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Yeager CE, Garg RK. Advances and Future Trends in the Diagnosis and Management of Intracerebral Hemorrhage. Neurol Clin 2024; 42:689-703. [PMID: 38937036 DOI: 10.1016/j.ncl.2024.03.004] [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: 06/29/2024]
Abstract
Spontaneous intracerebral hemorrhage accounts for approximately 10% to 15% of all strokes in the United States and remains one of the deadliest. Of concern is the increasing prevalence, especially in younger populations. This article reviews the following: epidemiology, risk factors, outcomes, imaging findings, medical management, and updates to surgical management.
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Affiliation(s)
- Christine E Yeager
- Division of Critical Care Neurology, Rush University Medical Center, 1725 W Harrison Street, Suite 1106, Chicago, IL, USA.
| | - Rajeev K Garg
- Division of Critical Care Neurology, Section of Cognitive Neurosciences, Rush University Medical Center, 1725 W Harrison Street, Suite 1106, Chicago, IL, USA
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Piqueras-Sanchez C, Esteve-Pastor MA, Moreno-Fernandez J, Soler-Espejo E, Rivera-Caravaca JM, Roldán V, Marín F. Advances in the medical treatment and diagnosis of intracranial hemorrhage associated with oral anticoagulation. Expert Rev Neurother 2024:1-16. [PMID: 39039686 DOI: 10.1080/14737175.2024.2379413] [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: 05/05/2024] [Accepted: 07/09/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION With the increasing prevalence of atrial fibrillation (AF), it entails expanding oral anticoagulants (OACs) use, carrying a higher risk of associated hemorrhagic events, including intracranial hemorrhage (ICH). Despite advances in OACs development with a better safety profile and reversal agent for these anticoagulants, there is still no consensus on the optimal management of patients with OACs-associated ICH. AREAS COVERED In this review, the authors have carried out an exhaustive search on the advances in recent years. The authors provide an update on the management of ICH in anticoagulated patients, as well as an update on the latest evidence on anticoagulation resumption, recent therapeutic strategies, and investigational drugs that could play a role in the future. EXPERT OPINION Following an ICH event in an anticoagulated patient, a comprehensive clinical evaluation is imperative. Anticoagulation should be promptly withdrawn and reversed. Once the patient is stabilized, a reintroduction of anticoagulation should be considered, typically within a timeframe of 4-8 weeks, if feasible. If re-anticoagulation is not possible, alternative options such as Left Atrial Appendage Occlusion are available.
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Affiliation(s)
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- CIBERCV, Murcia, Spain
| | - Jorge Moreno-Fernandez
- Department of Cardiology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Eva Soler-Espejo
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- Department of Hematology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
| | | | - Vanessa Roldán
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- Department of Hematology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen De La Arrixaca, Murcia, Spain
- Instituto Murciano De Investigación Biosanitaria (IMIB- Arrixaca), Murcia, Spain
- CIBERCV, Murcia, Spain
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Ruff IM, de Havenon A, Bergman DL, Dugue R, Frontera JA, Goldstein JN, Hemphill JC, Marulanda-Londono E, Prabhakaran S, Richards CT, Sunmonu NA, Vilar P, Wolfe SQ. 2024 AHA/ASA Performance and Quality Measures for Spontaneous Intracerebral Hemorrhage: A Report From the American Heart Association/American Stroke Association. Stroke 2024; 55:e199-e230. [PMID: 38695183 DOI: 10.1161/str.0000000000000464] [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: 06/26/2024]
Abstract
The American Heart Association/American Stroke Association released a revised spontaneous intracerebral hemorrhage guideline in 2022. A working group of stroke experts reviewed this guideline and identified a subset of recommendations that were deemed suitable for creating performance measures. These 15 performance measures encompass a wide spectrum of intracerebral hemorrhage patient care, from prehospital to posthospital settings, highlighting the importance of timely interventions. The measures also include 5 quality measures and address potential challenges in data collection, with the aim of future improvements.
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Suzuki K, Katano T, Numao S, Nishi Y, Kutsuna A, Kanamaru T, Saito T, Aoki J, Nishiyama Y, Kimura K. Clinical significance of intracranial hemorrhage after thrombectomy detected solely by magnetic resonance imaging and not by computed tomography. J Neurol Sci 2024; 460:122999. [PMID: 38705135 DOI: 10.1016/j.jns.2024.122999] [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] [Received: 03/05/2024] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Whether intracranial hemorrhage (ICH) detected using magnetic resonance imaging (MRI) affects the clinical outcomes of patients with large-vessel occlusion (LVO) treated with mechanical thrombectomy (MT) remains unclear. This study investigated the clinical features of ICH after MT detected solely by MRI. METHODS This was a retrospective analysis of patients with acute ischemic stroke and occlusion of the internal carotid artery or middle cerebral artery treated with MT between April 2011 and March 2021. Among 632 patients, patients diagnosed with no ICH using CT, with a pre-morbid modified Rankin Scale (mRS) score ≤ 2, and those who underwent MRI including T2* and computed tomography (CT) within 72 h from MT were enrolled. The main outcomes were the association between ICH detected solely by MRI and clinical outcomes at 90 days. Poor clinical outcomes were defined as mRS score > 2 at 90 days after onset. RESULTS Of the 246 patients, 29 (12%) had ICH on MRI (MRI-ICH(+)), and 217 (88%) were MRI-ICH(-). There was no significant difference between number of patients with MRI-ICH(+) experiencing poor (10 [12%]) and favorable (19 [12%]) outcomes. The mRS score at 90 days between patients with MRI-ICH (+) and MRI-ICH(-) was not significantly different (2 [1-4] vs. 2 [1-4], respectively). Higher age and lower ASPECTS were independent risk factors for poor outcomes, as shown by multivariate regression analysis. MRI-ICH(+) status was not associated with poor outcomes. CONCLUSIONS ICH detected by MRI alone did not influence clinical outcomes in patients with LVO treated with MT.
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Affiliation(s)
- Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Tokyo, Japan.
| | - Takehiro Katano
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | | | - Yuji Nishi
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Akihito Kutsuna
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Takuya Kanamaru
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Tomonari Saito
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | - Junya Aoki
- Department of Neurology, Nippon Medical School, Tokyo, Japan
| | | | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Tokyo, Japan
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Penckofer M, Kazmi KS, Thon J, Tonetti DA, Ries C, Rajagopalan S. Neuro-imaging in intracerebral hemorrhage: updates and knowledge gaps. Front Neurosci 2024; 18:1408288. [PMID: 38784090 PMCID: PMC11111865 DOI: 10.3389/fnins.2024.1408288] [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: 03/28/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Intracerebral hemorrhage (ICH) is characterized by hematoma development within the brain's parenchyma, contributing significantly to the burden of stroke. While non-contrast head computed tomography (CT) remains the gold standard for initial diagnosis, this review underscores the pivotal role of magnetic resonance imaging (MRI) in ICH management. Beyond diagnosis, MRI offers invaluable insights into ICH etiology, prognosis, and treatment. Utilizing echo-planar gradient-echo or susceptibility-weighted sequences, MRI demonstrates exceptional sensitivity and specificity in identifying ICH, aiding in differentiation of primary and secondary causes. Moreover, MRI facilitates assessment of hemorrhage age, recognition of secondary lesions, and evaluation of perihematomal edema progression, thus guiding tailored therapeutic strategies. This comprehensive review discusses the multifaceted utility of MRI in ICH management, highlighting its indispensable role in enhancing diagnostic accuracy as well as aiding in prognostication. As MRI continues to evolve as a cornerstone of ICH assessment, future research should explore its nuanced applications in personalized care paradigms.
