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Lu J, Lu Z, Li Y, Li F, Feng Y, Dang M, Yang Y, Tang F, Li T, Zhao L, Jian Y, Wang X, Zhang L, Fan H, Zhang G. Association between ASPECTS region of infarction and clinical outcome in non-acute large vessel occlusion ischaemic stroke after endovascular recanalisation. Stroke Vasc Neurol 2024:svn-2024-003355. [PMID: 39266208 DOI: 10.1136/svn-2024-003355] [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: 04/26/2024] [Accepted: 09/04/2024] [Indexed: 09/14/2024] Open
Abstract
PURPOSE This study retrospectively investigated whether infarction in specific Alberta Stroke Program Early CT Score (ASPECTS) regions is associated with clinical outcome in patients with symptomatic non-acute internal carotid or middle cerebral artery occlusion who underwent endovascular recanalisation (ER). METHODS Preoperative ASPECTS and region of infarction were recorded before recanalisation. Clinical outcome was evaluated 90 days after the procedure using the modified Rankin Scale; a score>2 was defined as poor outcome. Secondary outcomes included postprocedural cerebral oedema, intracranial haemorrhage (ICH) and symptomatic ICH. RESULTS Among the 86 patients included, 90-day outcome was poor in 30 (34.9%) and 40 experienced cerebral oedema (46.5%). Multivariate logistic regression models showed that lenticular nucleus infarction (OR 19.61-26.00, p<0.05), admission diastolic blood pressure (OR 1.07-1.08, p<0.05), preprocedural National Institutes of Health Stroke Scale (OR 1.96-2.05, p<0.001) and haemorrhagic transformation (OR 14.99-18.81, p<0.05) were independent predictors of poor 90-day outcome. The area under the receiver operating characteristic curve for lenticular nucleus infarction as a predictor of poor outcome was 0.73. M2 region infarction (OR 26.07, p<0.001) and low American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology collateral circulation grade (OR 0.16, p=0.001) were independent predictors of postprocedural cerebral oedema. The area under the receiver operating characteristic curve for M2 region infarction as a predictor of cerebral oedema was 0.64. Region of infarction did not significantly differ between patients with and without postprocedural ICH or symptomatic ICH. CONCLUSIONS Lenticular nucleus and M2 region infarction were independent predictors of poor 90-day outcome and postprocedural cerebral oedema, respectively, in patients with non-acute anterior circulation large artery occlusion who underwent ER.
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Affiliation(s)
- Jialiang Lu
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Ziwei Lu
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Ye Li
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Fangcun Li
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yuxuan Feng
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Meijuan Dang
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yang Yang
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Fan Tang
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Tao Li
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Lili Zhao
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Yating Jian
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Xiaoya Wang
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Lei Zhang
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Hong Fan
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
| | - Guilian Zhang
- Neurology, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, Shaanxi, China
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Wang X, Duan C, Lyu J, Han D, Cheng K, Meng Z, Wu X, Chen W, Wang G, Niu Q, Li X, Bian Y, Han D, Guo W, Yang S, Wang X, Zhang T, Bi J, Wu F, Xia S, Tong D, Duan K, Li Z, Wang R, Wang J, Lou X. Impact of the Alberta Stroke Program CT Score subregions on long-term functional outcomes in acute ischemic stroke: Results from two multicenter studies in China. J Transl Int Med 2024; 12:197-208. [PMID: 38779116 PMCID: PMC11107184 DOI: 10.2478/jtim-2022-0057] [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] Open
Abstract
Background and Objectives The Alberta Stroke Program CT Score (ASPECTS) is a widely used rating system for assessing infarct extent and location. We aimed to investigate the prognostic value of ASPECTS subregions' involvement in the long-term functional outcomes of acute ischemic stroke (AIS). Materials and Methods Consecutive patients with AIS and anterior circulation large-vessel stenosis and occlusion between January 2019 and December 2020 were included. The ASPECTS score and subregion involvement for each patient was assessed using posttreatment magnetic resonance diffusion-weighted imaging. Univariate and multivariable regression analyses were conducted to identify subregions related to 3-month poor functional outcome (modified Rankin Scale scores, 3-6) in the reperfusion and medical therapy cohorts, respectively. In addition, prognostic efficiency between the region-based ASPECTS and ASPECTS score methods were compared using receiver operating characteristic curves and DeLong's test. Results A total of 365 patients (median age, 64 years; 70% men) were included, of whom 169 had poor outcomes. In the reperfusion therapy cohort, multivariable regression analyses revealed that the involvement of the left M4 cortical region in left-hemisphere stroke (adjusted odds ratio [aOR] 5.39, 95% confidence interval [CI] 1.53-19.02) and the involvement of the right M3 cortical region in right-hemisphere stroke (aOR 4.21, 95% CI 1.05-16.78) were independently associated with poor functional outcomes. In the medical therapy cohort, left-hemisphere stroke with left M5 cortical region (aOR 2.87, 95% CI 1.08-7.59) and caudate nucleus (aOR 3.14, 95% CI 1.00-9.85) involved and right-hemisphere stroke with right M3 cortical region (aOR 4.15, 95% CI 1.29-8.18) and internal capsule (aOR 3.94, 95% CI 1.22-12.78) affected were related to the increased risks of poststroke disability. In addition, region-based ASPECTS significantly improved the prognostic efficiency compared with the conventional ASPECTS score method. Conclusion The involvement of specific ASPECTS subregions depending on the affected hemisphere was associated with worse functional outcomes 3 months after stroke, and the critical subregion distribution varied by clinical management. Therefore, region-based ASPECTS could provide additional value in guiding individual decision making and neurological recovery in patients with AIS.
