-CTP) combined with the ABCD3 score in patients with transient ischemic attack (TIA). Methods A total of 336 TIA patients with TIA underwent WB-CTP and ABCD3 score assessment within 48 h of admission. Spearman correlation test was performed to analyze the relationship between the degree of vascular stenosis, relative perfusion values, and ABCD3 score. Logistic regression analysis was used to identify independent risk factors for secondary cerebral infarction. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of relative cerebral blood flow (rCBF), degree of vascular stenosis, ABCD3 score, and the WB-CTP-ABCD3 combined model for secondary cerebral infarction after TIA. Calibration curves and H-L tests were used to evaluate the predictive efficacy of the model. Results Among the 336 TIA patients, 143 showed abnormal perfusion areas and 146 had responsible vessel stenosis. The degree of vascular stenosis, relative time-to-maximum (rTmax), and relative mean transit time (rMTT) were positively correlated with the ABCD3 score, while rCBF and relative cerebral blood volume (rCBV) were negatively correlated with the ABCD3 score. ROC curve analysis identified a cutoff value of 0.8205 for rCBF, with a sensitivity of 84.10% and specificity of 58.10% for distinguishing the cerebral infarction group from the non-cerebral infarction group. Furthermore, rCBF ≤ 0.8205, degree of vascular stenosis, and ABCD3 score > 6 were identified as independent risk factors for secondary cerebral infarction in TIA patients within 90 days in TIA patients. The AUC of the WB-CTP-ABCD3 combined model for predicting secondary cerebral infarction within 90 days was 0.836. The model risk was assessed by plotting calibration curves. The value of p for the H-L goodness of fit test was 0.366 (p > 0.05), which indicated that the difference between the obtained model and the perfect model were statistically insignificant. Conclusion The combined model of WB-CTP-ABCD3 shows promise as a valuable method for predicting secondary cerebral infarction within 90 days following TIA.
Collapse
Affiliation(s)
- Shushu Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Medical Imaging, People’s Hospital of Fengjie, Chongqing, China
| | - Ting Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Wu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
3
|
Patil S, Rossi R, Jabrah D, Doyle K. Detection, Diagnosis and Treatment of Acute Ischemic Stroke: Current and Future Perspectives. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:748949. [PMID: 35813155 PMCID: PMC9263220 DOI: 10.3389/fmedt.2022.748949] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Stroke is one of the leading causes of disability worldwide. Early diagnosis and treatment of stroke are important for better clinical outcome. Rapid and accurate diagnosis of stroke subtypes is critical. This review discusses the advantages and disadvantages of the current diagnostic and assessment techniques used in clinical practice, particularly for diagnosing acute ischemic stroke. Alternative techniques for rapid detection of stroke utilizing blood based biomarkers and novel portable devices employing imaging methods such as volumetric impedance phase-shift spectroscopy, microwave tomography and Doppler ultrasound are also discussed. Current therapeutic approaches for treating acute ischemic stroke using thrombolytic drugs and endovascular thrombectomy are discussed, with a focus on devices and approaches recently developed to treat large cranial vessel occlusions.
Collapse
Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Rosanna Rossi
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Duaa Jabrah
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
4
|
Reitz SC, Gerhard E, Breuer S, Bohmann FO, Pfeilschifter W, Berkefeld J. Outcome after Thrombectomy of Acute M1 and Carotid-T Occlusions with Involvement of the Corticospinal Tract in Postinterventional Imaging. J Clin Med 2022; 11:jcm11102823. [PMID: 35628948 PMCID: PMC9145944 DOI: 10.3390/jcm11102823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/14/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Until now, thrombectomy studies have provided little reliable information about the correlation between the infarct topography and clinical outcome of acute stroke patients with embolic large-vessel occlusions. Therefore, we aimed to analyze whether infarcts of the corticospinal tracts in the central white matter (CWM) or the internal capsule on postinterventional imaging controls are associated with poor clinical outcome after thrombectomy. MATERIALS AND METHODS We retrospectively analyzed imaging data from 70 patients who underwent endovascular thrombectomy for emergent middle cerebral artery or carotid-T occlusions. Inclusion criteria were postinterventional infarct demarcation in the regions of the internal capsule, caudate, lentiform nucleus, and CWM. Primary outcome was the mRS after 90 days and secondary endpoints were subgroup analyses regarding additional cortical infarction. CONCLUSIONS In this exploratory study, we found no indication that infarcts in the course of the corticospinal tracts predict poor clinical outcome after successful thrombectomy in patients with embolic carotid-T or M1 occlusions. In our analysis, a significant number of patients showed a favorable 90 day outcome. Additional cortical infarcts may have a greater impact on the risk of an unfavorable outcome. RESULTS Good clinical outcome after 90 days (mRS 0-2) was shown in 36 out of 70 patients (51.4%), with excellent clinical outcome (mRS 0-1) in 23 patients (32.9%). Here, 58.6% patients lived at home without nursing service after 90 days. Patients with minimal additional cortical infarction in postinterventional imaging had a 75.6% better chance of excellent outcome.
Collapse
Affiliation(s)
- Sarah Christina Reitz
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.O.B.); (W.P.)
- Correspondence:
| | - Ellen Gerhard
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (E.G.); (S.B.); (J.B.)
| | - Stella Breuer
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (E.G.); (S.B.); (J.B.)
| | - Ferdinand Oliver Bohmann
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.O.B.); (W.P.)
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (F.O.B.); (W.P.)