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Affiliation(s)
- Mary Penckofer
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Khuram S. Kazmi
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neuroradiology, Cooper University Health Care, Camden, NJ, United States
| | - Jesse Thon
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurology, Cooper University Health Care, Camden, NJ, United States
| | - Daniel A. Tonetti
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurosurgery, Cooper University Health Care, Camden, NJ, United States
| | - Casey Ries
- Department of Radiology, Cooper University Health Care, Camden, NJ, United States
| | - Swarna Rajagopalan
- Cooper Medical School of Rowan University, Camden, NJ, United States
- Department of Neurology, Cooper University Health Care, Camden, NJ, United States
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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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Oshida S, Yokosawa T, Araya S, Sato S, Suzuki T, Akamatsu Y, Ogasawara K. Subarachnoid Hemorrhage Confirmed by Magnetic Resonance Imaging in a Patient with Brain Death owing to Hypoxic Encephalopathy Following Suicide by Hanging. NMC Case Rep J 2024; 11:61-67. [PMID: 38590926 PMCID: PMC10999757 DOI: 10.2176/jns-nmc.2023-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024] Open
Abstract
Although true subarachnoid hemorrhage (SAH) is an atypical complication owing to suicide by hanging, pseudo-SAH can often develop because of hypoxic encephalopathy. Therefore, differentiating pseudo-SAH from true SAH using brain computed tomography (CT) is often challenging. In Japan, an individual's cause of brain death must be determined to be eligible for organ donation, regardless of whether true SAH is involved or not. Herein, we report a case of SAH confirmed by magnetic resonance imaging (MRI) in a patient with brain death owing to hypoxic encephalopathy following suicide by hanging. A 48-year-old man attempted suicide by hanging. Upon arrival at the hospital, he developed pulseless electrical activity with apnea. Although spontaneous circulation returned within a few minutes of his arrival, spontaneous breathing did not recover. The patient was in deep comatose state without response to pain stimulation, brainstem reflexes, or electrical activities on an electroencephalogram. Consequently, the patient met diagnostic criteria for clinical brain death based on the Japanese organ transplantation law. Brain CT revealed global hypoxic injury and high density in the basal cisterns and subarachnoid space. Brain MR T2*-weighted imaging revealed low intensity at the left Sylvian fissure underlying the hematoma. These findings indicated brain death owing to hypoxic encephalopathy following hanging, and incidental true SAH was confirmed by MRI. Donor surgery and organ transplantation were performed. Spontaneous SAH can often develop secondary to hanging, and brain MRI can effectively determine whether the cause of brain death involves true SAH.
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Affiliation(s)
- Sotaro Oshida
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
- Department of Neurosurgery, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Tomoki Yokosawa
- Emergency and Critical Care Center, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Shizuka Araya
- Department of Neurosurgery, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Shinpei Sato
- Department of Neurosurgery, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Taro Suzuki
- Department of Neurosurgery, Iwate Prefectural Ofunato Hospital, Ofunato, Japan
| | - Yosuke Akamatsu
- Department of Neurosurgery, Iwate Medical University, Yahaba, Japan
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Zhang Y, Chen M, Liu C, He B, Dang H, Li J, Chen H, Liang Z. Global trends and research hotspots of stroke and magnetic resonance imaging: A bibliometric analysis. Medicine (Baltimore) 2023; 102:e36545. [PMID: 38134079 PMCID: PMC10735157 DOI: 10.1097/md.0000000000036545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND In this study, we used CiteSpace and VOSviewer to create a bibliometric visualization of research papers relating to stroke and magnetic resonance imaging (MRI) between 2000 and 2022. To fully understand the trends and hotspots in MRI and stroke research and provide new perspectives for future studies. METHODS The Web of Science Core Collection was selected as the source of data for this paper. Using CiteSpace and VOSviewer, publications were analyzed for authors, countries, institutions, journals, references, and keywords. RESULTS We found 1423 papers after searching and removing duplicates, which indicated an upward trend over the previous 23 years. Fiebach J.B. is the most published author (21 publications), Hacke W. is the most cited author (213 citations), and the United States (449 publications) and Harvard University (86 publications) are the most prolific nations and institutions. Stroke is the journal with the most co-citations (1275) and the most papers (171) published. The most representative reference was the 1995 article by Marler et al, which received 115 citations and had the top 3 co-occurring keywords: stroke, magnetic resonance imaging, and MRI. The article by Nogueria et al showed the strongest citation burst at the end of 2022 (strength = 17.32). High-frequency keywords in recent years are time, association, functional connectivity, thrombectomy, and rehabilitation. CONCLUSION This study provides a scientific perspective on stroke and MRI research, provides valuable information for researchers to understand the current status of research, hotspots, and trends, and guides future research directions.
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Affiliation(s)
- Yuting Zhang
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mengtong Chen
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunlong Liu
- College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingjie He
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Hongbin Dang
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Jiamin Li
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Hanwei Chen
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
| | - Zhenzhong Liang
- Department of Radiology, Panyu Health Management Center (Panyu Rehabilitation Hospital), Guangzhou, China
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Mazurek MH, Parasuram NR, Peng TJ, Beekman R, Yadlapalli V, Sorby-Adams AJ, Lalwani D, Zabinska J, Gilmore EJ, Petersen NH, Falcone GJ, Sujijantarat N, Matouk C, Payabvash S, Sze G, Schiff SJ, Iglesias JE, Rosen MS, de Havenon A, Kimberly WT, Sheth KN. Detection of Intracerebral Hemorrhage Using Low-Field, Portable Magnetic Resonance Imaging in Patients With Stroke. Stroke 2023; 54:2832-2841. [PMID: 37795593 PMCID: PMC11103256 DOI: 10.1161/strokeaha.123.043146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 09/13/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Neuroimaging is essential for detecting spontaneous, nontraumatic intracerebral hemorrhage (ICH). Recent data suggest ICH can be characterized using low-field magnetic resonance imaging (MRI). Our primary objective was to investigate the sensitivity and specificity of ICH on a 0.064T portable MRI (pMRI) scanner using a methodology that provided clinical information to inform rater interpretations. As a secondary aim, we investigated whether the incorporation of a deep learning (DL) reconstruction algorithm affected ICH detection. METHODS The pMRI device was deployed at Yale New Haven Hospital to examine patients presenting with stroke symptoms from October 26, 2020 to February 21, 2022. Three raters independently evaluated pMRI examinations. Raters were provided the images alongside the patient's clinical information to simulate real-world context of use. Ground truth was the closest conventional computed tomography or 1.5/3T MRI. Sensitivity and specificity results were grouped by DL and non-DL software to investigate the effects of software advances. RESULTS A total of 189 exams (38 ICH, 89 acute ischemic stroke, 8 subarachnoid hemorrhage, 3 primary intraventricular hemorrhage, 51 no intracranial abnormality) were evaluated. Exams were correctly classified as positive or negative for ICH in 185 of 189 cases (97.9% overall accuracy). ICH was correctly detected in 35 of 38 cases (92.1% sensitivity). Ischemic stroke and no intracranial abnormality cases were correctly identified as blood-negative in 139 of 140 cases (99.3% specificity). Non-DL scans had a sensitivity and specificity for ICH of 77.8% and 97.1%, respectively. DL scans had a sensitivity and specificity for ICH of 96.6% and 99.3%, respectively. CONCLUSIONS These results demonstrate improvements in ICH detection accuracy on pMRI that may be attributed to the integration of clinical information in rater review and the incorporation of a DL-based algorithm. The use of pMRI holds promise in providing diagnostic neuroimaging for patients with ICH.
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Affiliation(s)
- Mercy H. Mazurek
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Teng J. Peng
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Annabel J. Sorby-Adams
- Department of Neurology, Division of Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Dheeraj Lalwani
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Julia Zabinska
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Emily J. Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Nils H. Petersen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Sam Payabvash
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Gordon Sze
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Steven J. Schiff
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
- Yale Center for Brain & Mind Heath, Yale School of Medicine, New Haven, CT, USA
| | - Juan Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Centre for Medical Image Computing, University College London, London, UK
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matthew S. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - W. Taylor Kimberly
- Department of Neurology, Division of Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Yale Center for Brain & Mind Heath, Yale School of Medicine, New Haven, CT, USA
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Sotardi ST, Alves CAPF, Serai SD, Beslow LA, Schwartz ES, Magee R, Vossough A. Magnetic resonance imaging protocols in pediatric stroke. Pediatr Radiol 2023; 53:1324-1335. [PMID: 36604317 DOI: 10.1007/s00247-022-05576-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/30/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
Neuroimaging protocols play an important role in the timely evaluation and treatment of pediatric stroke and its mimics. MRI protocols for stroke in the pediatric population should be guided by the clinical scenario and neurologic examination, with consideration of age, suspected infarct type and underlying risk factors. Acute stroke diagnosis and causes in pediatric age groups can differ significantly from those in adult populations, and delay in stroke diagnosis among children is a common problem. An awareness of pediatric stroke presentations and risk factors among pediatric emergency physicians, neurologists, pediatricians, subspecialists and radiologists is critical to ensuring timely diagnosis. Given special considerations related to unique pediatric stroke risk factors and the need for sedation in some children, expert consensus guidelines for the imaging of suspected pediatric infarct have been proposed. In this article the authors review standard and rapid MRI protocols for the diagnosis of pediatric stroke, as well as the key differences between pediatric and adult stroke imaging.
