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Grau García M, Pérez Bea M, Angulo Saiz A, Díez Fontaneda V, Cintora Leon E. Update on imaging in Code Stroke. RADIOLOGÍA (ENGLISH EDITION) 2023; 65 Suppl 1:S3-S10. [PMID: 37024228 DOI: 10.1016/j.rxeng.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/31/2022] [Indexed: 04/08/2023]
Abstract
"Code Stroke" is a multidisciplinary procedure designed to detect acute ischemic strokes and transfer patients for early reperfusion. Selecting these patients requires multimodal imaging with either CT or MRI. 1) Conventional studies without contrast material are obligatory to detect bleeding. Applying the ASPECTS scale, these studies can also identify and quantify areas of early infarction. 2) In candidates for mechanical thrombectomy, angiographic studies are necessary to identify stenoses and obstructions and to evaluate the collateral circulation. 3) Patients with known onset between 6 and 24h or with unknown onset require perfusion studies to distinguish between infracted tissue and recoverable ischemic tissue. Semi-automatic software facilitates diagnosis, but radiologists must interpret its output.
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Affiliation(s)
- M Grau García
- Médico adjunto de Radiodiagnóstico, Sección Urgencias, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain.
| | - M Pérez Bea
- Médico adjunto de Radiodiagnóstico, Sección Urgencias, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - A Angulo Saiz
- Médico adjunto de Radiodiagnóstico, Sección Urgencias, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - V Díez Fontaneda
- Médico residente de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - E Cintora Leon
- Jefa de Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
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Grau García M, Pérez Bea M, Angulo Saiz A, Díez Fontaneda V, Cintora Leon E. Actualización del código ictus en urgencias. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Study on Model Iterative Reconstruction Algorithm vs. Filter Back Projection Algorithm for Diagnosis of Acute Cerebral Infarction Using CT Images. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5000102. [PMID: 34394893 PMCID: PMC8360711 DOI: 10.1155/2021/5000102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
The aim was to explore the application value of computed tomography (CT) perfusion (CTP) imaging based on the iterative model reconstruction (IMR) in the diagnosis of acute cerebral infarction (ACI). 80 patients with ACI, admitted to hospital, were selected as the research objects and divided randomly into a routine treatment group (group A) and a low-dose group (group B) (each group with 40 patients). Patients in group A were scanned at 80 kV–150 mAs, and the traditional filtered back projection (FBP) algorithm was employed to reconstruct the images; besides, 80 kV–30 mAs was adopted to scan the patients in group B, and the images were reconstructed by IMR1, IMR2, IMR3, iDose4 (a kind of hybrid iterative reconstruction technology), and FBP, respectively. The application values of different algorithms were evaluated by CTP based on the collected CTP images of patients and detecting indicators. The results showed that the gray and white matter CT value, SD value, SNR, CNR, and subjective image scores of patients in group B were basically consistent with those of group A (p > 0.05) after the IMR1 reconstruction, and the CT and SD of gray and white matter in patients from group B reduced steeply (p < 0.05), while SNR and CNR increased dramatically after IMR2 and IMR3 reconstruction in contrast to group A (p < 0.05). Furthermore, the cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT) of contrast agent, and time to peak (TTP) of contrast agent in patients from group B after iDose4 and IMR reconstruction were basically the same as those of group A (p > 0.05). Therefore, IMR combined with low-dose CTP could obtain high-quality CTP images of the brain with stable perfusion indicators and low radiation dose, which could be clinically applied in the diagnosis of ACI.
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Matei N, Camara J, Zhang JH. The Next Step in the Treatment of Stroke. Front Neurol 2021; 11:582605. [PMID: 33551950 PMCID: PMC7862333 DOI: 10.3389/fneur.2020.582605] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/23/2020] [Indexed: 12/12/2022] Open
Abstract
Although many patients do not receive reperfusion therapy because of delayed presentation and/or severity and location of infarct, new reperfusion approaches are expanding the window of intervention. Novel application of neuroprotective agents in combination with the latest methods of reperfusion provide a path to improved stroke intervention outcomes. We examine why neuroprotective agents have failed to translate to the clinic and provide suggestions for new approaches. New developments in recanalization therapy in combination with therapeutics evaluated in parallel animal models of disease will allow for novel, intra-arterial deployment of therapeutic agents over a vastly expanded therapeutic time window and with greater likelihood success. Although the field of neuronal, endothelial, and glial protective therapies has seen numerous large trials, the application of therapies in the context of newly developed reperfusion strategies is still in its infancy. Given modern imaging developments, evaluation of the penumbra will likely play a larger role in the evolving management of stroke. Increasingly more patients will be screened with neuroimaging to identify patients with adequate collateral blood supply allowing for delayed rescue of the penumbra. These patients will be ideal candidates for therapies such as reperfusion dependent therapeutic agents that pair optimally with cutting-edge reperfusion techniques.