- Klinik für Neurologie und Klinische Neurophysiologie, Klinikum Lüneburg, 21339 Lüneburg, Germany
| | - Joachim Berkefeld
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, 60528 Frankfurt am Main, Germany; (E.G.); (S.B.); (J.B.)
| |
Collapse
|
5
|
Fladt J, d'Esterre CD, Joundi R, McDougall C, Gensicke H, Barber P. Acute stroke imaging selection for mechanical thrombectomy in the extended time window: is it time to go back to basics? A review of current evidence. J Neurol Neurosurg Psychiatry 2022; 93:238-245. [PMID: 35115388 DOI: 10.1136/jnnp-2021-328000] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/05/2022] [Indexed: 12/15/2022]
Abstract
Treatment with endovascular therapy in the extended time window for acute ischaemic stroke with large vessel occlusion involves stringent selection criteria based on the two landmark studies DAWN and DEFUSE3. Current protocols typically include the requirement of advanced perfusion imaging which may exclude a substantial proportion of patients from receiving a potentially effective therapy. Efforts to offer endovascular reperfusion therapies to all appropriate candidates may be facilitated by the use of simplified imaging selection paradigms with widely available basic imaging techniques, such as non-contrast CT and CT angiography. Currently available evidence from our literature review suggests that patients meeting simplified imaging selection criteria may benefit as much as those patients selected using advanced imaging techniques (CT perfusion or MRI) from endovascular therapy in the extended time window. A comprehensive understanding of the role of imaging in patient selection is critical to optimising access to endovascular therapy in the extended time window and improving outcomes in acute stroke. This article provides an overview on current developments and future directions in this emerging area.
Collapse
Affiliation(s)
- Joachim Fladt
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Stroke Center and Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Christopher D d'Esterre
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Raed Joundi
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Connor McDougall
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Henrik Gensicke
- Stroke Center and Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Philip Barber
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
6
|
Shen GC, Chu Y, Ma G, Xu XQ, Lu SS, Shi HB, Wu FY. Use of ABC/2 method for rapidly estimating the target mismatch on computed tomography perfusion imaging in patients with acute ischemic stroke. Acta Radiol 2021; 64:320-327. [PMID: 34970928 DOI: 10.1177/02841851211069778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Target mismatch (ischemic core, mismatch volume and mismatch ratio) in patients with acute ischemic stroke (AIS) highly relies on the automated perfusion analysis software. PURPOSE To evaluate the feasibility and accuracy of using the ABC/2 method to rapidly estimate the target mismatch on computed tomography perfusion (CTP) imaging in patients with AIS, using RAPID results as a reference. MATERIAL AND METHODS In total, 243 patients with anterior circulation AIS who underwent CTP imaging were retrospectively reviewed. Target mismatch associated perfusion parameters were derived from RAPID results and calculated using the ABC/2 method. Paired t-test was used to assess the difference of volumetric parameters between the two methods. The ability of using the ABC/2 method to predict the important cutoff volumetric metrics was also evaluated. RESULT There was no significant difference in the volumes of ischemic core (P = 0.068), ischemic area (P = 0.209), and mismatch volume (P = 0.518) between ABC/2 and RAPID. Using RAPID results as reference, the ABC/2 method showed high accuracy for predicting perfusion parameters (70 mL and 90 mL: sensitivity=98.5% and 98.5%, specificity=100% and 100%, positive predictive value [PPV]=100% and 100%, negative predictive value [NPV]=93.8% and 92.9%; 10 mL and 15mL: sensitivity=99.6% and 99.5%, specificity=55.6% and 50.0%, PPV=96.6% and 94.8%, NPV=90.9% and 92.3%; 1.2 and 1.8: sensitivity=99.6% and 94.8%, specificity=75.0% and 96.9%, PPV=98.7% and 99.5%, NPV=90.0% and 73.8%). CONCLUSION The ABC/2 method may be a feasible alternative to RAPID for estimation of target mismatch parameters on CTP in patients with AIS.
Collapse
Affiliation(s)
- Guang-Chen Shen
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yue Chu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Gao Ma
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao-Quan Xu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Shan-Shan Lu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Fei-Yun Wu
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| |
Collapse
|
7
|
Rethinking the Collateral Vasculature Assessment in Acute Ischemic Stroke: The Comprehensive Collateral Cascade. Top Magn Reson Imaging 2021; 30:181-186. [PMID: 34397967 DOI: 10.1097/rmr.0000000000000274] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Occlusion of a cervical or cerebral artery results in disruption of blood flow to the brain and may result in irreversible infarction. Intracranial pial collaterals are a network of arteries that may preserve blood flow to otherwise critically hypoperfused brain areas until vessel recanalization is achieved. The robustness of these arterial collaterals is pivotal for the survivability of ischemic brain tissue and is associated with treatment success and long-term clinical outcome. More recently, the importance of venous outflow from ischemic brain tissue has been appreciated. Arterial collaterals and venous outflow are evaluated by neuroimaging parameters, and recent imaging advances have enabled a more comprehensive assessment of the entire collateral cascade in patients with acute ischemic stroke. Here we review novel imaging biomarkers for the assessment of arterial collaterals, tissue-level collateral blood flow, and venous outflow. We also summarize how a more comprehensive assessment of the cerebral blood flow leads to a better prediction of treatment efficacy and improved clinical outcomes.
Collapse
|
8
|
Affiliation(s)
| | - Manu S Goyal
- Washington University School of Medicine, St. Louis, MO
| | | | | |
Collapse
|
9
|
|