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Affiliation(s)
- Susan T Sotardi
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Cesar Augusto P F Alves
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lauren A Beslow
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erin Simon Schwartz
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ralph Magee
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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11
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Puy L, Parry-Jones AR, Sandset EC, Dowlatshahi D, Ziai W, Cordonnier C. Intracerebral haemorrhage. Nat Rev Dis Primers 2023; 9:14. [PMID: 36928219 DOI: 10.1038/s41572-023-00424-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/18/2023]
Abstract
Intracerebral haemorrhage (ICH) is a dramatic condition caused by the rupture of a cerebral vessel and the entry of blood into the brain parenchyma. ICH is a major contributor to stroke-related mortality and dependency: only half of patients survive for 1 year after ICH, and patients who survive have sequelae that affect their quality of life. The incidence of ICH has increased in the past few decades with shifts in the underlying vessel disease over time as vascular prevention has improved and use of antithrombotic agents has increased. The pathophysiology of ICH is complex and encompasses mechanical mass effect, haematoma expansion and secondary injury. Identifying the causes of ICH and predicting the vital and functional outcome of patients and their long-term vascular risk have improved in the past decade; however, no specific treatment is available for ICH. ICH remains a medical emergency, with prevention of haematoma expansion as the key therapeutic target. After discharge, secondary prevention and management of vascular risk factors in patients remains challenging and is based on an individual benefit-risk balance evaluation.
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Affiliation(s)
- Laurent Puy
- Lille Neuroscience & Cognition (LilNCog) - U1172, University of Lille, Inserm, CHU Lille, Lille, France
| | - Adrian R Parry-Jones
- Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust & University of Manchester, Manchester, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Wendy Ziai
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charlotte Cordonnier
- Lille Neuroscience & Cognition (LilNCog) - U1172, University of Lille, Inserm, CHU Lille, Lille, France.
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12
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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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13
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Hakimi R. Imaging of Central Nervous System Hemorrhage. Continuum (Minneap Minn) 2023; 29:73-103. [PMID: 36795874 DOI: 10.1212/con.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article aims to familiarize the reader with the various types of nontraumatic central nervous system (CNS) hemorrhage and the various neuroimaging modalities used to help diagnose and manage them. LATEST DEVELOPMENTS According to the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, intraparenchymal hemorrhage accounts for 28% of the global stroke burden. In the United States, hemorrhagic stroke makes up 13% of all strokes. The incidence of intraparenchymal hemorrhage increases substantially with age; thus, despite improvements in blood pressure control through various public health measures, the incidence is not decreasing as the population ages. In fact, in the most recent longitudinal study of aging, autopsy findings showed intraparenchymal hemorrhage and cerebral amyloid angiopathy in 30% to 35% of patients. ESSENTIAL POINTS Rapid identification of CNS hemorrhage, which includes intraparenchymal hemorrhage, intraventricular hemorrhage, and subarachnoid hemorrhage, requires either head CT or brain MRI. Once hemorrhage is identified on the screening neuroimaging study, the pattern of blood in conjunction with the history and physical examination can guide subsequent neuroimaging, laboratory, and ancillary tests as part of the etiologic assessment. After determination of the cause, the chief aims of the treatment regimen are reducing hemorrhage expansion and preventing subsequent complications such as cytotoxic cerebral edema, brain compression, and obstructive hydrocephalus. In addition, nontraumatic spinal cord hemorrhage will also be briefly discussed.
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14
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Nontraumatic Neurosurgical Emergencies. Crit Care Nurs Q 2023; 46:2-16. [DOI: 10.1097/cnq.0000000000000434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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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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16
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Gil-Garcia CA, Alvarez EF, Garcia RC, Mendoza-Lopez AC, Gonzalez-Hermosillo LM, Garcia-Blanco MDC, Valadez ER. Essential topics about the imaging diagnosis and treatment of Hemorrhagic Stroke: a comprehensive review of the 2022 AHA guidelines. Curr Probl Cardiol 2022; 47:101328. [PMID: 35870549 DOI: 10.1016/j.cpcardiol.2022.101328] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Intracerebral hemorrhage (ICH) is a severe stroke with a high death rate (40 % mortality). The prevalence of hemorrhagic stroke has increased globally, with changes in the underlying cause over time as anticoagulant use and hypertension treatment have improved. The fundamental etiology of ICH and the mechanisms of harm from ICH, particularly the complex interaction between edema, inflammation, and blood product toxicity, have been thoroughly revised by the American Heart Association (AHA) in 2022. Although numerous trials have investigated the best medicinal and surgical management of ICH, there is still no discernible improvement in survival and functional tests. Small vessel diseases, such as cerebral amyloid angiopathy (CAA) or deep perforator arteriopathy (hypertensive arteriopathy), are the most common causes of spontaneous non-traumatic intracerebral hemorrhage (ICH). Even though ICH only causes 10-15% of all strokes, it contributes significantly to morbidity and mortality, with few acute or preventive treatments proven effective. Current AHA guidelines acknowledge up to 89% sensitivity for unenhanced brain CT and 81% for brain MRI. The imaging findings of both methods are helpful for initial diagnosis and follow-up, sometimes necessary a few hours after admission, especially for detecting hemorrhagic transformation or hematoma expansion. This review summarized the essential topics on hemorrhagic stroke epidemiology, risk factors, physiopathology, mechanisms of injury, current management approaches, findings in neuroimaging, goals and outcomes, recommendations for lifestyle modifications, and future research directions ICH. A list of updated references is included for each topic.
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Affiliation(s)
| | | | | | | | | | | | - Ernesto-Roldan Valadez
- Directorado de investigación, Hospital General de Mexico "Dr. Eduardo Liceaga," 06720, CDMX, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia.
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17
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Patil S, Rossi R, Jabrah D, Doyle K. Detection, Diagnosis and Treatment of Acute Ischemic Stroke: Current and Future Perspectives. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:748949. [PMID: 35813155 PMCID: PMC9263220 DOI: 10.3389/fmedt.2022.748949] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 06/02/2022] [Indexed: 11/30/2022] Open
Abstract
Stroke is one of the leading causes of disability worldwide. Early diagnosis and treatment of stroke are important for better clinical outcome. Rapid and accurate diagnosis of stroke subtypes is critical. This review discusses the advantages and disadvantages of the current diagnostic and assessment techniques used in clinical practice, particularly for diagnosing acute ischemic stroke. Alternative techniques for rapid detection of stroke utilizing blood based biomarkers and novel portable devices employing imaging methods such as volumetric impedance phase-shift spectroscopy, microwave tomography and Doppler ultrasound are also discussed. Current therapeutic approaches for treating acute ischemic stroke using thrombolytic drugs and endovascular thrombectomy are discussed, with a focus on devices and approaches recently developed to treat large cranial vessel occlusions.
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Affiliation(s)
- Smita Patil
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Rosanna Rossi
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Duaa Jabrah
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
| | - Karen Doyle
- CÚRAM, SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
- Department of Physiology, National University of Ireland Galway, Galway, Ireland
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18
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Malikova H, Weichet J. Diagnosis of Ischemic Stroke: As Simple as Possible. Diagnostics (Basel) 2022; 12:diagnostics12061452. [PMID: 35741262 PMCID: PMC9221735 DOI: 10.3390/diagnostics12061452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
The absolute majority of strokes in high-income countries, roughly 91%, are of ischemic origin. This review is focused on acute ischemic stroke (AIS) with large vessel occlusion (LVO) in the anterior circulation, which is considered the most devastating subtype of AIS. Moreover, stroke survivors impose substantial direct and indirect costs of care as well as costs due to productivity loss. We review of diagnostic possibilities of individual imaging methods such as computed tomography and magnetic resonance imaging, and discuss their pros and cons in the imaging of AIS. The goals of non-invasive imaging in AIS are as follows: (a) to rule out intracranial hemorrhage and to quickly exclude hemorrhagic stroke and contraindications for intravenous thrombolysis; (b) to identify potential LVO and its localization and to quickly provide guidance for endovascular treatment; (c) to assess/estimate the volume or size of the ischemic core. We suggest fast diagnostic management, which is able to quickly satisfy the above-mentioned diagnostic goals in AIS with LVO.