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Affiliation(s)
- Nathanael Matei
- Department of Ophthalmology, University of Southern California, Los Angeles, CA, United States
| | - Justin Camara
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, United States.,Department of Anesthesiology, Loma Linda University, Loma Linda, CA, United States.,Department of Neurosurgery, Loma Linda University, Loma Linda, CA, United States
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Xiao J, Li J, Yang Q, Liu M. Research on the Head and Neck MRA Image to Explore the Comprehensive Effect on the Recovery of Neurological Function and Rehabilitation Nursing of Patients with Acute Stroke. World Neurosurg 2020; 149:420-427. [PMID: 33130135 DOI: 10.1016/j.wneu.2020.10.135] [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] [Received: 09/17/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND This paper uses head and neck magnetic resonance angiography (MRA) images in the diagnosis of acute ischemic stroke (AIS), as well as the neurologic rehabilitation and the effect of rehabilitation treatment in patients with acute stroke. METHODS We used computed tomography and head and neck MRA images to calculate the sensitivity and specificity of AIS. We measured the parameters of cerebral blood flow, cerebral blood volume, mean transit time, and peak transit time, and evaluated the degree of cerebral artery stenosis. We also analyzed the changes in these parameters in different diseased brain tissues and their correlation with the degree of cerebral artery stenosis. We used comprehensive rehabilitation care interventions on patients. RESULTS Among 294 patients, 253 (86.05%) were finally diagnosed with AIS. The sensitivity and specificity of head and neck MRA images were 85.37% and 92.68%, respectively. CONCLUSIONS Examination can effectively assess cerebral hemodynamic changes, the severity of ischemia, and accurately distinguish between infarct area and penumbra. MRA images of the head and neck can accurately detect the location and degree of cerebral artery stenosis. The combination of the two methods can not only accurately diagnose AIS, but also evaluate the condition and efficacy of the disease, and provide an imaging basis for the clinical choice of reasonable treatment options. Comprehensive rehabilitation care can significantly improve the neurologic function and quality of life of prospective patients.
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Affiliation(s)
- Juan Xiao
- Department of Neurology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jirong Li
- Department of Radiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Qiming Yang
- Department of Neurology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Meng Liu
- Department of Nursing, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
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Grau García M, Pérez Bea M, López Medina A. Papel del estudio radiológico multimodal en el código ictus. RADIOLOGIA 2018; 60:3-9. [DOI: 10.1016/j.rx.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/11/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022]
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Reinhardt M, Brandmaier P, Seider D, Kolesnik M, Jenniskens S, Sequeiros RB, Eibisberger M, Voglreiter P, Flanagan R, Mariappan P, Busse H, Moche M. A prospective development study of software-guided radio-frequency ablation of primary and secondary liver tumors: Clinical intervention modelling, planning and proof for ablation cancer treatment (ClinicIMPPACT). Contemp Clin Trials Commun 2017; 8:25-32. [PMID: 29696193 PMCID: PMC5898513 DOI: 10.1016/j.conctc.2017.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/12/2017] [Accepted: 08/14/2017] [Indexed: 01/26/2023] Open
Abstract
Introduction Radio-frequency ablation (RFA) is a promising minimal-invasive treatment option for early liver cancer, however monitoring or predicting the size of the resulting tissue necrosis during the RFA-procedure is a challenging task, potentially resulting in a significant rate of under- or over treatments. Currently there is no reliable lesion size prediction method commercially available. Objectives ClinicIMPPACT is designed as multicenter-, prospective-, non-randomized clinical trial to evaluate the accuracy and efficiency of innovative planning and simulation software. 60 patients with early liver cancer will be included at four European clinical institutions and treated with the same RFA system. The preinterventional imaging datasets will be used for computational planning of the RFA treatment. All ablations will be simulated simultaneously to the actual RFA procedure, using the software environment developed in this project. The primary outcome measure is the comparison of the simulated ablation zones with the true lesions shown in follow-up imaging after one month, to assess accuracy of the lesion prediction. Discussion This unique multicenter clinical trial aims at the clinical integration of a dedicated software solution to accurately predict lesion size and shape after radiofrequency ablation of liver tumors. Accelerated and optimized workflow integration, and real-time intraoperative image processing, as well as inclusion of patient specific information, e.g. organ perfusion and registration of the real RFA needle position might make the introduced software a powerful tool for interventional radiologists to optimize patient outcomes.