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Affiliation(s)
- Xinrui Wang
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Caohui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Dongshan Han
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Kun Cheng
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
| | - Zhihua Meng
- Department of Radiology, Yuebei People’s Hospital, Shaoguan512000, Guangdong Province, China
| | - Xiaoyan Wu
- Department of Radiology, Anshan Changda Hospital, Anshan114000, Liaoning Province, China
| | - Wen Chen
- Department of Radiology, Shiyan Taihe Hospital, Shiyan442000, Hubei Province, China
| | - Guohua Wang
- Department of Radiology, Qingdao Municipal Hospital, Qingdao University, Qingdao266011, Shandong Province, China
| | - Qingliang Niu
- Department of Radiology, WeiFang Traditional Chinese Hospital, Weifang261053, Shandong Province, China
| | - Xin Li
- Department of Radiology, The Second Hospital of Jilin University, Jilin University, Changchun130014, Jilin Province, China
| | - Yitong Bian
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an710061, Shaanxi Province, China
| | - Dan Han
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming650032, Yunnan Province, China
| | - Weiting Guo
- Department of Radiology, Shanxi Provincial People’s Hospital, Taiyuan030012, Shanxi Province, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha410008, Hunan Province, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou215006, Jiangsu Province, China
| | - Tijiang Zhang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi Medical University, Zunyi563000, Guizhou Province, China
| | - Junying Bi
- Department of Radiology, The Third People’s Hospital of Hubei Province, Wuhan430030, Hubei Province, China
| | - Feiyun Wu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing210029, Jiangsu Province, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Nankai University, Tianjin300190, China
| | - Dan Tong
- Department of Radiology, The First Hospital of Jilin University, Jilin University, Changchun130021, Jilin Province, China
| | - Kai Duan
- Department of Radiology, Liangxiang Hospital, Beijing102401, China
| | - Zhi Li
- Department of Radiology, The First People’s Hospital of Yunnan Province, Kunming650034, Yunnan Province, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People’s Hospital, Guiyang550499, Guizhou Province, China
| | - Jinan Wang
- Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen361004, Fujian Province, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing100853, China
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Aguirre C, Trillo S, Ramos C, Zapata-Wainberg G, Sanz-García A, Ximénez-Carrillo Á, Barbosa A, Caniego JL, Vivancos J. Predictive value of ischemia location on multimodal CT in thrombectomy-treated patients. Neuroradiol J 2023; 36:319-328. [PMID: 36281569 PMCID: PMC10268084 DOI: 10.1177/19714009221128658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE Alberta Stroke Program Early CT Score (ASPECTS) applied to CT-perfusion (CTP) and CT-angiography-source-images (CTA-SI) may improve outcome prediction in large vessel occlusion (LVO) stroke if compared to non-contrast CT (NCCT) alone. Besides, ischemia location may have enhanced capabilities, compared to ischemia volume alone, in predicting stroke outcomes. We aim to evaluate the association between ischemia location as measured by ASPECTS regions in NCCT, CTP maps and CTA-SI and 3 months outcome in patients with LVO treated with mechanical thrombectomy (MT). MATERIAL AND METHODS Consecutive patients with anterior circulation stroke treated with MT were recorded in a prospectively maintained database at a single center. Modified Rankin scale (mRS) at 3 months >2 was considered a poor outcome. Association of patients' characteristics, NCCT, CTP, and CTA-SI parameters with outcome was evaluated using single-variable analysis and binary logistic regression multivariate analysis for each imaging technique. RESULTS 177 patients were included. 115 (65%) patients reached a favorable outcome. The involvement of lenticular, caudate, M1, or M2 in all imaging techniques, insula in NCCT and CTA-SI and M5 in CBV maps and CTA-SI was related to functional outcome in bivariate analysis. However, in the multivariate analysis, none ischemia location was independently related to outcome, no matter the imaging technique studied. This finding remained unchanged when restricted to patients with good recanalization and when analyzing subpopulations according to hemisphere involvement or territories association. CONCLUSIONS Our study suggests ischemia location shouldn't be used solely for decision-making in LVO stroke patients. Its predictive value may be taken in consideration together with other clinical and radiological variables.