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Affiliation(s)
- Hana Malikova
- Correspondence: ; Tel.: +420-267-162-400; Fax: +420-267-162-409
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19
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Greenberg SM, Ziai WC, Cordonnier C, Dowlatshahi D, Francis B, Goldstein JN, Hemphill JC, Johnson R, Keigher KM, Mack WJ, Mocco J, Newton EJ, Ruff IM, Sansing LH, Schulman S, Selim MH, Sheth KN, Sprigg N, Sunnerhagen KS. 2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2022; 53:e282-e361. [PMID: 35579034 DOI: 10.1161/str.0000000000000407] [Citation(s) in RCA: 355] [Impact Index Per Article: 177.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - William J Mack
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison
| | | | | | - Ilana M Ruff
- AHA Stroke Council Stroke Performance Measures Oversight Committee liaison
| | | | | | | | - Kevin N Sheth
- AHA Stroke Council Scientific Statement Oversight Committee on Clinical Practice Guideline liaison.,AAN representative
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20
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Yuen MM, Prabhat AM, Mazurek MH, Chavva IR, Crawford A, Cahn BA, Beekman R, Kim JA, Gobeske KT, Petersen NH, Falcone GJ, Gilmore EJ, Hwang DY, Jasne AS, Amin H, Sharma R, Matouk C, Ward A, Schindler J, Sansing L, de Havenon A, Aydin A, Wira C, Sze G, Rosen MS, Kimberly WT, Sheth KN. Portable, low-field magnetic resonance imaging enables highly accessible and dynamic bedside evaluation of ischemic stroke. SCIENCE ADVANCES 2022; 8:eabm3952. [PMID: 35442729 PMCID: PMC9020661 DOI: 10.1126/sciadv.abm3952] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/08/2022] [Indexed: 05/26/2023]
Abstract
Brain imaging is essential to the clinical management of patients with ischemic stroke. Timely and accessible neuroimaging, however, can be limited in clinical stroke pathways. Here, portable magnetic resonance imaging (pMRI) acquired at very low magnetic field strength (0.064 T) is used to obtain actionable bedside neuroimaging for 50 confirmed patients with ischemic stroke. Low-field pMRI detected infarcts in 45 (90%) patients across cortical, subcortical, and cerebellar structures. Lesions as small as 4 mm were captured. Infarcts appeared as hyperintense regions on T2-weighted, fluid-attenuated inversion recovery and diffusion-weighted imaging sequences. Stroke volume measurements were consistent across pMRI sequences and between low-field pMRI and conventional high-field MRI studies. Low-field pMRI stroke volumes significantly correlated with stroke severity and functional outcome at discharge. These results validate the use of low-field pMRI to obtain clinically useful imaging of stroke, setting the stage for use in resource-limited environments.
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Affiliation(s)
- Matthew M. Yuen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Anjali M. Prabhat
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Mercy H. Mazurek
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Isha R. Chavva
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Anna Crawford
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Bradley A. Cahn
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer A. Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin T. Gobeske
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Nils H. Petersen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Guido J. Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Emily J. Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - David Y. Hwang
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Adam S. Jasne
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Hardik Amin
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Richa Sharma
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Charles Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Adrienne Ward
- Neuroscience Intensive Care Unit, Yale New Haven Hospital, New Haven, CT, USA
| | - Joseph Schindler
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Lauren Sansing
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Adam de Havenon
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Ani Aydin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Charles Wira
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Gordon Sze
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Matthew S. Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - W. Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
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21
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Surgery for Intracerebral Hemorrhage. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Kakkar P, Kakkar T, Patankar T, Saha S. Current approaches and advances in the imaging of stroke. Dis Model Mech 2021; 14:273651. [PMID: 34874055 PMCID: PMC8669490 DOI: 10.1242/dmm.048785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A stroke occurs when the blood flow to the brain is suddenly interrupted, depriving brain cells of oxygen and glucose and leading to further cell death. Neuroimaging techniques, such as computed tomography and magnetic resonance imaging, have greatly improved our ability to visualise brain structures and are routinely used to diagnose the affected vascular region of a stroke patient's brain and to inform decisions about clinical care. Currently, these multimodal imaging techniques are the backbone of the clinical management of stroke patients and have immensely improved our ability to visualise brain structures. Here, we review recent developments in the field of neuroimaging and discuss how different imaging techniques are used in the diagnosis, prognosis and treatment of stroke. Summary: Stroke imaging has undergone seismic shifts in the past decade. Although magnetic resonance imaging (MRI) is superior to computed tomography in providing vital information, further research on MRI is still required to bring its full potential into clinical practice.
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Affiliation(s)
- Pragati Kakkar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Tarun Kakkar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | | | - Sikha Saha
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
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23
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Portable, bedside, low-field magnetic resonance imaging for evaluation of intracerebral hemorrhage. Nat Commun 2021; 12:5119. [PMID: 34433813 PMCID: PMC8387402 DOI: 10.1038/s41467-021-25441-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/05/2021] [Indexed: 02/07/2023] Open
Abstract
Radiological examination of the brain is a critical determinant of stroke care pathways. Accessible neuroimaging is essential to detect the presence of intracerebral hemorrhage (ICH). Conventional magnetic resonance imaging (MRI) operates at high magnetic field strength (1.5-3 T), which requires an access-controlled environment, rendering MRI often inaccessible. We demonstrate the use of a low-field MRI (0.064 T) for ICH evaluation. Patients were imaged using conventional neuroimaging (non-contrast computerized tomography (CT) or 1.5/3 T MRI) and portable MRI (pMRI) at Yale New Haven Hospital from July 2018 to November 2020. Two board-certified neuroradiologists evaluated a total of 144 pMRI examinations (56 ICH, 48 acute ischemic stroke, 40 healthy controls) and one ICH imaging core lab researcher reviewed the cases of disagreement. Raters correctly detected ICH in 45 of 56 cases (80.4% sensitivity, 95%CI: [0.68-0.90]). Blood-negative cases were correctly identified in 85 of 88 cases (96.6% specificity, 95%CI: [0.90-0.99]). Manually segmented hematoma volumes and ABC/2 estimated volumes on pMRI correlate with conventional imaging volumes (ICC = 0.955, p = 1.69e-30 and ICC = 0.875, p = 1.66e-8, respectively). Hematoma volumes measured on pMRI correlate with NIH stroke scale (NIHSS) and clinical outcome (mRS) at discharge for manual and ABC/2 volumes. Low-field pMRI may be useful in bringing advanced MRI technology to resource-limited settings.
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24
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Abstract
Multimodal MR imaging provides valuable information in the management of patients with acute ischemic stroke (AIS), with diagnostic, therapeutic, and prognostic implications. MR imaging plays a critical role in treatment decision making for (1) thrombolytic treatment of AIS patients with unknown symptom-onset and (2) endovascular treatment of patients with large vessel occlusion presenting beyond 6 hours from the symptom onset. MR imaging provides the most accurate information for detection of ischemic brain and is invaluable for differentiating AIS from stroke mimics.
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25
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Sapir G, Shaul D, Lev-Cohain N, Sosna J, Gomori MJ, Katz-Brull R. LDH and PDH Activities in the Ischemic Brain and the Effect of Reperfusion-An Ex Vivo MR Study in Rat Brain Slices Using Hyperpolarized [1- 13C]Pyruvate. Metabolites 2021; 11:210. [PMID: 33808434 PMCID: PMC8066106 DOI: 10.3390/metabo11040210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 12/11/2022] Open
Abstract
Ischemic stroke is a leading cause for neurologic disability worldwide, for which reperfusion is the only available treatment. Neuroimaging in stroke guides treatment, and therefore determines the clinical outcome. However, there are currently no imaging biomarkers for the status of the ischemic brain tissue. Such biomarkers could potentially be useful for guiding treatment in patients presenting with ischemic stroke. Hyperpolarized 13C MR of [1-13C]pyruvate is a clinically translatable method used to characterize tissue metabolism non-invasively in a relevant timescale. The aim of this study was to utilize hyperpolarized [1-13C]pyruvate to investigate the metabolic consequences of an ischemic insult immediately during reperfusion and upon recovery of the brain tissue. The rates of lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) were quantified by monitoring the rates of [1-13C]lactate and [13C]bicarbonate production from hyperpolarized [1-13C]pyruvate. 31P NMR of the perfused brain slices showed that this system is suitable for studying ischemia and recovery following reperfusion. This was indicated by the levels of the high-energy phosphates (tissue viability) and the chemical shift of the inorganic phosphate signal (tissue pH). Acidification, which was observed during the ischemic insult, has returned to baseline level following reperfusion. The LDH/PDH activity ratio increased following ischemia, from 47.0 ± 12.7 in the control group (n = 6) to 217.4 ± 121.3 in the ischemia-reperfusion group (n = 6). Following the recovery period (ca. 1.5 h), this value had returned to its pre-ischemia (baseline) level, suggesting the LDH/PDH enzyme activity ratio may be used as a potential indicator for the status of the ischemic and recovering brain.
