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Herpe G, Platon A, Poletti PA, Lövblad KO, Machi P, Becker M, Muster M, Perneger T, Guillevin R. Dual-Energy CT in Acute Stroke: Could Non-Contrast CT Be Replaced by Virtual Non-Contrast CT? A Feasibility Study. J Clin Med 2024; 13:3647. [PMID: 38999213 PMCID: PMC11242297 DOI: 10.3390/jcm13133647] [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: 06/11/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Purpose: We aimed to evaluate whether virtual non-contrast cerebral computed tomography (VNCCT) reconstructed from intravenous contrast-enhanced dual-energy CT (iv-DECT) could replace non-contrast CT (NCCT) in patients with suspected acute cerebral ischemia. Method: This retrospective study included all consecutive patients in whom NCCT followed by iv-DECT were performed for suspected acute ischemia in our emergency department over a 1-month period. The Alberta Stroke Program Early CT Score (ASPECTS) was used to determine signs of acute ischemia in the anterior and posterior circulation, the presence of hemorrhage, and alternative findings, which were randomly evaluated via the consensus reading of NCCT and VNCCT by two readers blinded to the final diagnosis. An intraclass correlation between VNCCT and NCCT was calculated for the ASPECTS values. Both techniques were evaluated for their ability to detect ischemic lesions (ASPECTS <10) when compared with the final discharge diagnosis (reference standard). Results: Overall, 148 patients (80 men, mean age 64 years) were included, of whom 46 (30%) presented with acute ischemia, 6 (4%) presented with intracerebral hemorrhage, 11 (7%) had an alternative diagnosis, and 85 (59%) had no pathological findings. The intraclass correlation coefficients of the two modalities were 0.97 (0.96-0.98) for the anterior circulation and 0.77 (0.69-0.83) for the posterior circulation. The VNCCT's sensitivity for detecting acute ischemia was higher (41%, 19/46) than that of NCCT (33%, 15/46). Specificity was similar between the two techniques, at 94% (97/103) and 98% (101/103), respectively. Conclusions: Our results show that VNCCT achieved a similar diagnostic performance as NCCT and could, thus, replace NCCT in assessing patients with suspected acute cerebral ischemia.
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Affiliation(s)
- Guillaume Herpe
- Emergency Radiology Unit, Division of Radiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland;
- DACTIM-MIS Lab, I3M, Poitiers University, 86021 Poitiers, France;
| | - Alexandra Platon
- Emergency Radiology Unit, Division of Radiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland;
| | - Pierre-Alexandre Poletti
- Division of Radiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland; (P.-A.P.); (M.B.)
| | - Karl O. Lövblad
- Division of Neuroradiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland; (K.O.L.); (P.M.); (M.M.)
| | - Paolo Machi
- Division of Neuroradiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland; (K.O.L.); (P.M.); (M.M.)
| | - Minerva Becker
- Division of Radiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland; (P.-A.P.); (M.B.)
| | - Michel Muster
- Division of Neuroradiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland; (K.O.L.); (P.M.); (M.M.)
| | - Thomas Perneger
- Division of Clinical Epidemiology, University Hospital of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1205 Geneva, Switzerland;
| | - Rémy Guillevin
- DACTIM-MIS Lab, I3M, Poitiers University, 86021 Poitiers, France;
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Aderinto N, Olatunji D, Abdulbasit M, Edun M. The essential role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa: a review. Ann Med 2023; 55:2251490. [PMID: 37643607 PMCID: PMC10496522 DOI: 10.1080/07853890.2023.2251490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/11/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Cerebrovascular disease is a significant cause of morbidity and mortality in Africa, and using neuroimaging techniques has improved the diagnosis and management of this disease. However, there is a lack of comprehensive reviews of the role and effectiveness of neuroimaging techniques in the African context. METHODS We reviewed the literature to evaluate the role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa. Our search included electronic databases such as PubMed, Scopus, and Google Scholar from 2000 to April 2023. We included peer-reviewed studies written in English that reported on the use of neuroimaging in diagnosing and managing cerebrovascular disease in African populations. We excluded non-peer-reviewed articles, letters, editorials, and studies unrelated to cerebrovascular disease, neuroimaging, or Africa. A total of 102 potential articles were identified; after applying our exclusion criteria and removing duplicated articles, 51 articles were reviewed. RESULTS Our findings suggest that neuroimaging techniques such as CT, MRI, and Skull x-ray play a crucial role in diagnosing and managing cerebrovascular disease in Africa. CT and MRI were the most commonly used techniques, with CT being more widely available and less expensive than MRI. However, challenges to using neuroimaging in Africa include the high cost of equipment and maintenance, lack of trained personnel, and inadequate infrastructure. These challenges limit the widespread use of neuroimaging in diagnosing and managing cerebrovascular disease in Africa. CONCLUSION Neuroimaging techniques are essential for diagnosing and managing cerebrovascular disease in Africa, but challenges to their use must be addressed to improve healthcare outcomes. Our policy recommendations can help improve the availability and accessibility of neuroimaging services in Africa.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Nigeria
| | - Deji Olatunji
- Department of Medicine and Surgery, University of Ilorin, Nigeria
| | - Muili Abdulbasit
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Nigeria
| | - Mariam Edun
- Department of Medicine and Surgery, University of Ilorin, Nigeria
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Chen Z, Shi Z, Lu F, Li L, Li M, Wang S, Wang W, Li Y, Luo Y, Tong D. Validation of two automated ASPECTS software on non-contrast computed tomography scans of patients with acute ischemic stroke. Front Neurol 2023; 14:1170955. [PMID: 37090971 PMCID: PMC10116051 DOI: 10.3389/fneur.2023.1170955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