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Affiliation(s)
- Martin Reinhardt
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Philipp Brandmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Daniel Seider
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Marina Kolesnik
- Fraunhofer Institute for Applied Information Technology FIT, Germany
| | - Sjoerd Jenniskens
- Department of Diagnostic and Interventional Radiology, University Hospital Nijmegen, The Netherlands
| | | | - Martin Eibisberger
- Department of Surgery, Medical University Graz, Austria.,University Clinic of Radiology Graz, Graz, Austria
| | - Philip Voglreiter
- Graz University of Technology, Institute of Computer Graphics and Vision, Austria
| | | | | | - Harald Busse
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
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El-Tawil S, Wardlaw J, Ford I, Mair G, Robinson T, Kalra L, Muir KW. Penumbra and re-canalization acute computed tomography in ischemic stroke evaluation: PRACTISE study protocol. Int J Stroke 2017; 12:671-678. [PMID: 28730951 DOI: 10.1177/1747493017696099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rationale Multimodal imaging, including computed tomography angiography and computed tomography perfusion imaging, yields additional information on intracranial vessels and brain perfusion and can differentiate between ischemic core and penumbra which may affect patient selection for intravenous thrombolysis. Hypothesis The use of multimodal imaging will increase the number of patients receiving intravenous thrombolysis and lead to better treatment outcomes. Sample size 400 patients. Methods and design PRACTISE is a prospective, multicenter, randomized, controlled trial in which patients presenting within 4.5 h of symptom onset are randomized to either the current evidence-based imaging (NCCT alone) or additional multimodal computed tomography imaging (NCCT + computed tomography angiography + computed tomography perfusion). Clinical decisions on intravenous recombinant tissue plasminogen activator are documented. Total imaging time in both arms and time to initiation of treatment delivery in those treated with intravenous recombinant tissue plasminogen activator, is recorded. Follow-up will include brain imaging at 24 h to document infarct size, the presence of edema and the presence of intra-cerebral hemorrhage. Clinical evaluations include NIHSS score at baseline, 24 h and day 7 ± 2, and mRS at day 90 to define functional outcomes. Study outcomes The primary outcome is the proportion of patients receiving intravenous recombinant tissue plasminogen activator. Secondary end-points evaluate times to decision-making, comparison of different image processing software and clinical outcomes at three months. Discussion Multimodal computed tomography is a widely available tool for patient selection for revascularization therapy, but it is currently unknown whether the use of additional imaging in all stroke patients is beneficial. The study opened for recruitment in March 2015 and will provide data on the value of multimodal imaging in treatment decisions for acute stroke.
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Affiliation(s)
- Salwa El-Tawil
- 1 Institute of Neuroscience & Psychology, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Joanna Wardlaw
- 2 Division of Neuroimaging Sciences, Western General Hospital, Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Ian Ford
- 3 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Grant Mair
- 2 Division of Neuroimaging Sciences, Western General Hospital, Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Tom Robinson
- 4 Department of Cardiovascular Sciences, Ageing and Stroke Medicine Group, University of Leicester, Leicester, UK
| | - Lalit Kalra
- 5 Department of Basic and Clinical Neurosciences, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Keith W Muir
- 1 Institute of Neuroscience & Psychology, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
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Abstract
Recent rapid advances in endovascular treatment for acute ischemic stroke highlight the crucial role of neuroimaging especially multimodal computed tomography (CT) including CT perfusion in stroke triage and management decisions. With an increasing focus on changes in cerebral physiology along with time-based matrices in clinical decisions for acute ischemic stroke, CT perfusion provides a rapid and practical modality for assessment and identification of salvageable tissue at risk and infarct core and provides a better understanding of the changes in cerebral physiology. Although there are challenges with the lack of standardization and accuracy of quantitative assessment, CT perfusion is evolving as a cornerstone for imaging-based strategies in the rapid management of acute ischemic stroke.