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Affiliation(s)
- Gal Sapir
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - David Shaul
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Moshe J. Gomori
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
- The Wohl Institute for Translational Medicine, Jerusalem 9112001, Israel
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26
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Cho T, Kreatsoulas D, Fritz J, McGregor JM, Hardesty DA. An institutional review of hospital resource utilization and patient radiation exposure in shunted idiopathic intracranial hypertension. Neurosurg Rev 2021; 44:3359-3373. [PMID: 33611722 DOI: 10.1007/s10143-021-01502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/12/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
Patients with idiopathic intracranial hypertension (IIH) frequently utilize healthcare services and undergo radiological studies to assess refractory headache symptoms despite cerebrospinal fluid diversion. To delineate the clinical utility of different imaging modalities and to estimate cumulative patient radiation exposure in shunted patients with IIH, we retrospectively reviewed 100 randomly selected patients with IIH and a prior cerebrospinal fluid diversion procedure treated at our institution between July 2010 and August 2018. Patients had an average of 16.3 office (SD ± 13.8), 12.4 emergency department (± 21.0), and 4.6 inpatient (± 5.1) encounters over an average 4.8 years of follow-up. Patients underwent an average of 9.0 head CTs (± 8.1), 10.3 shunt series x-rays (± 11.2), and 4.3 MRIs (± 3.7). Approximated radiation exposure per patient was 21.4 mSv (± 18.7). Radiological studies performed for acute symptoms usually demonstrated no actionable findings (82.5% CTs, 97.5% shunt series x-rays, and 79.6% MRIs). Shunted IIH patients undergo numerous radiological studies and are subject to considerable levels of radiation, yet imaging shows actionable findings in less than 10% percent of radiographic studies. IIH patients may benefit from radiation-reducing protocols and the use of alternative imaging to assess symptoms.
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Affiliation(s)
- Tyler Cho
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Daniel Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Doan Hall, Columbus, OH, 43210, USA
| | - Joel Fritz
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John M McGregor
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Doan Hall, Columbus, OH, 43210, USA
| | - Douglas A Hardesty
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, Doan Hall, Columbus, OH, 43210, USA.
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27
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Sato T, Nishiyama Y, Suda S, Shimoyama T, Takahashi S, Sakamoto Y, Aoki J, Suzuki K, Sekine T, Kumita SI, Kimura K. "Computed Tomography Perihematomal Rims": A Perihematomal Low-Density Area Is a Part of an Acute Brain Hemorrhage. Intern Med 2021; 60:2395-2403. [PMID: 34334590 PMCID: PMC8381191 DOI: 10.2169/internalmedicine.6653-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective Computed tomography (CT) can be used for visualizing acute intracerebral hemorrhages (ICHs) as distinct hyperdense areas and cerebral edema as perihematomal low-density areas (LDAs). We observed a perihematomal LDA on CT, which appeared to be part of a hemorrhage on magnetic resonance imaging (MRI) in acute ICH. We named this "CT perihematomal rim" and evaluated its characteristics and clinical significance. Methods We stratified patients with acute ICH according to the presence or absence of a CT perihematomal rim and then compared their radiologic findings. Logistic regression analyses were performed to assess whether the CT findings can predict the presence of a CT perihematomal rim. Patients Patients within 24 hours of ICH onset who were admitted between September 1, 2014, and October 31, 2018, were registered. Results Overall, 139 patients (91 men; mean age, 66 years) were investigated. CT perihematomal rims were observed in 40 patients (29%). ICH volumes on CT were 30% smaller than those on MRI in patients with CT perihematomal rims. On a multivariate analysis, the presence of a CT perihematomal rim was independently associated with the maximum diameter of the perihematomal LDA. According to a receiver operating characteristic analysis, the maximum LDA diameter threshold was 7.5 mm (sensitivity, 85%; specificity, 83%). Conclusion CT perihematomal rims were observed in 29% of the patients with acute ICH. A perihematomal LDA (>7.5 mm) in acute ICH cases should be considered a CT perihematomal rim. Clinicians should be aware that the ICH volume on CT may be underestimated by 30%.
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Affiliation(s)
- Takahiro Sato
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Satoshi Suda
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Takashi Shimoyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shiro Takahashi
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Yuki Sakamoto
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kentaro Suzuki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Tetsuro Sekine
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Graduate School of Medicine, Nippon Medical School, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Japan
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Schnelle MRT-Sequenzen für die akute neurologische Abklärung. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00803-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shoamanesh A, Patrice Lindsay M, Castellucci LA, Cayley A, Crowther M, de Wit K, English SW, Hoosein S, Huynh T, Kelly M, O'Kelly CJ, Teitelbaum J, Yip S, Dowlatshahi D, Smith EE, Foley N, Pikula A, Mountain A, Gubitz G, Gioia LC. Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020. Int J Stroke 2020; 16:321-341. [PMID: 33174815 DOI: 10.1177/1747493020968424] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Spontaneous intracerebral hemorrhage is a particularly devastating type of stroke with greater morbidity and mortality compared with ischemic stroke and can account for half or more of all deaths from stroke. The seventh update of the Canadian Stroke Best Practice Recommendations includes a new stand-alone module on intracerebral hemorrhage, with a focus on elements of care that are unique or affect persons disproportionately relative to ischemic stroke. Prior to this edition, intracerebral hemorrhage was included in the Acute Stroke Management module and was limited to its management during the first 12 h. With the growing evidence on intracerebral hemorrhage, a separate module focused on this topic across the care continuum was added. In addition to topics related to initial clinical management, neuroimaging, blood pressure management, and surgical management, new sections have been introduced addressing topics surrounding inpatient complications such as venous thromboembolism, seizure management, and increased intracranial pressure, rehabilitation as well as issues related to secondary management including lifestyle management, maintaining a normal blood pressure and antithrombotic therapy, are addressed. The Canadian Stroke Best Practice Recommendations (CSBPR) are intended to provide up-to-date evidence-based guidelines for the prevention and management of stroke and to promote optimal recovery and reintegration for people who have experienced stroke, including patients, families, and informal caregivers.
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Affiliation(s)
- Ashkan Shoamanesh
- Faculty of Medicine (Neurology), McMaster University, Hamilton, Canada.,Hamilton Health Sciences, Division of Neurology, Hamilton, Canada
| | | | - Lana A Castellucci
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Department of Medicine, Divisions of Hematology and General Internal Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Anne Cayley
- Toronto West Regional Stroke Program, University Health Network, Toronto, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Kerstin de Wit
- Department of Medicine (Emergency Medicine), McMaster University, Hamilton, Canada.,Hamilton Health Sciences, Divisions of Emergency Medicine and Thrombosis, Hamilton, Canada
| | - Shane W English
- Ottawa Hospital Research Institute (Clinical Epidemiology Program), Ottawa, Canada.,University of Ottawa, Department of Medicine (Critical Care) and School of Epidemiology and Public Health, Ottawa, Canada
| | - Sharon Hoosein
- Trillium Health Partners Stroke Program, Mississauga, Canada
| | - Thien Huynh
- Department of Diagnostic and Interventional Neuroradiology, Queen Elizabeth II Health Sciences Centre, Halifax, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Michael Kelly
- Department of Neurosurgery, University of Saskatchewan, Saskatoon, Canada
| | - Cian J O'Kelly
- Department of Neurological Surgery, University of Alberta, Edmonton, Canada
| | - Jeanne Teitelbaum
- Department of Neurology, Universite de Montreal, Montreal, Canada.,Department of Neurocritical Care, Montreal Neurological Institute MUHC, Montreal, Canada
| | - Samuel Yip
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, Canada
| | | | - Eric E Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Aleksandra Pikula
- Toronto West Regional Stroke Program, University Health Network, Toronto, Canada
| | - Anita Mountain
- Division of Physical Medicine and Rehabilitation, Dalhousie University, Halifax, Canada.,Queen Elizabeth II Health Sciences Centre, Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Stroke Program, Halifax, Canada
| | - Laura C Gioia
- Department of Neurology, Universite de Montreal, Montreal, Canada.,CHUM-Centre Hospitalier de l'Université de Montréal, Stroke Program, Montréal, Canada
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Gupta R, Krishnam SP, Schaefer PW, Lev MH, Gilberto Gonzalez R. An East Coast Perspective on Artificial Intelligence and Machine Learning: Part 1: Hemorrhagic Stroke Imaging and Triage. Neuroimaging Clin N Am 2020; 30:459-466. [PMID: 33038996 DOI: 10.1016/j.nic.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hemorrhagic stroke is a medical emergency. Artificial intelligence techniques and algorithms may be used to automatically detect and quantitate intracranial hemorrhage in a semiautomated fashion. This article reviews the use of deep learning convolutional neural networks for managing hemorrhagic stroke. Such a capability may be used to alert appropriate care teams, make decisions about patient transport from a primary care center to a comprehensive stroke center, and assist in treatment selection. This article reviews artificial intelligence algorithms for intracranial hemorrhage detection, quantification, and prognostication. Multiple algorithms currently being explored are described and illustrated with the help of examples.