PurposeThe Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was designed for semi-quantitative assessment of early ischemic changes on non-contrast computed tomography (NCCT) for acute ischemic stroke (AIS). We evaluated two automated ASPECTS software in comparison with reference standard.MethodsNCCT of 276 AIS patients were retrospectively reviewed (March 2018–June 2020). A three-radiologist consensus for ASPECTS was used as reference standard. Imaging data from both baseline and follow-up were evaluated for reference standard. Automated ASPECTS were calculated from baseline NCCT with 1-mm and 5-mm slice thickness, respectively. Agreement between automated ASPECTS and reference standard was assessed using intra-class correlation coefficient (ICC). Correlation of automated ASPECTS with baseline stroke severity (NIHSS) and follow-up ASPECTS were evaluated using Spearman correlation analysis.ResultsIn score-based analysis, automated ASPECTS calculated from 5-mm slice thickness images agreed well with reference standard (software A: ICC = 0.77; software B: ICC = 0.65). Bland–Altman analysis revealed that the mean differences between automated ASPECTS and reference standard were ≤ 0.6. In region-based analysis, automated ASPECTS derived from 5-mm slice thickness images by software A showed higher sensitivity (0.60 vs. 0.54), lower specificity (0.91 vs. 0.94), and higher AUC (0.76 vs. 0.74) than those using 1-mm slice thickness images (p < 0.05). Automated ASPECTS derived from 5-mm slice thickness images by software B showed higher sensitivity (0.56 vs. 0.51), higher specificity (0.87 vs. 0.81), higher accuracy (0.80 vs. 0.73), and higher AUC (0.71 vs. 0.66) than those using 1-mm slice thickness images (p < 0.05). Automated ASPECTS were significantly associated with baseline NIHSS and follow-up ASPECTS.ConclusionAutomated ASPECTS showed good reliability and 5 mm was the optimal slice thickness.
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Affiliation(s)
- Zhongping Chen
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Zhenzhen Shi
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Fei Lu
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Linna Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Mingyang Li
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Shuo Wang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | | | - Yongxin Li
- Neusoft Medical Systems Co., Ltd., Shenyang, Liaoning, China
| | - Yu Luo
- Department of Radiology, Shanghai Fourth People's Hospital, Shanghai, China
| | - Dan Tong
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Dan Tong,
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Doumbouya I, Barry SD, Toure ML, Barry DN, Diawara K, Traoré M, Diallo MH, Cissé FA, Cissé A. Post-stroke Chorea in the Neurology Department of Ignace Deen Hospital of Conakry, Guinea. Cureus 2023; 15:e35515. [PMID: 37007400 PMCID: PMC10051035 DOI: 10.7759/cureus.35515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Chorea is an uncommon complication of stroke. The pathophysiology, the exact location of the lesions, and the evolution of this type of chorea are still poorly understood. The objective was to describe the epidemiological, clinical, and imaging profile of post-stroke chorea in a tropical environment in the context of a stroke epidemic. MATERIAL AND METHODS We conducted a five-year retrospective observational study from 2015 to 2020 on stroke patients who presented with chorea in our department. Epidemiological, clinical, and imaging data were registered. RESULTS Fourteen patients presented with chorea after their stroke, a frequency of 0.6%. The average age was 57.1 years with a male predominance. Hypertension was the cardiovascular risk factor in half of the patients; three patients (21.4) were diabetic. Chorea was the initial manifestation of the stroke in eight patients (57.1%). Thirteen patients (92.9%) had an ischaemic stroke and one had a cerebral haemorrhage. The middle cerebral artery (MCA) was involved in nine patients (64.3%), the anterior cerebral artery (ACA) in three patients (21.4%), and two patients (14.3%) had posterior cerebral artery (PCA) involvement. The lesions were cortical in five patients (35.7%), five other patients (35.7%) had a deep location, and four patients (28.6%) had both deep and cortical locations of their lesions. The structures affected were the lentiform nucleus (50%), the insula (35.7%), the caudate nucleus (14.3%), and the thalamus (14.3%). CONCLUSION Post-stroke chorea is poorly studied in the tropics. In the presence of any acute abnormal movement associated with cardiovascular risk factors, post-stroke chorea should be considered. Recovery is rapid when treated early.
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Cui L, Fan Z, Yang Y, Liu R, Wang D, Feng Y, Lu J, Fan Y. Deep Learning in Ischemic Stroke Imaging Analysis: A Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2456550. [PMID: 36420096 PMCID: PMC9678444 DOI: 10.1155/2022/2456550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/27/2022] [Accepted: 10/20/2022] [Indexed: 09/15/2023]
Abstract
Ischemic stroke is a cerebrovascular disease with a high morbidity and mortality rate, which poses a serious challenge to human health and life. Meanwhile, the management of ischemic stroke remains highly dependent on manual visual analysis of noncontrast computed tomography (CT) or magnetic resonance imaging (MRI). However, artifacts and noise of the equipment as well as the radiologist experience play a significant role on diagnostic accuracy. To overcome these defects, the number of computer-aided diagnostic (CAD) methods for ischemic stroke is increasing substantially during the past decade. Particularly, deep learning models with massive data learning capabilities are recognized as powerful auxiliary tools for the acute intervention and guiding prognosis of ischemic stroke. To select appropriate interventions, facilitate clinical practice, and improve the clinical outcomes of patients, this review firstly surveys the current state-of-the-art deep learning technology. Then, we summarized the major applications in acute ischemic stroke imaging, particularly in exploring the potential function of stroke diagnosis and multimodal prognostication. Finally, we sketched out the current problems and prospects.