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Affiliation(s)
- Pradeep Krishnan
- *Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre †Diagnostic Imaging, The Hospital for Sick Children ‡Division of Neuroradiology, Department of Medical Imaging, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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McDermott M, Jacobs T, Morgenstern L. Critical care in acute ischemic stroke. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:153-176. [PMID: 28187798 DOI: 10.1016/b978-0-444-63600-3.00010-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Most ischemic strokes are managed on the ward or on designated stroke units. A significant proportion of patients with ischemic stroke require more specialized care. Several studies have shown improved outcomes for patients with acute ischemic stroke when neurocritical care services are available. Features of acute ischemic stroke patients requiring intensive care unit-level care include airway or respiratory compromise; large cerebral or cerebellar hemisphere infarction with swelling; infarction with symptomatic hemorrhagic transformation; infarction complicated by seizures; and a large proportion of patients require close management of blood pressure after thrombolytics. In this chapter, we discuss aspects of acute ischemic stroke care that are of particular relevance to a neurointensivist, covering neuropathology, neurodiagnostics and imaging, blood pressure management, glycemic control, temperature management, and the selection and timing of antithrombotics. We also focus on the care of patients who have received intravenous thrombolysis or mechanical thrombectomy. Complex clinical decision making in decompressive hemicraniectomy for hemispheric infarction and urgent management of basilar artery thrombosis are specifically addressed.
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Affiliation(s)
- M McDermott
- Stroke Program, University of Michigan, Ann Arbor, MI, USA.
| | - T Jacobs
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - L Morgenstern
- Stroke Program, University of Michigan, Ann Arbor, MI, USA
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Kasasbeh AS, Christensen S, Straka M, Mishra N, Mlynash M, Bammer R, Albers GW, Lansberg MG. Optimal Computed Tomographic Perfusion Scan Duration for Assessment of Acute Stroke Lesion Volumes. Stroke 2016; 47:2966-2971. [PMID: 27895299 DOI: 10.1161/strokeaha.116.014177] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The minimal scan duration needed to obtain reliable lesion volumes with computed tomographic perfusion (CTP) has not been well established in the literature. METHODS We retrospectively assessed the impact of gradual truncation of the scan duration on acute ischemic lesion volume measurements. For each scan, we identified its optimal scan time, defined as the shortest scan duration that yields measurements of the ischemic lesion volumes similar to those obtained with longer scanning, and the relative height of the fitted venous output function at its optimal scan time. RESULTS We analyzed 70 computed tomographic perfusion scans of acute stroke patients. An optimal scan time could not be determined in 11 scans (16%). For the other 59 scans, the median optimal scan time was 32.7 seconds (90th percentile 52.6 seconds; 100th percentile 68.9 seconds), and the median relative height of the fitted venous output function at the optimal scan times was 0.39 (90th percentile 0.02; 100th percentile 0.00). On the basis of a linear model, the optimal scan time was T0 plus 1.6 times the width of the venous output function (P<0.001; R2=0.49). CONCLUSIONS This study shows how the optimal duration of a computed tomographic perfusion scan relates to the arrival time and width of the contrast bolus. This knowledge can be used to optimize computed tomographic perfusion scan protocols and to determine whether a scan is of sufficient duration. Provided a baseline (T0) of 10 seconds, a total scan duration of 60 to 70 seconds, which includes the entire downslope of the venous output function in most patients, is recommended.
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Affiliation(s)
- Aimen S Kasasbeh
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Søren Christensen
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Matus Straka
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Nishant Mishra
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Michael Mlynash
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Roland Bammer
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Gregory W Albers
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA
| | - Maarten G Lansberg
- From the Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA.