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Affiliation(s)
- Rajiv Gupta
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Room: GRB-273A, 55 Fruit Street, Boston, MA 02114, USA.
| | - Sanjith Prahas Krishnam
- Department of Neurology, University of Alabama at Birmingham, SC 350, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - Pamela W Schaefer
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Room: GRB-273A, 55 Fruit Street, Boston, MA 02114, USA
| | - Michael H Lev
- Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, Harvard Medical School, Room: GRB-273A, 55 Fruit Street, Boston, MA 02114, USA; Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Room: GRB-273A, 55 Fruit Street, Boston, MA 02114, USA
| | - R Gilberto Gonzalez
- Department of Radiology, Division of Neuroradiology, Massachusetts General Hospital, Harvard Medical School, Room: GRB-273A, 55 Fruit Street, Boston, MA 02114, USA
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Abstract
CLINICAL/METHODICAL ISSUE Neurological symptoms account for approximately 30% of emergency room (ER) visits. Clinical outcome often relies on a timely diagnosis and treatment initiation. Clinical imaging requirements are fast availability and high diagnostic value. STANDARD RADIOLOGICAL METHODS Availability and quality of magnetic resonance imaging (MRI) in emergency rooms outside of core hours are limited compared to computed tomography (CT). Common reasons are infrastructural accessibility (hospitals using outpatient radiology centers), a lack of experienced and qualified staff and high patient compliance requirements. However, in a neurological emergency setting, MRI may show relevant advantages over CT in certain areas, such as diagnosis of stroke. METHODOLOGICAL INNOVATIONS Advances in MRI technology have led to shorter exam times and robust motion reduction strategies. Common fast sequences and time reduction techniques for imaging of neurological emergencies are presented in this article. ACHIEVEMENTS Recommendations for specific sequences or techniques depend on the institute's MRI hardware and software components. If available, parallel imaging is highly recommended for imaging of neurological emergencies. PRACTICAL RECOMMENDATIONS Imaging of neurological emergencies requires fast, significant and motion insensitive standard acquisitions. Additional sequences should be acquired dependent on clinical and standard protocol imaging findings. An MRI emergency protocol is introduced for the most common neurologic emergencies including recommendations for fast MRI sequences and techniques for imaging time reduction.
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32
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McDermott B, Elahi A, Santorelli A, O'Halloran M, Avery J, Porter E. Multi-frequency symmetry difference electrical impedance tomography with machine learning for human stroke diagnosis. Physiol Meas 2020; 41:075010. [PMID: 32554876 DOI: 10.1088/1361-6579/ab9e54] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Multi-frequency symmetry difference electrical impedance tomography (MFSD-EIT) can robustly detect and identify unilateral perturbations in symmetric scenes. Here, an investigation is performed to assess if the algorithm can be successfully applied to identify the aetiology of stroke with the aid of machine learning. METHODS Anatomically realistic four-layer finite element method models of the head based on stroke patient images are developed and used to generate EIT data over a 5 Hz-100 Hz frequency range with and without bleed and clot lesions present. Reconstruction generates conductivity maps of each head at each frequency. Application of a quantitative metric assessing changes in symmetry across the sagittal plane of the reconstructed image and over the frequency range allows lesion detection and identification. The algorithm is applied to both simulated and human (n = 34 subjects) data. A classification algorithm is applied to the metric value in order to differentiate between normal, haemorrhage and clot values. MAIN RESULTS An average accuracy of 85% is achieved when MFSD-EIT with support vector machines (SVM) classification is used to identify and differentiate bleed from clot in human data, with 77% accuracy when differentiating normal from stroke in human data. CONCLUSION Applying a classification algorithm to metrics derived from MFSD-EIT images is a novel and promising technique for detection and identification of perturbations in static scenes. SIGNIFICANCE The MFSD-EIT algorithm used with machine learning gives promising results of lesion detection and identification in challenging conditions like stroke. The results imply feasible translation to human patients.
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Affiliation(s)
- Barry McDermott
- Translational Medical Device Lab, National University of Ireland, Galway, Ireland
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33
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Abstract
Wake-up stroke (WUS) or ischemic stroke occurring during sleep accounts for 14%-29.6% of all ischemic strokes. Management of WUS is complicated by its narrow therapeutic time window and attributable risk factors, which can affect the safety and efficacy of administering intravenous (IV) tissue plasminogen activator (t-PA). This manuscript will review risk factors of WUS, with a focus on obstructive sleep apnea, potential mechanisms of WUS, and evaluate studies assessing safety and efficacy of IV t-PA treatment in WUS patients guided by neuroimaging to estimate time of symptom onset. The authors used PubMed (1966 to March 2018) to search for the term "Wake-Up Stroke" cross-referenced with "pathophysiology," ''pathogenesis," "pathology," "magnetic resonance imaging," "obstructive sleep apnea," or "treatment." English language Papers were reviewed. Also reviewed were pertinent papers from the reference list of the above-matched manuscripts. Studies that focused only on acute Strokes with known-onset of symptoms were not reviewed. Literature showed several potential risk factors associated with increased risk of WUS. Although the onset of WUS is unknown, a few studies investigated the potential benefit of magnetic resonance imaging (MRI) in estimating the age of onset which encouraged conducting clinical trials assessing the efficacy of MRI-guided thrombolytic therapy in WUS.
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34
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Abstract
Spontaneous nontraumatic intracerebral hemorrhage is associated with high morbidity and mortality. Given the risk of rapid neurological deterioration, early identification with rapid neuroimaging is vital. Predictors of outcome, such as spot sign and intracerebral hemorrhage score, can help guide management goals. Management should be aimed at prevention of hematoma expansion, treatment of increased intracranial pressure, and prevention of secondary brain injury and medical complications.
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35
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Arnold SA, Platt SR, Gendron KP, West FD. Imaging Ischemic and Hemorrhagic Disease of the Brain in Dogs. Front Vet Sci 2020; 7:279. [PMID: 32528985 PMCID: PMC7266937 DOI: 10.3389/fvets.2020.00279] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/27/2020] [Indexed: 01/12/2023] Open
Abstract
Strokes, both ischemic and hemorrhagic, are the most common underlying cause of acute, non-progressive encephalopathy in dogs. In effect, substantial information detailing the underlying causes and predisposing factors, affected vessels, imaging features, and outcomes based on location and extent of injury is available. The features of canine strokes on both computed tomography (CT) and magnetic resonance imaging (MRI) have been described in numerous studies. This summary article serves as a compilation of these various descriptions. Drawing from the established and emerging stroke evaluation sequences used in the investigation of strokes in humans, this summary describes all theoretically available sequences. Particular detail is given to logistics of image acquisition, description of imaging findings, and each sequence's advantages and disadvantages. As the imaging features of both forms of strokes are highly representative of the underlying pathophysiologic stages in the hours to months following stroke onset, the descriptions of strokes at various stages are also discussed. It is unlikely that canine strokes can be diagnosed within the same rapid time frame as human strokes, and therefore the opportunity for thrombolytic intervention in ischemic strokes is unattainable. However, a thorough understanding of the appearance of strokes at various stages can aid the clinician when presented with a patient that has developed a stroke in the days or weeks prior to evaluation. Additionally, investigation into new imaging techniques may increase the sensitivity and specificity of stroke diagnosis, as well as provide new ways to monitor strokes over time.
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Affiliation(s)
- Susan A Arnold
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, St. Paul, MN, United States
| | - Simon R Platt
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Karine P Gendron
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Franklin D West
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
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36
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McDermott B, O'Halloran M, Avery J, Porter E. Bi-Frequency Symmetry Difference EIT-Feasibility and Limitations of Application to Stroke Diagnosis. IEEE J Biomed Health Inform 2019; 24:2407-2419. [PMID: 31869810 DOI: 10.1109/jbhi.2019.2960862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Bi-Frequency Symmetry Difference (BFSD)-EIT can detect, localize and identify unilateral perturbations in symmetric scenes. Here, we test the viability and robustness of BFSD-EIT in stroke diagnosis. METHODS A realistic 4-layer Finite Element Method (FEM) head model with and without bleed and clot lesions is developed. Performance is assessed with test parameters including: measurement noise, electrode placement errors, contact impedance errors, deviations in assumed tissue conductivity, deviations in assumed anatomy, and a frequency-dependent background. A final test is performed using ischemic patient data. Results are assessed using images and quantitative metrics. RESULTS BFSD-EIT may be feasible for stroke diagnosis if a signal-to-noise ratio (SNR) of ≥60 dB is achievable. Sensitivity to errors in electrode positioning is seen with a tolerance of only ±5 mm, but a tolerance of up to ±30 mm is possible if symmetry is maintained between symmetrically opposite partner electrodes. The technique is robust to errors in contact impedance and assumed tissue conductivity up to at least ±50%. Asymmetric internal anatomy affects performance but may be tolerable for tissues with frequency-dependent conductivity. Errors in assumed external geometry marginally affect performance. A frequency-dependent background does not affect performance with carefully chosen frequency points or use of multiple frequency points across a band. The Global Left-Hand Side (LHS) & Right-Hand Side (RHS) Mean Intensity metric is particularly robust to errors. CONCLUSION BFSD-EIT is a promising technique for stroke diagnosis, provided parameters are within the tolerated ranges. SIGNIFICANCE BFSD-EIT may prove an important step forward in imaging of static scenes such as stroke.