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Affiliation(s)
- Liyuan Cui
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhiyuan Fan
- Centre of Intelligent Medical Technology and Equipment, Binjiang Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Yingjian Yang
- School of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Rui Liu
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Dajiang Wang
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yingying Feng
- School of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Jiahui Lu
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yifeng Fan
- School of Medical Imaging, Hangzhou Medical College, Hangzhou, Zhejiang, China
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Laflamme M, Carrondo-Cottin S, Valdès MM, Simonyan D, Audet MÈ, Gariépy JL, Camden MC, Gariépy C, Verreault S, Lavoie P. Association between Early Ischemic Changes and Collaterals in Acute Stroke: A Retrospective Study. AJNR Am J Neuroradiol 2022; 43:1424-1430. [PMID: 36137656 PMCID: PMC9575540 DOI: 10.3174/ajnr.a7632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE The quality of leptomeningeal collaterals may influence the speed of infarct progression in acute stroke. Our main objective was to evaluate the association of leptomeningeal collateral score and its interaction with time with ischemic changes on CT in patients with acute stroke. MATERIALS AND METHODS Adult patients with acute stroke symptoms and anterior circulation large-vessel occlusion on CTA from 2015 to 2019 were included. Routinely performed NCCT and multiphase CTA were reviewed to assess ASPECTS and the leptomeningeal collateral score. We built multivariate regression models to assess the association between leptomeningeal collateral score and its interaction with time and ASPECTS. Performance measures to predict poor ASPECTS at different time thresholds (identified with receiver operating characteristic curve analysis) were estimated in a subgroup of patients with poor leptomeningeal collateral scores. RESULTS Leptomeningeal collateral scores 0-1 were associated with lower ASPECTS, and the model with dichotomized and trichotomized leptomeningeal collateral score showed a significant multiplicative interaction between time and the leptomeningeal collateral score. The negative predictive value for poor ASPECTS was >0.9 for at least the first 3 hours from stroke onset to imaging, and the positive predictive value was <0.5 for every time threshold tested in the subgroup of patients with leptomeningeal collateral scores 0-3. CONCLUSIONS Poor (0-1) leptomeningeal collateral scores were associated with lower ASPECTS, and an increase in time has a multiplicative interaction with the leptomeningeal collateral score on ASPECTS.
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Affiliation(s)
- M Laflamme
- Form the Division of Neurosurgery, Department of Surgery (M.L., C.G., P.L.)
| | - S Carrondo-Cottin
- Department of Neurosciences, Centre Hospitalier Universitaire de Québec -Université Laval Research Center (S.C.C.), Quebec, Canada
| | - M-M Valdès
- Department of Radiology (M.-M.V., M.-È.A, J.-L.G.)
| | - D Simonyan
- Clinical and Evaluative Research Platform (D.S.)
| | - M-È Audet
- Department of Radiology (M.-M.V., M.-È.A, J.-L.G.)
| | - J-L Gariépy
- Department of Radiology (M.-M.V., M.-È.A, J.-L.G.)
| | - M-C Camden
- Division of Neurology, Department of Medicine (M.-C.C., S.V.), Centre Hospitalier Universitaire de Québec -Université Laval, Quebec, Canada
| | - C Gariépy
- Form the Division of Neurosurgery, Department of Surgery (M.L., C.G., P.L.)
| | - S Verreault
- Division of Neurology, Department of Medicine (M.-C.C., S.V.), Centre Hospitalier Universitaire de Québec -Université Laval, Quebec, Canada
| | - P Lavoie
- Form the Division of Neurosurgery, Department of Surgery (M.L., C.G., P.L.)