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Affiliation(s)
- Clara Aguirre
- Stroke Center, Neurology
Department, Instituto de Investigación Sanitaria, Hospital Universitario de La
Princesa, Madrid, Spain
| | - Santiago Trillo
- Stroke Center, Neurology
Department, Instituto de Investigación Sanitaria, Hospital Universitario de La
Princesa, Madrid, Spain
| | - Carmen Ramos
- Stroke Center, Neurology
Department, Instituto de Investigación Sanitaria, Hospital Universitario de La
Princesa, Madrid, Spain
| | - Gustavo Zapata-Wainberg
- Stroke Center, Neurology
Department, Instituto de Investigación Sanitaria, Hospital Universitario de La
Princesa, Madrid, Spain
| | - Ancor Sanz-García
- Data Analysis Unit, Instituto de
Investigación Sanitaria, Hospital Universitario de la
Princesa, Madrid, Spain
| | - Álvaro Ximénez-Carrillo
- Stroke Center, Neurology
Department, Instituto de Investigación Sanitaria, Hospital Universitario de La
Princesa, Madrid, Spain
| | - Antonio Barbosa
- Neuroradiology Department, Hospital Universitario de La
Princesa., Madrid, Spain
| | - José L Caniego
- Neuroradiology Department, Hospital Universitario de La
Princesa., Madrid, Spain
| | - José Vivancos
- Stroke Center, Neurology
Department, Instituto de Investigación Sanitaria, Hospital Universitario de La
Princesa, Madrid, Spain
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Neurological Functional Independence After Endovascular Thrombectomy and Different Imaging Modalities for Large Infarct Core Assessment : A Systematic Review and Meta-analysis. Clin Neuroradiol 2023; 33:21-29. [PMID: 35920865 DOI: 10.1007/s00062-022-01202-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the rate of neurological functional independence (NFI) at 90 days in patients with large infarct core (LIC), which was evaluated by different imaging modalities before endovascular thrombectomy (EVT). METHODS PubMed and EMBASE were searched for original studies on clinical functional outcomes at 90 days in LIC patients who received EVT treatment from inception to 28 September 2021. The pooled NFI rates were calculated using random effects model according to different imaging modalities and criteria. RESULTS We included 34 studies enrolling 2997 LIC patients. The NFI rates were 23% (95% confidence interval, CI 15-32%) and 24% (95% CI 10-38%) when LIC was defined as core volume ≥50 ml and ≥ 70 ml separately on computed tomography perfusion, 36% (95% CI 23-48%) and 21% (95% CI 17-25%) when LIC was defined as core volume ≥ 50 ml and ≥ 70 ml separately on magnetic resonance diffusion-weighted imaging (DWI), 28% (95% CI 24-32%) and 37% (95% CI 21-53%) when LIC was defined as DWI-ASPECTS ≤ 5 and ≤ 6 separately, 23% (95% CI 19-27%) and 32% (95% CI 18-46%) when LIC was defined as NCCT-ASPECTS ≤ 5 and ≤ 6 separately. CONCLUSION Similar NFI rates could be obtained after EVT in LIC patients if proper LIC criteria were select according to the imaging modality.
