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Xu XQ, Ma G, Shen GC, Lu SS, Shi HB, Zhang YX, Zhang Y, Wu FY, Liu S. Spatial accuracy of computed tomography perfusion to estimate the follow-up infarct on diffusion-weighted imaging after successful mechanical thrombectomy. BMC Neurol 2023; 23:31. [PMID: 36670367 PMCID: PMC9854062 DOI: 10.1186/s12883-023-03075-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/17/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Volumetric accuracy of using computed tomography perfusion (CTP) to estimate the post-treatment infarct in stroke patients with successful recanalization after mechanical thrombectomy (MT) has been studied a lot, however the spatial accuracy and its influence factors has not been fully investigated. METHODS This retrospective study reviewed the data from consecutive anterior large vessel occlusion (LVO) patients who had baseline CTP, successful recanalization after MT, and post-treatment diffusion-weighed imaging (DWI). Ischemic core on baseline CTP was estimated using relative cerebral blood flood (CBF) of < 30%. The infarct area was outlined manually on post-treatment DWI, and registered to CTP. Spatial agreement was assessed using the Dice similarity coefficient (DSC) and average Hausdorff distance. According to the median DSC, the study population was dichotomized into high and low Dice groups. Univariable and multivariable regression analyses were used to determine the factors independently associated with the spatial agreement. RESULTS In 72 included patients, the median DSC was 0.26, and the median average Hausdorff distance was 1.77 mm. High Dice group showed significantly higher median ischemic core volume on baseline CTP (33.90 mL vs 3.40 mL, P < 0.001), lower proportion of moderate or severe leukoaraiosis [27.78% vs 52.78%, P = 0.031], and higher median infarct volume on follow-up DWI (51.17 mL vs 9.42 mL, P < 0.001) than low Dice group. Ischemic core volume on baseline CTP was found to be independently associated with the spatial agreement (OR, 1.092; P < 0.001). CONCLUSIONS CTP could help to spatially locate the post-treatment infarct in anterior LVO patients who achieving successful recanalization after MT. Ischemic core volume on baseline CTP was independently associated with the spatial agreement.
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Affiliation(s)
- Xiao-Quan Xu
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gao Ma
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guang-Chen Shen
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shan-Shan Lu
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Bin Shi
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ya-Xi Zhang
- Shukun Network Technology Co., Ltd, Beijing, China
| | - Yu Zhang
- Shukun Network Technology Co., Ltd, Beijing, China
| | - Fei-Yun Wu
- grid.412676.00000 0004 1799 0784Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sheng Liu
- grid.412676.00000 0004 1799 0784Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kilic M, Scalzo F, Lyle C, Baldaranov D, Dirnbacher M, Honda T, Liebeskind DS, Schlachetzki F. A mobile battery-powered brain perfusion ultrasound (BPU) device designed for prehospital stroke diagnosis: correlation to perfusion MRI in healthy volunteers. Neurol Res Pract 2022; 4:13. [PMID: 35399083 PMCID: PMC8996400 DOI: 10.1186/s42466-022-00179-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/11/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Early prehospital stroke identification is crucial for goal directed hospital admission especially in rural areas. However, clinical prehospital stroke scales are designed to identify any stroke but cannot sufficiently differentiate hemorrhagic from ischemic stroke, including large vessel occlusion (LVO) amenable to mechanical thrombectomy. We report on a novel small, portable and battery driven point-of-care ultrasound system (SONAS®) specifically developed for mobile non-invasive brain perfusion ultrasound (BPU) measurement after bolus injection of an echo-enhancing agent suitable for the use in prehospital stroke diagnosis filling a current, unmet and critical need for LVO identification. METHODS In a phase I study of healthy volunteers we performed comparative perfusion-weighted magnetic resonance imaging (PWI) and BPU measurements, including safety analysis. RESULTS Twelve volunteers (n = 7 females, n = 5 males, age ranging between 19 and 55 years) tolerated the measurement extremely well including analysis of blood-brain barrier integrity, and the correlation coefficient between the generated time kinetic curves after contrast agent bolus between PWI and BPU transducers ranged between 0.89 and 0.76. CONCLUSIONS Mobile BPU using the SONAS® device is feasible and safe with results comparable to PWI. When applied in conjunction with prehospital stroke scales this may lead to a more accurate stroke diagnosis and patients bypassing regular stroke units to comprehensive stroke centers. Further studies are needed in acute stroke patients and in the prehospital phase including assessment of immediate and long-term morbidity and mortality in stroke. TRIAL REGISTRATION Clinical trials.gov, registered 28.Sep.2017, Identifier: NCT03296852.
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Affiliation(s)
- Mustafa Kilic
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, medbo Bezirksklinikum Regensburg, Universitaetsstr.84, 93053, Regensburg, Germany
| | - Fabien Scalzo
- Department of Neurology, UCLA Stroke Center and Brain Research Institute, 635 Charles E Young Drive South, Suite 116, Los Angeles, CA, 90095, USA
| | - Chandler Lyle
- BURL Concepts, Inc., 4901 Morena Boulevard Suite 703, San Diego, CA, 92117, USA
| | - Dobri Baldaranov
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, medbo Bezirksklinikum Regensburg, Universitaetsstr.84, 93053, Regensburg, Germany
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, 9860 Mesa Rim Road, San Diego, CA, 92121, USA
| | | | - Tristan Honda
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California Los Angeles, Ronald Reagan UCLA Medical Center, 300 Medical Plaza Driveway B200, Los Angeles, CA, 90095, USA
| | - David S Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California Los Angeles, Ronald Reagan UCLA Medical Center, 300 Medical Plaza Driveway B200, Los Angeles, CA, 90095, USA
| | - Felix Schlachetzki
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, medbo Bezirksklinikum Regensburg, Universitaetsstr.84, 93053, Regensburg, Germany.
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Bhan C, Koehler TJ, Elisevich L, Singer J, Mazaris P, James E, Zachariah J, Combs J, Dejesus M, Tubergen T, Packard L, Min J, Wees N, Khan N, Mulderink T, Khan M. Mechanical Thrombectomy for Acute Stroke: Early versus Late Time Window Outcomes. J Neuroimaging 2020; 30:315-320. [DOI: 10.1111/jon.12698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chantal Bhan
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | | | | | - Justin Singer
- Michgan State University East Lansing MI
- Division of Neurosurgery, Neuroscience InstituteSpectrum Health Grand Rapids MI
| | - Paul Mazaris
- Michgan State University East Lansing MI
- University of Michigan Ann Arbor MI
| | - Elysia James
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | - Joseph Zachariah
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | - Jordan Combs
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | - Michelle Dejesus
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | | | - Laurel Packard
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
| | - Jiangyong Min
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | - Nabil Wees
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | - Nadeem Khan
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
| | - Todd Mulderink
- Department of RadiologySpectrum Health Grand Rapids MI
- Division of RadiologyMichigan State University Grand Rapids MI
- Advanced Radiology ServicesPC Grand Rapids MI
| | - Muhib Khan
- Division of Neurology, Neuroscience InstituteSpectrum Health Grand Rapids MI
- Michgan State University East Lansing MI
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