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Padrick MM, Brown W, Lyden PD. Intravenous Thrombolysis. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liebeskind DS, Saber H, Bhuva P, Xiang B, Yoo AJ, Jadhav AP, Haussen DC, Budzik RF, Bonafe A, Yavagal DR, Hanel RA, Ribo M, Cognard C, Sila C, Hassan AE, Smith WS, Saver JL, Nogueira RG, Jovin TG. Serial ASPECTS in the DAWN Trial: Infarct Evolution and Clinical Impact. Stroke 2021; 52:3318-3324. [PMID: 34281376 DOI: 10.1161/strokeaha.120.033477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The impact of baseline ischemia on Alberta Stroke Program Early CT Score (ASPECTS) and evolution over 24 hours may be distinct in late thrombectomy. We analyzed predictors of serial ASPECTS and clinical outcomes in the DAWN trial (Diffusion-Weighted Imaging or CTP Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo). METHODS The DAWN Imaging Core Laboratory independently scored ASPECTS at baseline and 24 hours. Descriptive statistics characterized ASPECTS on computed tomography/magnetic resonance imaging at baseline and 24 hours, delineating ASPECTS change over 24 hours. RESULTS 206 subjects (mean age 70.0±13.7 years; 54.9% (n=113) female; baseline National Institutes of Health Stroke Scale median (interquartile range) 17 (13, 21) were included. Baseline ASPECTS was median (interquartile range) 8.0 (7-8), with 92/205 (44.9%) between 0 and 7 and 113/205 (55.1%) 8 and 10. 24-hour ASPECTS was median 6.0 (4-8), with ASPECTS change or infarct evolution having median -1, ranging from -8 to +2. Multivariable logistic regression showed older age (odds ratio [OR] for 10-year interval, 1.26 [95% CI, 1.02-1.55], P=0.030) and dyslipidemia (OR, 1.84 [95% CI, 1.06-3.19], P=0.031) were independently associated with higher baseline ASPECTS. Higher 24-hour ASPECTS was predicted by endovascular treatment (OR, 2.76 [95% CI, 1.58-4.81], P=0.0004), baseline glucose <150 mg/dL (OR, 2.86 [95% CI, 1.50-5.46], P=0.001), lower baseline National Institutes of Health Stroke Scale (OR, 0.93 [95% CI, 0.89-0.98], P=0.010), and older age (OR for 10-year interval, 1.25 [95% CI, 1.01-1.55], P=0.041). Internal carotid artery lesion location (OR, 0.47 [95% CI, 0.24-0.89], P=0.021) was inversely related to 24-hour ASPECTS. Good clinical outcome (day 90 modified Rankin Scale score 0-2) was predicted by 24-hour ASPECTS (OR, 1.46 [95% CI, 1.08-1.96], P=0.014). Extensive infarct evolution (ASPECTS decrease ≥6) occurred in 14/201 (7.0%). Elevated baseline serum glucose ≥150 mg/dL was a predictor of ASPECTS decrease of ≥4 points (OR, 2.78 [95% CI, 1.21-6.35] P=0.016) as was internal carotid artery occlusion (OR, 2.49 [95% CI, 1.05-5.88]; P=0.038). ASPECTS change was influenced by treatment arm (P=0.001 by Wilcoxon), including 0 ASPECTS change in 42/105 (40.0%) of the endovascular arm and only 20/96 (20.8%) of the medical arm. CONCLUSIONS DAWN subjects enrolled with small infarct cores had a broad range of baseline ASPECTS. Twenty-four-hour ASPECTS, strikingly influenced by endovascular therapy, predicted good clinical outcomes. REGISTRATION: https://www.clinicaltrials.gov; Unique identifier: NCT02142283.
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Affiliation(s)
- David S Liebeskind
- Neurovascular Imaging Research Core, UCLA, Los Angeles, CA (D.S.L., H.S.)
| | - Hamidreza Saber
- Neurovascular Imaging Research Core, UCLA, Los Angeles, CA (D.S.L., H.S.)
| | - Parita Bhuva
- Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.)
| | - Bin Xiang
- Prospect Analytical, Inc, San Jose, CA (B.X.)
| | - Albert J Yoo
- Texas Stroke Institute, Dallas-Fort Worth (P.B., A.J.Y.)
| | | | - Diogo C Haussen
- Emory University School of Medicine/Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)
| | - Ronald F Budzik
- OhioHealth Riverside Methodist Hospital, Columbus, OH (R.F.B.)
| | - Alain Bonafe
- Hôpital Gui-de-Chauliac, Montpellier, France (A.B.)
| | - Dileep R Yavagal
- University of Miami Miller School of Medicine-Jackson Memorial Hospital, FL (D.R.Y.)
| | | | - Marc Ribo
- Hosp Vall d'Hebrón, Barcelona, Spain (M.R.)
| | | | - Cathy Sila
- University Hospital of Cleveland, OH (C.S.)
| | - Ameer E Hassan
- University of Texas Rio Grande Valley - Valley Baptist Medical Center, Harlingen (A.E.H.)
| | - Wade S Smith
- University of California, San Francisco (W.S.S.)
| | | | - Raul G Nogueira
- Emory University School of Medicine/Grady Memorial Hospital, Atlanta, GA (D.C.H., R.G.N.)
| | - Tudor G Jovin
- University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
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Rapid Assessment of Acute Ischemic Stroke by Computed Tomography Using Deep Convolutional Neural Networks. J Digit Imaging 2021; 34:637-646. [PMID: 33963421 DOI: 10.1007/s10278-021-00457-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/10/2021] [Accepted: 04/27/2021] [Indexed: 01/01/2023] Open
Abstract
Acute stroke is one of the leading causes of disability and death worldwide. Regarding clinical diagnoses, a rapid and accurate procedure is necessary for patients suffering from acute stroke. This study proposes an automatic identification scheme for acute ischemic stroke using deep convolutional neural networks (DCNNs) based on non-contrast computed tomographic (NCCT) images. Our image database for the classification model was composed of 1254 grayscale NCCT images from 96 patients (573 images) with acute ischemic stroke and 121 normal controls (681 images). According to the consensus of critical stroke findings by two neuroradiologists, a gold standard was established and used to train the proposed DCNN using machine-generated image features. Including the earliest DCNN, AlexNet, the popular Inception-v3, and ResNet-101 were proposed. To train the limited data size, transfer learning with ImageNet parameters was also used. The established models were evaluated by tenfold cross-validation and tested on an independent dataset containing 50 patients with acute ischemic stroke (108 images) and 58 normal controls (117 images) from another institution. AlexNet without pretrained parameters achieved an accuracy of 97.12%, a sensitivity of 98.11%, a specificity of 96.08%, and an area under the receiver operating characteristic curve (AUC) of 0.9927. Using transfer learning, transferred AlexNet, transferred Inception-v3, and transferred ResNet-101 achieved accuracies between 90.49 and 95.49%. Tested with a dataset from another institution, AlexNet showed an accuracy of 60.89%, a sensitivity of 18.52%, and a specificity of 100%. Transferred AlexNet, Inception-v3, and ResNet-101 achieved accuracies of 81.77%, 85.78%, and 80.89%, respectively. The proposed DCNN architecture as a computer-aided diagnosis system showed that training from scratch can generate a customized model for a specific scanner, and transfer learning can generate a more generalized model to provide diagnostic suggestions of acute ischemic stroke to radiologists.