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Toyoda K, Koga M, Iguchi Y, Itabashi R, Inoue M, Okada Y, Ogasawara K, Tsujino A, Hasegawa Y, Hatano T, Yamagami H, Iwama T, Shiokawa Y, Terayama Y, Minematsu K. Guidelines for Intravenous Thrombolysis (Recombinant Tissue-type Plasminogen Activator), the Third Edition, March 2019: A Guideline from the Japan Stroke Society. Neurol Med Chir (Tokyo) 2019; 59:449-491. [PMID: 31801934 PMCID: PMC6923159 DOI: 10.2176/nmc.st.2019-0177] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuyuki Iguchi
- Department of Neurology, The Jikei University School of Medicine
| | | | - Manabu Inoue
- Division of Stroke Care Unit, National Cerebral and Cardiovascular Center
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center
| | | | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital
| | - Hiroshi Yamagami
- Department of Stroke Neurology, National Hospital Organization Osaka National Hospital
| | - Toru Iwama
- Department of Neurosurgery, Gifu University School of Medicine
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El Hasbani G, Balaghi A, Assaker R, Rojas A, Troya M, Kofahi A, Assaker JP, Diab C, Al Husayni H. Intraparenchymal hemorrhage and cerebral venous thrombosis in an adult with congenital porencephalic cyst presenting for generalized tonic-clonic seizures. Radiol Case Rep 2019; 15:95-99. [PMID: 31762865 PMCID: PMC6854081 DOI: 10.1016/j.radcr.2019.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/16/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022] Open
Abstract
Prothrombotic conditions are known risk factors for porencephalic cyst formation and cerebral vein thrombosis. Intracerebral hemorrhage is a potential complication of a cerebral vein thrombosis. Porencephaly is a risk factor for intracerebral hemorrhage and cerebral vein thrombosis formation. We present the case of an adult patient with a past medical history of epilepsy and congenital porencephalic cyst with de novo mutation of the COL4A1 gene who presented for episodes of generalized tonic-clonic seizure after a substantial symptom-free period. A brain CT scan showed an intracerebral hemorrhage with porencephalic cyst and superior sagittal sinus thrombosis despite negative thrombophilia work-up. A CT perfusion study, CT angiography, and brain MRI confirmed the diagnosis. The cause-and-effect relationship between porencephalic cysts, cerebral venous thrombosis, and intracerebral hemorrhage is still not clear in the literature.
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Affiliation(s)
| | - Alaa Balaghi
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Blat, Lebanon
| | | | - Alberto Rojas
- Lincoln Medical Mental Health Center, Bronx, NY, USA
| | - Marcelo Troya
- Lincoln Medical Mental Health Center, Bronx, NY, USA
| | - Ahmad Kofahi
- Lincoln Medical Mental Health Center, Bronx, NY, USA
| | | | - Chadi Diab
- Texas Tech University, Health Sciences Center, El Paso, TX, USA
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50:e344-e418. [PMID: 31662037 DOI: 10.1161/str.0000000000000211] [Citation(s) in RCA: 3266] [Impact Index Per Article: 653.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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Haacke EM, Chen Y, Utriainen D, Wu B, Wang Y, Xia S, He N, Zhang C, Wang X, Lagana MM, Luo Y, Fatemi A, Liu S, Gharabaghi S, Wu D, Sethi SK, Huang F, Sun T, Qu F, Yadav BK, Ma X, Bai Y, Wang M, Cheng J, Yan F. STrategically Acquired Gradient Echo (STAGE) imaging, part III: Technical advances and clinical applications of a rapid multi-contrast multi-parametric brain imaging method. Magn Reson Imaging 2019; 65:15-26. [PMID: 31629075 DOI: 10.1016/j.mri.2019.09.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/11/2019] [Accepted: 09/15/2019] [Indexed: 12/15/2022]
Abstract
One major thrust in radiology today is image standardization with a focus on rapidly acquired quantitative multi-contrast information. This is critical for multi-center trials, for the collection of big data and for the use of artificial intelligence in evaluating the data. Strategically acquired gradient echo (STAGE) imaging is one such method that can provide 8 qualitative and 7 quantitative pieces of information in 5 min or less at 3 T. STAGE provides qualitative images in the form of proton density weighted images, T1 weighted images, T2* weighted images and simulated double inversion recovery (DIR) images. STAGE also provides quantitative data in the form of proton spin density, T1, T2* and susceptibility maps as well as segmentation of white matter, gray matter and cerebrospinal fluid. STAGE uses vendors' product gradient echo sequences. It can be applied from 0.35 T to 7 T across all manufacturers producing similar results in contrast and quantification of the data. In this paper, we discuss the strengths and weaknesses of STAGE, demonstrate its contrast-to-noise (CNR) behavior relative to a large clinical data set and introduce a few new image contrasts derived from STAGE, including DIR images and a new concept referred to as true susceptibility weighted imaging (tSWI) linked to fluid attenuated inversion recovery (FLAIR) or tSWI-FLAIR for the evaluation of multiple sclerosis lesions. The robustness of STAGE T1 mapping was tested using the NIST/NIH phantom, while the reproducibility was tested by scanning a given individual ten times in one session and the same subject scanned once a week over a 12-week period. Assessment of the CNR for the enhanced T1W image (T1WE) showed a significantly better contrast between gray matter and white matter than conventional T1W images in both patients with Parkinson's disease and healthy controls. We also present some clinical cases using STAGE imaging in patients with stroke, metastasis, multiple sclerosis and a fetus with ventriculomegaly. Overall, STAGE is a comprehensive protocol that provides the clinician with numerous qualitative and quantitative images.
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Affiliation(s)
- E Mark Haacke
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA.
| | - Yongsheng Chen
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - David Utriainen
- The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Bo Wu
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Yu Wang
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China; Neusoft Medical Systems Co., Ltd., Shanghai, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunyan Zhang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | - Yu Luo
- Department of Radiology, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Ali Fatemi
- Departments of Radiology and Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Saifeng Liu
- The MRI Institute for Biomedical Research, Bingham Farms, MI, USA
| | - Sara Gharabaghi
- Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai, China
| | - Sean K Sethi
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA; The MRI Institute for Biomedical Research, Bingham Farms, MI, USA; Magnetic Resonance Innovations, Inc., Bingham Farms, MI, USA
| | - Feng Huang
- Neusoft Medical Systems Co., Ltd., Shanghai, China
| | - Taotao Sun
- Department of Radiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feifei Qu
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brijesh K Yadav
- Department of Radiology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaoyue Ma
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Yan Bai
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China; Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.
| | - Jingliang Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Nael K, Sakai Y, Khatri P, Prestigiacomo CJ, Puig J, Vagal A. Imaging-based Selection for Endovascular Treatment in Stroke. Radiographics 2019; 39:1696-1713. [DOI: 10.1148/rg.2019190030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kim H, Yang X, Choi YH, Yoon BC, Kim K, Kim DJ. Abilities of a Densitometric Analysis of Computed Tomography Images and Hemorrhagic Parameters to Predict Outcome Favorability in Patients With Intracerebral Hemorrhage. Neurosurgery 2019; 83:226-236. [PMID: 28973583 DOI: 10.1093/neuros/nyx379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 06/19/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability. OBJECTIVE To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes. METHODS Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted. RESULTS The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes. CONCLUSION Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.