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Chu Y, Ma G, Xu XQ, Lu SS, Cao YZ, Shi HB, Liu S, Wu FY. Total and regional ASPECT score for non-contrast CT, CT angiography, and CT perfusion: inter-rater agreement and its association with the final infarction in acute ischemic stroke patients. Acta Radiol 2022; 63:1093-1101. [PMID: 34219495 DOI: 10.1177/02841851211029080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a grading system to assess the extent and distribution of early ischemic changes. PURPOSE To assess inter-rater agreement for total and regional ASPECTS on non-contrast computed tomography (NCCT) images, CT angiography source images (CTA-SI), and CT-perfusion cerebral blood volume (CTP-CBV) maps, and their association with final infarction in patients with acute ischemic stroke (AIS). MATERIAL AND METHODS A total of 96 consecutive patients with AIS who underwent pre-treatment NCCT and CTP were retrospectively enrolled. CTA-SI was reconstructed using the raw data of CTP. Total and regional ASPECTS were assessed on baseline NCCT, CTA-SI, and CTP-CBV, and on follow-up NCCT or diffusion-weighted imaging. Follow-up ASPECTS served as the reference standard for final infarction. RESULTS CTP-CBV demonstrated higher concordance for total ASPECTS (interclass correlation coefficient, 0.895 vs. 0.771 vs. 0.777) and regional ASPECTS in internal capsule, lentiform, caudate nuclei, M5 and M6, compared with NCCT and CTA-SI. CTP-CBV showed a trend of stronger correlation with final ASPECTS than NCCT and CTA-SI (0.717 vs. 0.711 vs. 0.565; P > 0.05). ASPECTS in the internal capsule (ρ, 0.756 vs. 0.556; P = 0.016) and caudate nucleus (ρ, 0.717 vs. 0.476; P = 0.010) on CTP-CBV were more strongly correlated with follow-up ASPECTS than NCCT. CTP-CBV showed higher accuracy for predicting final infarction in the internal capsule (92.5% vs. 90.3% and 87.1%; P > 1.000, P = 0.125, respectively) and caudate nucleus (87.1% vs. 79.6% and 77.4%; P = 0.453, P = 0.039, respectively) than CTA-SI and NCCT. CONCLUSION CTP-CBV ASPECTS might be more reliable for delineating early ischemic changes and predicting final infarction.
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Affiliation(s)
- Yue Chu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Gao Ma
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Xiao-Quan Xu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Shan-Shan Lu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Yue-Zhou Cao
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Hai-Bin Shi
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Sheng Liu
- Department of Interventional Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
| | - Fei-Yun Wu
- Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China
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Seyedsaadat S, Neuhaus A, Nicholson P, Polley E, Hilditch C, Mihal D, Krings T, Benson J, Mark I, Kallmes D, Brinjikji W, Schaafsma J. Differential Contribution of ASPECTS Regions to Clinical Outcome after Thrombectomy for Acute Ischemic Stroke. AJNR Am J Neuroradiol 2021; 42:1104-1108. [PMID: 33926898 PMCID: PMC8191662 DOI: 10.3174/ajnr.a7096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Ischemic stroke is the leading cause of long-term disability in adults, but our ability to prognosticate from baseline imaging data is limited. The ASPECTS measures ischemic change in the middle cerebral artery territory on noncontrast CT based on 10 anatomic regions. Here, we investigated whether infarction in particular regions was associated with worse long-term outcome. MATERIALS AND METHODS We identified consecutive patients receiving mechanical thrombectomy for ICA/MCA occlusion at 2 comprehensive stroke centers. Pretreatment ASPECTS was assessed by 2 blinded reviewers. Clinical data including demographics, baseline NIHSS score, and 90-day mRS were collected. The relationship between individual ASPECTS regions and the mRS score (0-2 versus 3-6) was assessed using multivariable logistic regression. RESULTS Three hundred fifty-three patients were included (mean age, 70 years; 46% men), of whom 214 had poor outcome (mRS = 3-6). Caudate (OR = 3.26; 95% CI, 1.33-8.82), M4 region (OR = 2.94; 95% CI, 1.09-9.46), and insula (OR = 1.75; 95% CI, 1.08-2.85) infarcts were associated with significantly greater odds of poor outcome, whereas M1 region infarction reduced the odds of poor outcome (OR = 0.38; 95% CI, 0.14-0.99). This finding remained unchanged when restricted to only patients with good recanalization. No significant associations were found by laterality. Similarly, no region was predictive of neurologic improvement during the first 24 hours or of symptomatic intracerebral hemorrhage. CONCLUSIONS Our results indicate that ASPECTS regions are not equal in their contribution to functional outcome. This finding suggests that patient selection based on total ASPECTS alone might be insufficient, and infarct topography should be considered when deciding eligibility for thrombectomy.