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Wang T, Chen L, Jin X, Yuan Y, Zhang Q, Shao C, Lu J. CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion. BMC Med Imaging 2021; 21:67. [PMID: 33845791 PMCID: PMC8040219 DOI: 10.1186/s12880-021-00593-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background ASPECTS scoring method varies, but which one is most suitable for predicting the prognosis still unclear. We aimed to evaluate the diagnostic performance of Automated (Auto)-, noncontrast CT (NCCT)- and CT perfusion (CTP) -ASPECTS for early ischemic changes (EICs) in acute ischemic stroke patients with large vessel occlusion (LVO) and to explore which scoring method is most suitable for predicting the clinical outcome. Methods Eighty-one patients with anterior circulation LVO were retrospectively enrolled and grouped as having a good (0–2) or poor (3–6) clinical outcome using a 90-day modified Rankin Scale score. Clinical characteristics and perfusion parameters were compared between the patients with good and poor outcomes. Differences in scores obtained with the three scoring methods were assessed. Diagnosis performance and receiver operating characteristic (ROC) curves were used to evaluate the value of the three ordinal or dichotomized ASPECTS methods for predicting the clinical outcome. Results Sixty-three patients were finally included, with 36 (57.1%) patients having good clinical outcome. Significant differences were observed in the ordinal or dichotomized Auto-, NCCT- and CTP-ASPECTS between the patients with good and poor clinical outcomes (all p < 0.01). The areas under the curves (AUCs) of the ordinal and dichotomized CTP-ASPECTS were higher than that of the other two methods (all p < 0.01), but the AUCs of the Auto-ASPECTS was similar to that of the NCCT-ASPECTS (p > 0.05). Conclusions The CTP-ASPECTS is superior to the Auto- and NCCT-ASPECTS in detecting EICs in LVO. CTP-ASPECTS with a cutoff value of 6 is a good predictor of the clinical outcome at 90-day follow-up.
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Affiliation(s)
- Tiegong Wang
- Department of Radiology, Changhai Hospital of Shanghai, Navy Medical University (Second Military Medical University), No. 168 Changhai Road, Shanghai, 200433, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital of Shanghai, Navy Medical University (Second Military Medical University), No. 168 Changhai Road, Shanghai, 200433, China
| | - Xianglan Jin
- Department of Cardiac Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Shanghai, 200072, China
| | - Yuan Yuan
- Department of Radiology, Changhai Hospital of Shanghai, Navy Medical University (Second Military Medical University), No. 168 Changhai Road, Shanghai, 200433, China
| | - Qianwen Zhang
- Department of Radiology, Changhai Hospital of Shanghai, Navy Medical University (Second Military Medical University), No. 168 Changhai Road, Shanghai, 200433, China
| | - Chengwei Shao
- Department of Radiology, Changhai Hospital of Shanghai, Navy Medical University (Second Military Medical University), No. 168 Changhai Road, Shanghai, 200433, China.
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Navy Medical University (Second Military Medical University), No. 168 Changhai Road, Shanghai, 200433, China.
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Wolman DN, van Ommen F, Tong E, Kauw F, Dankbaar JW, Bennink E, de Jong HWAM, Molvin L, Wintermark M, Heit JJ. Non-contrast dual-energy CT virtual ischemia maps accurately estimate ischemic core size in large-vessel occlusive stroke. Sci Rep 2021; 11:6745. [PMID: 33762589 PMCID: PMC7991428 DOI: 10.1038/s41598-021-85143-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
Dual-energy CT (DECT) material decomposition techniques may better detect edema within cerebral infarcts than conventional non-contrast CT (NCCT). This study compared if Virtual Ischemia Maps (VIM) derived from non-contrast DECT of patients with acute ischemic stroke due to large-vessel occlusion (AIS-LVO) are superior to NCCT for ischemic core estimation, compared against reference-standard DWI-MRI. Only patients whose baseline ischemic core was most likely to remain stable on follow-up MRI were included, defined as those with excellent post-thrombectomy revascularization or no perfusion mismatch. Twenty-four consecutive AIS-LVO patients with baseline non-contrast DECT, CT perfusion (CTP), and DWI-MRI were analyzed. The primary outcome measure was agreement between volumetric manually segmented VIM, NCCT, and automatically segmented CTP estimates of the ischemic core relative to manually segmented DWI volumes. Volume agreement was assessed using Bland–Altman plots and comparison of CT to DWI volume ratios. DWI volumes were better approximated by VIM than NCCT (VIM/DWI ratio 0.68 ± 0.35 vs. NCCT/DWI ratio 0.34 ± 0.35; P < 0.001) or CTP (CTP/DWI ratio 0.45 ± 0.67; P < 0.001), and VIM best correlated with DWI (rVIM = 0.90; rNCCT = 0.75; rCTP = 0.77; P < 0.001). Bland–Altman analyses indicated significantly greater agreement between DWI and VIM than NCCT core volumes (mean bias 0.60 [95%AI 0.39–0.82] vs. 0.20 [95%AI 0.11–0.30]). We conclude that DECT VIM estimates the ischemic core in AIS-LVO patients more accurately than NCCT.