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Chiu AH, Phillips TJ, Phatouros CC, Singh TP, Hankey GJ, Blacker DJ, McAuliffe W. CT perfusion in acute stroke calls: A pictorial review and differential diagnoses. J Med Imaging Radiat Oncol 2015; 60:165-71. [DOI: 10.1111/1754-9485.12422] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Albert H Chiu
- Neurological Intervention and Imaging Service of WA (NIISwa); Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - Timothy J Phillips
- Neurological Intervention and Imaging Service of WA (NIISwa); Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - Constantine C Phatouros
- Neurological Intervention and Imaging Service of WA (NIISwa); Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - Tejinder P Singh
- Neurological Intervention and Imaging Service of WA (NIISwa); Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - Graeme J Hankey
- Department of Neurology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
- School of Medicine and Pharmacology; The University of Western Australia; Crawley Western Australia Australia
| | - David J Blacker
- Department of Neurology; Sir Charles Gairdner Hospital; Perth Western Australia Australia
- Western Australian Neuroscience Research Institute; Nedlands Western Australia Australia
| | - William McAuliffe
- Neurological Intervention and Imaging Service of WA (NIISwa); Sir Charles Gairdner Hospital; Perth Western Australia Australia
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Bennink E, Oosterbroek J, Horsch AD, Dankbaar JW, Velthuis BK, Viergever MA, de Jong HWAM. Influence of Thin Slice Reconstruction on CT Brain Perfusion Analysis. PLoS One 2015; 10:e0137766. [PMID: 26361391 PMCID: PMC4567308 DOI: 10.1371/journal.pone.0137766] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 08/21/2015] [Indexed: 12/03/2022] Open
Abstract
Objectives Although CT scanners generally allow dynamic acquisition of thin slices (1 mm), thick slice (≥5 mm) reconstruction is commonly used for stroke imaging to reduce data, processing time, and noise level. Thin slice CT perfusion (CTP) reconstruction may suffer less from partial volume effects, and thus yield more accurate quantitative results with increased resolution. Before thin slice protocols are to be introduced clinically, it needs to be ensured that this does not affect overall CTP constancy. We studied the influence of thin slice reconstruction on average perfusion values by comparing it with standard thick slice reconstruction. Materials and Methods From 50 patient studies, absolute and relative hemisphere averaged estimates of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and permeability-surface area product (PS) were analyzed using 0.8, 2.4, 4.8, and 9.6 mm slice reconstructions. Specifically, the influence of Gaussian and bilateral filtering, the arterial input function (AIF), and motion correction on the perfusion values was investigated. Results Bilateral filtering gave noise levels comparable to isotropic Gaussian filtering, with less partial volume effects. Absolute CBF, CBV and PS were 22%, 14% and 46% lower with 0.8 mm than with 4.8 mm slices. If the AIF and motion correction were based on thin slices prior to reconstruction of thicker slices, these differences reduced to 3%, 4% and 3%. The effect of slice thickness on relative values was very small. Conclusions This study shows that thin slice reconstruction for CTP with unaltered acquisition protocol gives relative perfusion values without clinically relevant bias. It does however affect absolute perfusion values, of which CBF and CBV are most sensitive. Partial volume effects in large arteries and veins lead to overestimation of these values. The effects of reconstruction slice thickness should be taken into account when absolute perfusion values are used for clinical decision making.
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Affiliation(s)
- Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
| | - Jaap Oosterbroek
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexander D. Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max A. Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo W. A. M. de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
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Schwaiger BJ, Gersing AS, Zimmer C, Prothmann S. The Curved MCA: Influence of Vessel Anatomy on Recanalization Results of Mechanical Thrombectomy after Acute Ischemic Stroke. AJNR Am J Neuroradiol 2015; 36:971-6. [PMID: 25634721 DOI: 10.3174/ajnr.a4222] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/17/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vessel anatomy is assumed to influence results of endovascular mechanical thrombectomy using stent retrievers. The purpose of this study was to analyze the influence of vessel curvature on recanalization results in patients with acute ischemic stroke caused by large-vessel occlusion. MATERIALS AND METHODS In 159 patients (70 ± 12.8 years of age; 79 women) treated for acute ischemic stroke after carotid T and/or MCA occlusion by using stent retrievers, the following angles were measured in standard anteroposterior angiograms to describe vessel anatomy: first, between the terminal ICA segment and the most downward curved M1 segment conterminous to the proximal face of the thrombus (ICA/M1 angle); second, between the most proximal M1 segment and the segment immediately conterminous to the thrombus (M1/M1 angle); and additionally, in patients with distal M1/proximal M2 occlusion, the angle of the last curvature proximal of the thrombus (M1/M2 angle). Angles of patients with-versus-without successful recanalization were compared. RESULTS Patients without successful recanalization (TICI 0-2a) showed significantly larger ICA/M1 angles (mean, 110°± 23.8° versus 69°± 28.7°, P < .001) and significantly larger M1/M1 angles (56°± 29.2° versus 29°± 26.6°, P = .001) than patients with successful recanalization (TICI 2b/3). In patients without successful recanalization after a distal M1 or proximal M2 occlusion, the M1/M2 angle was significantly larger than that in patients with successful recanalization (117° ± 34.3° versus 67° ± 29.5°, P = .006). CONCLUSIONS This retrospective analysis showed that mechanical thrombectomy in the anterior circulation was significantly less often successful in patients with large vessel angles. Therefore, vessel curvature significantly influences the results of mechanical thrombectomy with stent retrievers for treatment of acute ischemic stroke. Further work is needed to understand the underlying causality.
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Affiliation(s)
- B J Schwaiger
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany.
| | - A S Gersing
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - C Zimmer
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - S Prothmann
- From the Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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