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Affiliation(s)
- S.M. Seyedsaadat
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota,Department of Radiology (S.M.S.), Mayo Clinic, Jacksonville, Florida
| | - A.A. Neuhaus
- Radcliffe Department of Medicine (A.A.N.), University of Oxford, Oxford, UK
| | - P.J. Nicholson
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - E.C. Polley
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - C.A. Hilditch
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada,Department of Neuroradiology (C.A.H.), Manchester Centre for Clinical Neurosciences, Salford Royal National Health Service Foundation Trust, Salford, UK
| | - D.C. Mihal
- Department of Radiology (D.C.M.), Division of Neuroradiology, Cleveland Clinic, Cleveland, Ohio
| | - T. Krings
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
| | - J. Benson
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - I. Mark
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - D.F. Kallmes
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W. Brinjikji
- From the Department of Radiology (S.M.S., E.C.P., J.B., I.M., D.F.K., W.B.), Mayo Clinic, Rochester, Minnesota,Department of Neurosurgery (W.B.), Mayo Clinic, Rochester, Minnesota
| | - J.D. Schaafsma
- Department of Medicine (P.J.N., C.A.H., T.K., J.D.S.), Division of Neurology. University Health Network/University of Toronto, Toronto, Ontario, Canada
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Yang Z, Zhou C, Shi H, Zhang N, Tang B, Ji N. Heme Induces BECN1/ATG5-Mediated Autophagic Cell Death via ER Stress in Neurons. Neurotox Res 2020; 38:1037-1048. [PMID: 32840757 DOI: 10.1007/s12640-020-00275-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/11/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
Intracerebral hemorrhage (ICH) is a serious medical problem, and effective treatment is limited. Hemorrhaged blood is highly toxic to the brain, and heme, which is mainly released from hemoglobin, plays a vital role in neurotoxicity. However, the specific mechanism involved in heme-mediated neurotoxicity has not been well studied. In this study, we investigated the neurotoxicity of heme in neurons. Neurons were treated with heme, and cell death, autophagy, and endoplasmic reticulum (ER) stress were analyzed. In addition, the relationship between autophagy and apoptosis in heme-induced cell death and the downstream effects were also assessed. We showed that heme induced cell death and autophagy in neurons. The suppression of autophagy using either pharmacological inhibitors (3-methyladenine) or RNA interference of essential autophagy genes (BECN1 and ATG5) decreased heme-induced cell death in neurons. Moreover, the ER stress activator thapsigargin increased cell autophagy and the cell death ratio following heme treatment. Autophagy promoted heme-induced cell apoptosis and cell death through the BECN1/ATG5 pathway. Our findings suggest that heme potentiates neuronal autophagy via ER stress, which in turn induces cell death via the BECN1/ATG5 pathway. Targeting ER stress-mediated autophagy might be a promising therapeutic strategy for ICH.
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Affiliation(s)
- Zhao Yang
- Department of Neurology and Chongqing Key Laboratory of Cerebrovascular Disease, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Changlong Zhou
- Department of Neurology and Chongqing Key Laboratory of Cerebrovascular Disease, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Hui Shi
- Department of Neurology and Chongqing Key Laboratory of Cerebrovascular Disease, Yongchuan Hospital, Chongqing Medical University, Chongqing, 402160, China
| | - Nan Zhang
- Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Bin Tang
- Department of General Surgery, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, China.
| | - Na Ji
- Department of Anesthesia, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Grange S, Grange R, Garnier P, Varvat J, Marinescu D, Barral FG, Boutet C, Schneider FC. Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping. Sci Rep 2020; 10:1662. [PMID: 32015357 PMCID: PMC6997399 DOI: 10.1038/s41598-020-58480-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/13/2020] [Indexed: 01/06/2023] Open
Abstract
Distinction between deep and superficial middle cerebral artery (MCA) territories and their junctional vascular area (the internal borderzone or IBZ) constitutes a predictor of stroke patient outcome. However, the IBZ boundaries are not well-defined because of substantial anatomical variance. Here, we built a statistical estimate of the IBZ and tested its vulnerability to ischemia using an independent sample. First, we used delineated lesions of 122 patients suffering of chronic ischemic stroke grouped in deep, superficial and territorial topographies and statistical comparisons to generate a probabilistic estimate of the IBZ. The IBZ extended from the insular cortex to the internal capsule and the anterior part of the caudate nucleus head. The IBZ showed the highest lesion frequencies (~30% on average across IBZ voxels) in our chronic stroke patients but also in an independent sample of 87 acute patients. Additionally, the most important apparent diffusion coefficient reductions (−6%), which reflect stroke severity, were situated within our IBZ estimate. The IBZ was most severely injured in case of a territorial infarction. Then, our results are in favour of an increased IBZ vulnerability to ischemia. Moreover, our probabilistic estimates of deep, superficial and IBZ regions can help the everyday spatial classification of lesions.