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Affiliation(s)
- Dylan N Wolman
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA.
| | - Fasco van Ommen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elizabeth Tong
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA
| | - Frans Kauw
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lior Molvin
- Department of Radiology, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94505, USA
| | - Max Wintermark
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA
| | - Jeremy J Heit
- Department of Neuroimaging and Neurointervention, Stanford University Hospital, 300 Pasteur Drive, Room S-047, Stanford, CA, 94305, USA.
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12
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Brain Imaging Findings and Response to Intravenous Thrombolysis in Posterior Circulation Stroke. Adv Ther 2021; 38:627-639. [PMID: 33196987 DOI: 10.1007/s12325-020-01547-z] [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: 08/04/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Intravenous thrombolysis (IVT) is a standard treatment for both anterior circulation ischaemic stroke (ACIS) and posterior circulation ischaemic stroke (PCIS). Our aim was to evaluate the predictors for a good clinical outcome and intracerebral haemorrhage (ICH) in patients undergoing posterior circulation IVT based on the initially performed CT or MR imaging. METHODS The study cohort consisted of 1643 consecutive patients with acute ischaemic stroke (1440 ACIS, 203 PCIS cases) who underwent IVT. ICH was classified according to the European Cooperative Acute Stroke Study (ECASS) I protocol. Clinical outcome was assessed using the modified Rankin scale (mRS). Early ischaemic signs and pre-existing structural signs were assessed. RESULTS Good clinical outcomes (mRS 0-1) were noted in 45.3% of patients with PCIS, with a mortality rate of 14.8%. ICH was noted in 8.3%, and a large haemorrhage was found in 2.4% of patients. Some early ischaemic signs and pre-existing structural signs on initial CT/MR imaging correlated significantly with the 90-day clinical outcome. CONCLUSIONS Early ischaemic signs and pre-existing structural signs should be considered during the assessment of patients with PCIS eligible for IVT. Tissue hypoattenuation on initial CT scans correlates with an increased risk of death. Similarly to anterior circulation, atrophy on initial MRI may negatively predict good clinical outcome in posterior circulation.
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13
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Chang YM, Tenenbaum M, Xiong Y, Selim M, Bhadelia R, Hacein-Bey L, Ivanovic V. Brain Computed Tomography Angiography Maximum Intensity Projection Images for ASPECTS Derivation and Detection of Large Infarct Volumes: Preliminary Study. J Stroke Cerebrovasc Dis 2020; 30:105548. [PMID: 33360519 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105548] [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: 11/05/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Non-contrast CT ASPECTS (NCCTasp) has an established role in determining eligibility for mechanical thrombectomy in centers without ready access to perfusion or DWI. Moreover, it has been suggested that CTA source ASPECTS (CTAasp) may be superior to NCCTasp in predicting final infarct volume (FIV). In this study, we hypothesized that CTA maximum intensity projection ASPECTS (MIPSasp) would be superior compared to both NCCTasp and CTAasp in predicting FIV as measured by DWI. MATERIALS AND METHODS In 41 consecutive patients with MCA territory infarcts, NCCTasp, CTAasp and MIPSasp were visually assessed by 2 neuroradiologists. Disagreements were adjudicated by a third neuroradiologist, and the reconciled data used for all further analysis. MR-DWI was used as the standard for FIV determination. Receiver operating characteristic curve analysis was used to compare the area under the curve for all three CT-based methods in predicting FIV ≥70 ml. RESULTS MIPSasp (AUC: 0.98, CI: 0.88-1.00) were statistically better than NCCTasp (AUC: 0.87, 95% CI: 0.72-0.95; p=0.01) in predicting FIV ≥70 ml. MIPSasp were also superior to CTAasp (AUC: 0.9, CI: 0.79-.98; p˂0.05). Optimal test performance for predicting FIV ≥70 ml for MIPSasp was ≤6 (sensitivity=100%, specificity=91.4%; Youden's J=0.98). CONCLUSION Our preliminary study suggests that a novel CTA-MIPS derived ASPECTS better predicts large MCA territory infarcts compared to CTA source and non-contrast ASPECTS. Thus, MIPSasp may be a promising technique for future studies aimed at improving ischemic stroke treatment in centers using ASPECTS for stroke management.