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Affiliation(s)
- Sylvain Grange
- Department of Radiology, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Pierre Garnier
- Stroke Unit, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Jérôme Varvat
- Stroke Unit, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Doina Marinescu
- Stroke Unit, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Fabrice-Guy Barral
- Department of Radiology, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France.,TAPE EA7423, University of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France
| | - Fabien C Schneider
- Department of Radiology, University Hospital of Saint Etienne, Saint-Priest-en-Jarez, France.
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9
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Kaesmacher J, Chaloulos-Iakovidis P, Panos L, Mordasini P, Michel P, Hajdu SD, Ribo M, Requena M, Maegerlein C, Friedrich B, Costalat V, Benali A, Pierot L, Gawlitza M, Schaafsma J, Mendes Pereira V, Gralla J, Fischer U. Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0-5. Stroke 2020; 50:880-888. [PMID: 30827193 PMCID: PMC6430594 DOI: 10.1161/strokeaha.118.023465] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.
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Affiliation(s)
- Johannes Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland.,University Institute of Diagnostic, Interventional and Pediatric Radiology (J.K.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Panagiotis Chaloulos-Iakovidis
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Leonidas Panos
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Pasquale Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Patrik Michel
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Steven D Hajdu
- Department of Neurology (P. Michel) and Department of Radiology (S.D.H.), CHUV Lausanne, Switzerland
| | - Marc Ribo
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Manuel Requena
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain (M. Ribo, M. Requena)
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Germany (C.M., B.F.)
| | - Vincent Costalat
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Amel Benali
- Department of Neuroradiology, CHU Montpellier, France (V.C., A.B.), Toronto Western Hospital, ON
| | - Laurent Pierot
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | - Matthias Gawlitza
- Department of Neuroradiology, CHU Reims, France (L.P., M.G.), Toronto Western Hospital, ON
| | | | | | - Jan Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (J.K., P. Mordasini, J.G.), University Hospital Bern, Inselspital, University of Bern, Switzerland
| | - Urs Fischer
- Department of Neurology (J.K., P.C.-I., L.P., U.F.), University Hospital Bern, Inselspital, University of Bern, Switzerland
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10
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Payabvash S, Falcone GJ, Sze GK, Jain A, Beslow LA, Petersen NH, Sheth KN, Kimberly WT. Poor Outcomes Related to Anterior Extension of Large Hemispheric Infarction: Topographic Analysis of GAMES-RP Trial MRI Scans. J Stroke Cerebrovasc Dis 2019; 29:104488. [PMID: 31787498 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We aimed to assess the correlation of lesion location and clinical outcome in patients with large hemispheric infarction (LHI). METHODS We analyzed admission MRI data from the GAMES-RP trial, which enrolled patients with anterior circulation infarct volumes of 82-300 cm3 within 10 hours of onset. Infarct lesions were segmented and co-registered onto MNI-152 brain space. Voxel-wise general linear models were applied to assess location-outcome correlations after correction for infarct volume as a co-variate. RESULTS We included 83 patients with known 3-month modified Rankin scale (mRS). In voxel-wise analysis, there was significant correlation between admission infarct lesions involving the anterior cerebral artery (ACA) territory and its middle cerebral artery (MCA) border zone with both higher 3-month mRS and post-stroke day 3 and 7 National Institutes of Health Stroke Scale (NIHSS) total score and arm/leg subscores. Higher NIHSS total scores from admission through poststroke day 2 correlated with left MCA infarcts. In multivariate analysis, ACA territory infarct volume (P = .001) and admission NIHSS (P = .005) were independent predictors of 3-month mRS. Moreover, in a subgroup of 36 patients with infarct lesions involving right MCA-ACA border zone, intravenous (IV) glibenclamide (BIIB093; glyburide) treatment was the only independent predictor of 3-month mRS in multivariate regression analysis (P = .016). CONCLUSIONS Anterior extension of LHI with involvement of ACA territory and ACA-MCA border zone is an independent predictor of poor functional outcome, likely due to impairment of arm/leg motor function. If confirmed in larger cohorts, infarct topology may potentially help triage LHI patients who may benefit from IV glibenclamide. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01794182.
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Affiliation(s)
- Seyedmehdi Payabvash
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Guido J Falcone
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Gordon K Sze
- Division of Neuroradiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
| | - Abhi Jain
- College of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nils H Petersen
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut.
| | - W Taylor Kimberly
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
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11
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A data-driven update of arterial perfusion territories. Nat Rev Neurol 2019; 15:624-625. [PMID: 31520084 DOI: 10.1038/s41582-019-0267-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Wang Y, Juliano JM, Liew SL, McKinney AM, Payabvash S. Stroke atlas of the brain: Voxel-wise density-based clustering of infarct lesions topographic distribution. NEUROIMAGE-CLINICAL 2019; 24:101981. [PMID: 31473544 PMCID: PMC6728875 DOI: 10.1016/j.nicl.2019.101981] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/19/2019] [Accepted: 08/11/2019] [Indexed: 11/15/2022]
Abstract
Objective The supply territories of main cerebral arteries are predominantly identified based on distribution of infarct lesions in patients with large arterial occlusion; whereas, there is no consensus atlas regarding the supply territories of smaller end-arteries. In this study, we applied a data-driven approach to construct a stroke atlas of the brain using hierarchical density clustering in large number of infarct lesions, assuming that voxels/regions supplied by a common end-artery tend to infarct together. Methods A total of 793 infarct lesions on MRI scans of 458 patients were segmented and coregistered to MNI-152 standard brain space. Applying a voxel-wise data-driven hierarchical density clustering algorithm, we identified those voxels that were most likely to be part of same infarct lesions in our dataset. A step-wise clustering scheme was applied, where the clustering threshold was gradually decreased to form the first 20 mother (>50 cm3) or main (1–50 cm3) clusters in addition to any possible number of tiny clusters (<1 cm3); and then, any resultant mother clusters were iteratively subdivided using the same scheme. Also, in a randomly selected 2/3 subset of our cohort, a bootstrapping cluster analysis with 100 permutations was performed to assess the statistical robustness of proposed clusters. Results Approximately 91% of the MNI-152 brain mask was covered by 793 infarct lesions across patients. The covered area of brain was parcellated into 4 mother, 16 main, and 123 tiny clusters at the first hierarchy level. Upon iterative clustering subdivision of mother clusters, the brain tissue was eventually parcellated into 1 mother cluster (62.6 cm3), 181 main clusters (total volume 1107.3 cm3), and 917 tiny clusters (total volume of 264.8 cm3). In bootstrap analysis, only 0.12% of voxels, were labelled as “unstable” – with a greater reachability distance in cluster scheme compared to their corresponding mean bootstrapped reachability distance. On visual assessment, the mother/main clusters were formed along supply territories of main cerebral arteries at initial hierarchical levels, and then tiny clusters emerged in deep white matter and gray matter nuclei prone to small vessel ischemic infarcts. Conclusions Applying voxel-wise data-driven hierarchical density clustering on a large number of infarct lesions, we have parcellated the brain tissue into clusters of voxels that tend to be part of same infarct lesion, and presumably representing end-arterial supply territories. This hierarchical stroke atlas of the brain is shared publicly, and can potentially be applied for future infarct location-outcome analysis. Using data-driven density clustering, a hierarchical brain atlas is constructed to identify voxels likely to infarct together. Different clusters can potentially be extracted from dendrogram through thresholding at different reachability thresholds. The hierarchical stroke atlas hypothetically represents the detailed anatomical distribution of distal arties in the brain. The stroke atlas is made publicly available for potential future location-outcome correlation studies in stroke patients.
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Affiliation(s)
- Yanlu Wang
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
| | - Julia M Juliano
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA
| | - Sook-Lei Liew
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA; Stevens Neuroimaging and Informatics Institute, Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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13
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Payabvash S, Palacios EM, Owen JP, Wang MB, Tavassoli T, Gerdes M, Brandes-Aitken A, Marco EJ, Mukherjee P. Diffusion tensor tractography in children with sensory processing disorder: Potentials for devising machine learning classifiers. Neuroimage Clin 2019; 23:101831. [PMID: 31035231 PMCID: PMC6488562 DOI: 10.1016/j.nicl.2019.101831] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/22/2019] [Accepted: 04/18/2019] [Indexed: 12/11/2022]
Abstract
The "sensory processing disorder" (SPD) refers to brain's inability to organize sensory input for appropriate use. In this study, we determined the diffusion tensor imaging (DTI) microstructural and connectivity correlates of SPD, and apply machine learning algorithms for identification of children with SPD based on DTI/tractography metrics. A total of 44 children with SPD and 41 typically developing children (TDC) were prospectively recruited and scanned. In addition to fractional anisotropy (FA), mean diffusivity (MD), and radial diffusivity (RD), we applied probabilistic tractography to generate edge density (ED) and track density (TD) from DTI maps. For identification of children with SPD, accurate classification rates from a combination of DTI microstructural (FA, MD, AD, and RD), connectivity (TD) and connectomic (ED) metrics with different machine learning algorithms - including naïve Bayes, random forest, support vector machine, and neural networks - were determined. In voxel-wise analysis, children with SPD had lower FA, ED, and TD but higher MD and RD compared to TDC - predominantly in posterior white matter tracts including posterior corona radiata, posterior thalamic radiation, and posterior body and splenium of corpus callosum. In stepwise penalized logistic regression, the only independent variable distinguishing children with SPD from TDC was the average TD in the splenium (p < 0.001). Among different combinations of machine learning algorithms and DTI/connectivity metrics, random forest models using tract-based TD yielded the highest accuracy in classification of SPD - 77.5% accuracy, 73.8% sensitivity, and 81.6% specificity. Our findings demonstrate impaired microstructural and connectivity/connectomic integrity in children with SPD, predominantly in posterior white matter tracts, and with reduced TD of the splenium of corpus callosum as the most distinctive pattern. Applying machine learning algorithms, these connectivity metrics can be used to devise novel imaging biomarkers for neurodevelopmental disorders.