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Affiliation(s)
- Yu-Ming Chang
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States.
| | | | - Yunyun Xiong
- Beijing Tiantan Hospital, China; Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Magdy Selim
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Rafeeque Bhadelia
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Lotfi Hacein-Bey
- Davis School of Medicine, University of California, United States
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14
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Greve T, Wagner A, Ille S, Wunderlich S, Ikenberg B, Meyer B, Zimmer C, Shiban E, Kreiser K. Motor evoked potentials during revascularization in ischemic stroke predict motor pathway ischemia and clinical outcome. Clin Neurophysiol 2020; 131:2307-2314. [PMID: 32622586 DOI: 10.1016/j.clinph.2020.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The relevance of motor evoked potential (MEP) recovery during mechanical endovascular thrombectomy (MT) in patients with ischemic stroke is unclear. We correlated MEP recovery during MT to symptom improvement and to ischemia in eloquent motor areas on magnetic resonance imaging (MRI) and compared the predictive value of MEPs to visual angiographic reperfusion status, classified by modified Thrombolysis in Cerebral Infarction grading (mTICI). METHODS Patients with hemisyndrome and large-vessel occlusion undergoing MT were included (n35, 49% females; 73.9 ± 14.5 years; n31 anterior circulation). MEPs were elicited transcranially and recorded at the abductor pollicis brevis muscle bilaterally throughout the procedure. An MRI was acquired within 7 days after MT. RESULTS The median door-to-needle time was 3.5 hours. Median National Institutes of Health Stroke Scale at presentation was 16 (7 - 37). Median Modified Rankin Scale score was 4 at day 7 and 3 months. After MT, MEP-recovery occurred in 21 cases after a median time span of 4.5 min [range 2 - 11 min]. Symptom improvement at day 7 (3 months) was noted in 22 (21) cases. Absence of ischemia on postinterventional MRI was noted in 21 cases, 19 of whom showed MEP-recovery. Stratified for symptom improvement at day 7, sensitivity (specificity) of MEP-recovery was 86% (85%) and of mTICI ≥ 2b was 95% (23%). Stratified for absence of ischemia on postinterventional MRI, sensitivity (specificity) of MEP-recovery was 90% (86%) and of mTICI ≥ 2b was of 95% (21%). CONCLUSIONS MEP recovery occurs early after successful endovascular mechanical revascularization and is superior to mTICI grading in predicting postoperative neurological outcome and postoperative motor-pathway ischemia. SIGNIFICANCE This is a new, significant and clinically important study since it emphasizes the additional value of MEP monitoring in a field, which has been traditionally unaffiliated with neurophysiological monitoring.
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Affiliation(s)
- Tobias Greve
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Neurosurgery, Ludwig-Maximilians-University, Campus Grosshadern, Munich, Germany.
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benno Ikenberg
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ehab Shiban
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Neurosurgery, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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15
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Culbertson CJ, Christensen S, Mlynash M, Heit JJ, Federau C, Sells CM, Legault C, McCaslin AFH, Werbaneth K, Albers GW, Lansberg MG. Tilt-Corrected Region Boundaries May Enhance the Alberta Stroke Program Early Computed Tomography Score for Less Experienced Raters. J Stroke Cerebrovasc Dis 2020; 29:104820. [PMID: 32307316 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104820] [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: 02/04/2020] [Revised: 02/11/2020] [Accepted: 03/14/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is widely used to quantify early ischemic changes in the anterior circulation but has limited inter-rater reliability. AIMS We investigated whether application of 3-dimensional boundaries outlining the ASPECTS regions improves inter-rater reliability and accuracy. METHODS We included all patients from our DEFUSE 2 database who had a pretreatment noncontrast computed tomography scan (NCCT) of acceptable quality. Six raters (2 neuroradiologists, 2 vascular neurologists, and 2 neurology residents) scored ASPECTS of each NCCT without ("CT-native") and with the superimposed boundary template ("CT-template"). Gold-standard ASPECTS were generated by the 2 neuroradiologists through joint adjudication. Inter-rater reliability and accuracy were assessed using the intraclass correlation coefficient (ICC) for full-scale agreements and Gwet's AC1 for dichotomized (ASPECTS 0-6 vs 7-10) agreements. RESULTS Eighty-two patients were included. Inter-rater reliability improved with higher training level for both CT-native (ICC = .15, .31, .54 for residents, neurologists, and radiologists, respectively) and CT-template (ICC = .18, .33, .56). Use of the boundary template improved correlation with the gold-standard for one resident on full-scale agreement (ICC increased from .01 to .31, P = .01) and another resident on dichotomized agreement (AC1 increased from .36 to .64, P = .01), but resulted in no difference for other raters. The template did not improve ICC between raters of the same training level. CONCLUSIONS Inter-rater reliability of ASPECTS improves with physician training level. Standardized display of ASPECTS region boundaries on NCCT does not improve inter-rater reliability but may improve accuracy for some less experienced raters.