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Affiliation(s)
- Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America; Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America
| | - Eva M Palacios
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America
| | - Julia P Owen
- Department of Radiology, University of Washington, Seattle, WA, United States of America
| | - Maxwell B Wang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America
| | - Teresa Tavassoli
- Department of Psychology and Clinical Sciences, University of Reading, Reading, United Kingdom
| | - Molly Gerdes
- Department of Neurology, University of California, San Francisco, CA, United States of America
| | - Anne Brandes-Aitken
- Department of Applied Psychology, New York University, New York, NY, United States of America
| | - Elysa J Marco
- Department of Neurology, University of California, San Francisco, CA, United States of America; Department of Pediatric Neurology, Cortica Healthcare, San Rafael, CA, United States of America
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States of America; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States of America.
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14
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Abstract
Acute ischemic stroke represents a major cause of long-term adult disability. Accurate prognostication of post-stroke functional outcomes is invaluable in guiding patient care, targeting early rehabilitation efforts, selecting patients for clinical research, and conveying realistic expectations to families. The involvement of specific brain regions by acute ischemia can alter post-stroke recovery potential. Understanding the influences of infarct topography on neurologic outcomes holds significant promise in prognosis of functional recovery. In this review, we discuss the recent evidence of the contribution of infarct location to patient management decisions and functional outcomes after acute ischemic stroke.
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Affiliation(s)
- Mark R Etherton
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Natalia S Rost
- 1 Harvard Medical School, Boston, MA, USA.,2 Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ona Wu
- 1 Harvard Medical School, Boston, MA, USA.,3 Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
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15
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Multivariate Prognostic Model of Acute Stroke Combining Admission Infarct Location and Symptom Severity: A Proof-of-Concept Study. J Stroke Cerebrovasc Dis 2017; 27:936-944. [PMID: 29198948 DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/23/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The information on topographic distribution of acute ischemic infarct can contribute to prediction of functional outcome. We aimed to develop a multivariate model for stroke prognostication, combining admission clinical and imaging variables, including the infarct topology. METHODS Acute ischemic stroke patients without baseline functional disability who had magnetic resonance imaging within 24 hours of onset or last-seen-well were included. The admission stroke severity was determined using the National Institutes of Health Stroke Scale (NIHSS) score. The relation between infarct location and outcome was assessed using both voxel-based and visual atlas-based analyses. The disability/death was defined by a modified Rankin Scale score greater than 2 at 3-month follow-up. RESULTS Among 198 patients included in this study, higher admission NIHSS score (P < .001), larger infarct volume (P < .001), and major arterial occlusions (P < .001) were associated with disability/death in univariate analyses. On voxel-based analysis, infarcts in the middle centrum semiovale, insula, and midbrain/pons were associated with higher rates of disability/death. In multivariate analysis, admission NIHSS score (P < .001), infarction of insula (P = .005), and midbrain/pons (P = .006) were independent predictors of disability/death. In receiver operating characteristics analysis, a simple 0-to-3 scoring system using these 3 variables had an area under the curve of .812 for prediction of disability/death (P < .001). CONCLUSIONS Admission symptom severity, infarction of insula, and midbrain/pons were independent predictors of clinical outcome in acute ischemic stroke patients. The methodology of this hypothesis-generating study can help conceive quantitative population-based probabilistic models for prognostication or treatment triage in stroke patients, combining admission clinical and imaging findings-including infarct topography.
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