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Affiliation(s)
- Collin J Culbertson
- Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California.
| | - Søren Christensen
- Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California
| | - Michael Mlynash
- Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California
| | - Jeremy J Heit
- Department of Diagnostic and Interventional Neuroradiology, Stanford University School of Medicine, Stanford, California
| | - Christian Federau
- Institute for Biomedical Engineering, ETH Zürich, Zürich, Switzerland
| | | | - Catherine Legault
- Department of Neurology and Neurosurgery, McGill University at the Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Addason F H McCaslin
- Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California
| | - Katherine Werbaneth
- Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California
| | - Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine, Palo Alto, California
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16
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Shah VS, Eaton RG, Cua S, Dornbos D, Hoang N, Schunemann V, Nimjee S, Youssef P, Powers CJ. Scoring of Middle Cerebral Artery Collaterals Predicts RAPID CT-Perfusion Analysis and Short-Term Outcomes in Acute Ischemic Stroke Patients Undergoing Thrombectomy. World Neurosurg 2019; 135:e494-e499. [PMID: 31843729 DOI: 10.1016/j.wneu.2019.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The rapid processing of perfusion and diffusion (RAPID) system for automating perfusion and diffusion data from head computed tomography has improved acute ischemic stroke treatment by quickly and accurately identifying those patients who may benefit from thrombectomy. Collateral scoring (CS) of cerebral arteries using computed tomography angiography (CTA) has proven useful in predicting postintervention infarct volumes and functional outcomes in ischemic stroke patients. Here we evaluate the relationship between CS and RAPID software in an effort to augment triage and provide improved predictability of functional outcomes in ischemic stroke patients. METHODS A retrospective review of 77 mechanical thrombectomy patients from January 2017 to October 2018 with large vessel occlusions of the anterior circulation who underwent RAPID and CTA imaging was performed. Baseline characteristics, RAPID data, CS, modified Rankin Scale score, and procedural data were collected. magnetic resonance imaging was used to calculate the postintervention stroke volume. RESULTS CS inversely correlates with the volume of RAPID cerebral blood flow <30% (β= -18.131, 95% confidence interval [CI] -24.384 to -11.879, P < 0.001), RAPID Tmax >6s (β= -22.205, 95% CI -39.125 to -5.285, P = 0.011), postintervention stroke volume (β= -30.637, 95% CI -41.554 to -19.720, P < 0.001), and discharge National Institutes of Health Stroke Scale score (β= -1.922, 95% CI -3.575 to -0.269, P = 0.023). CONCLUSIONS CS on CTA may be a useful way to identify patients who would benefit from mechanical thrombectomy and predict functional outcomes postintervention. CS may allow the stroke team to optimize the care of patients who may not be able to obtain RAPID analysis.
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Affiliation(s)
- Varun S Shah
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ryan G Eaton
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA
| | - Santino Cua
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David Dornbos
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA
| | - Nguyen Hoang
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA
| | - Victoria Schunemann
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA
| | - Shahid Nimjee
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA
| | - Patrick Youssef
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA
| | - Ciarán J Powers
- The Ohio State University Wexner Medical Center, Department of Neurological Surgery, Columbus, Ohio, USA.
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17
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Hause S, Oldag A, Breja A, Neumann J, Wilcke J, Schreiber S, Heinze HJ, Skalej M, Halloul Z, Goertler M. Acute symptomatic extracranial internal carotid occlusion - natural course and clinical impact. VASA 2019; 49:31-38. [PMID: 31621550 DOI: 10.1024/0301-1526/a000826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: To assess the vascular and clinical course of acute symptomatic extracranial internal carotid artery (ICA) occlusion. Patients and methods: Patients with an acute ischemic event in the anterior circulation and corresponding extracranial ICA occlusion at CT angiography and/or color-coded duplex sonography underwent recurrent duplex follow-up for detection of spontaneous recanalization. Stroke recurrence and functional outcome 4.5 months after the ischemic index event assessed by modified Rankin scale served as secondary outcome parameters. Results: 133 patients (91 men, mean age 62.3 years, SD 10.8) demonstrated symptomatic occlusion of the extracranial ICA with open intracranial ICA and open middle cerebral artery and were followed-up for spontaneous recanalization. Twenty-eight recanalized spontaneously, 25 to high-grade focal stenosis within 12 days, revealing an early cumulative recanalization rate of 23 %. Detection of recanalization was independently associated with de novo dual anti-platelet therapy (adjusted odds ratio [OR], 3.24; 95 % confidence interval [CI], 1.34 to 7.80). Ischemic recurrence occurred in 16 patients, of which 10 deemed to be embolic and 5 hemodynamic. Spontaneous ICA recanalization and an exhausted cerebrovascular reserve in the hemisphere distal to the occluded ICA were both independently associated with the occurrence of a recurrent ischemic event at Cox regression. An increasing NIHSS score at admission, a decreasing middle cerebral artery flow velocity and an ischemic recurrence independently predicted poor outcome (modified Rankin scale 3 to 6) in multivariate analysis. Conclusions: Acute symptomatic extracranial ICA occlusion is an unstable condition with frequent spontaneous recanalization to severe stenosis and early embolic stroke recurrence, demanding appropriate prevention especially in those patients with only mild deficit.
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Affiliation(s)
- Stephan Hause
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Andreas Oldag
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Andrea Breja
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Jens Neumann
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Juliane Wilcke
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Stefanie Schreiber
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
| | - Martin Skalej
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Institute of Neuroradiology, Magdeburg University Hospital, Magdeburg, Germany
| | - Zuhir Halloul
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of General, Abdominal and Vascular Surgery, Magdeburg University Hospital, Magdeburg, Germany
| | - Michael Goertler
- Vascular and Stroke Center, Magdeburg University Hospital, Magdeburg, Germany.,Department of Neurology, Magdeburg University Hospital, Magdeburg, Germany
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18
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Affiliation(s)
- Marc Fisher
- From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Rhode Island Hospital, Brown Alpert School of Medicine, Providence.
| | - Karen Furie
- From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Rhode Island Hospital, Brown Alpert School of Medicine, Providence
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