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Affiliation(s)
- Hakseung Kim
- Department of Brain and Cognitive Engi-neering, Korea University, Seoul, South Korea
| | - Xiaoke Yang
- Department of Brain and Cognitive Engi-neering, Korea University, Seoul, South Korea
| | - Young Hun Choi
- Department of Radiology, Se-oul National University Hospital, College of Medicine, Seoul, South Korea
| | - Byung C Yoon
- De-partment of Radiology, Stanford Uni-versity School of Medicine, Stanford, California
| | - Keewon Kim
- Department of Rehabilitation, Seoul National University Hospital, Coll-ege of Medicine, Seoul, South Korea
| | - Dong-Joo Kim
- Department of Brain and Cognitive Engi-neering, Korea University, Seoul, South Korea
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Reyes R, Viswanathan M, Aiyagari V. An update on neurocritical care for intracerebral hemorrhage. Expert Rev Neurother 2019; 19:557-578. [PMID: 31092052 DOI: 10.1080/14737175.2019.1618709] [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] [Indexed: 02/06/2023]
Abstract
Introduction: Intracerebral hemorrhage remains one of the leading causes of death and disability worldwide with few established interventions that improve neurologic outcome. Research dedicated to better understanding and treating hemorrhagic strokes has multiplied in the past decade. Areas Covered: This review aims to discuss the current landscape of management of intracerebral hemorrhage in a critical care setting and provide updates regarding developments in therapeutic interventions and targets. PubMed was utilized to review recent literature, with a focus on large trials and meta-analyses, which have shaped current practice. Published committee guidelines were also included. A focus was placed on research published after 2015 in an effort to supplement previous reviews included in this publication. Expert Opinion: Literature pertaining to ICH management has allowed for a greater understanding of ineffective strategies as opposed to those of benefit. Despite this, mortality has improved worldwide, which may be the result of growing research efforts. Areas of future research that will impact mortality and improve neurologic outcomes include prevention of hematoma expansion, optimization of blood pressure targets, effective coagulopathy reversal, and minimally invasive surgical techniques to reduce hematoma burden.
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Affiliation(s)
- Ranier Reyes
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Meera Viswanathan
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Venkatesh Aiyagari
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
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McDermott B, Avery J, O'Halloran M, Aristovich K, Porter E. Bi-frequency symmetry difference electrical impedance tomography-a novel technique for perturbation detection in static scenes. Physiol Meas 2019; 40:044005. [PMID: 30786267 DOI: 10.1088/1361-6579/ab08ba] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A novel method for the imaging of static scenes using electrical impedance tomography (EIT) is reported with implementation and validation using numerical and phantom models. The technique is applicable to regions featuring symmetry in the normal case, asymmetry in the presence of a perturbation, and where there is a known, frequency-dependent change in the electrical conductivity of the materials in the region. APPROACH The stroke diagnostic problem is used as a motivating sample application. The head is largely symmetrical across the sagittal plane. A haemorrhagic or ischaemic lesion located away from the sagittal plane will alter this natural symmetry, resulting in a symmetrical imbalance that can be detected using EIT. Specifically, application of EIT stimulation and measurement protocols at two distinct frequencies detects deviations in symmetry if an asymmetrically positioned lesion is present, with subsequent identification and localisation of the perturbation based on known frequency-dependent conductivity changes. Anatomically accurate computational models are used to demonstrate the feasibility of the proposed technique using different types, sizes, and locations of lesions with frequency-dependent (or independent) conductivity. Further, a realistic experimental head phantom is used to validate the technique using frequency-dependent perturbations emulating the key numerical simulations. MAIN RESULTS Lesion presence, type, and location are detectable using this novel technique. Results are presented in the form of images and corresponding robust quantitative metrics. Better detection is achieved for larger lesions, those further from the sagittal plane, and when measurements have a higher signal-to-noise ratio. SIGNIFICANCE Bi-frequency symmetry difference EIT is an exciting new modality of EIT with the ability to detect deviations in the symmetry of a region that occur due to the presence of a lesion. Notably, this modality does not require a time change in the region and thus may be used in static scenarios such as stroke detection.
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Affiliation(s)
- Barry McDermott
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
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Chen Y, Godage IS, Sengupta S, Liu CL, Weaver KD, Barth EJ. MR-conditional steerable needle robot for intracerebral hemorrhage removal. Int J Comput Assist Radiol Surg 2019; 14:105-115. [PMID: 30173334 PMCID: PMC7306193 DOI: 10.1007/s11548-018-1854-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is one of the deadliest forms of stroke in the USA. Conventional surgical techniques such as craniotomy or stereotactic aspiration disrupt a large volume of healthy brain tissue in their attempts to reach the surgical site. Consequently, the surviving patients suffer from debilitating complications. METHODS We fabricated a novel MR-conditional steerable needle robot for ICH treatment. The robot system is powered by a custom-designed high power and low-cost pneumatic motor. We tested the robot's targeting accuracy and MR-conditionality performance, and performed phantom evacuation experiment under MR image guidance. RESULTS Experiments demonstrate that the robotic hardware is MR-conditional; the robot has the targeting accuracy of 1.26 ± 1.22 mm in bench-top tests. With real-time MRI guidance, the robot successfully reached the desired target and evacuated an 11.3 ml phantom hematoma in 9 min. CONCLUSION MRI-guided steerable needle robotic system is a potentially feasible approach for ICH treatment by providing accurate needle guidance and intraoperative surgical outcome evaluation.
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Affiliation(s)
- Yue Chen
- Department of Mechanical Engineering, University of Arkansas, Fayetteville, AR, USA.
| | - Isuru S Godage
- School of Computing, DePaul University, Chicago, IL, USA
| | - Saikat Sengupta
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Cindy Lin Liu
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Kyle D Weaver
- Department of Neurological Surgery, Vanderbilt Medical Center, Nashville, TN, USA
| | - Eric J Barth
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Abstract
BACKGROUND Pediatric stroke is a distinct clinical entity as compared with that in adults due to its unique and diverse set of etiologies. Furthermore, the role and application of diagnostic imaging has specific constraints and considerations. The intention of this article is to review these concepts in a thorough manner to offer a pediatric stroke imaging framework that providers can employ when taking care of these patients. METHODS A comprehensive primary and secondary literature review was performed with specific attention to the common causes of pediatric stroke, appropriate use of neuroimaging, specific imaging findings, and developing techniques which may improve our ability to accurately diagnose these patients. RESULTS Findings from this literature review were synthesized and summarized in order to thoroughly review the aforementioned concepts and outline the current consensus-based approach to diagnostic imaging in pediatric stroke. Furthermore, imaging findings drawn from patients seen in our institution are demonstrated to familiarize readers with pediatric stroke neuroimaging. CONCLUSIONS The challenges posed by pediatric stroke can be mitigated, in part, by the thoughtful application of diagnostic imaging, with the ultimate hope of improving outcomes for these vulnerable patients.
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Affiliation(s)
- Alexander Khalaf
- Stanford University and Medical Center, Department of Radiology, Neuroradiology Section
| | - Iv Michael
- Stanford University and Medical Center, Department of Radiology, Neuroradiology Section
| | - Heather Fullerton
- University of California, San Francisco, Department of Neurology, Pediatric Neurology Section
| | - Max Wintermark
- Stanford University and Medical Center, Department of Radiology, Neuroradiology Section, Stanford, CA.
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Rudkin S, Cerejo R, Tayal A, Goldberg MF. Imaging of acute ischemic stroke. Emerg Radiol 2018; 25:659-672. [DOI: 10.1007/s10140-018-1623-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/26/2018] [Indexed: 10/28/2022]
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Abstract
Intracerebral hemorrhage (ICH) is a subset of stroke due to spontaneous bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, proper diagnosis, and early management of several specific issues such as blood pressure, coagulopathy reversal, and surgical hematoma evacuation for appropriate patients. ICH was chosen as an Emergency Neurological Life Support (ENLS) protocol because intervention within the first hours may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently.
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Martí-Fàbregas J, Prats-Sánchez L, Guisado-Alonso D, Martínez-Domeño A, Delgado-Mederos R, Camps-Renom P. SMASH-U versus H-ATOMIC: A Head-to-Head Comparison for the Etiologic Classification of Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2018; 27:2375-2380. [PMID: 29779884 DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 04/23/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is no agreement for the etiologic classification of patients with intracerebral hemorrhage (ICH). In a series of patients with ICH, we performed a randomized head-to-head comparison between the two recently proposed etiologic classification systems. METHODS We evaluated patients registered in a prospective database of consecutive patients. A simplified H-ATOMIC classification defines 8 categories: hypertension, amyloid, tumor, oral anticoagulants, malformation, infrequent, cryptogenic, and combination. SMASH-U also defines 8 categories: structural, medication, amyloid, systemic, hypertension, and undetermined, and nonstroke and stroke-non-ICH. Experienced stroke neurologists applied both classification systems to a randomly assigned list of patients. The concordances between the 2 systems were analyzed. In a subset of patients, the percent of agreement and the inter-rater reliability (kappa coefficient) were calculated. RESULTS A total of 156 patients (age 72.3 ± 13.5 years) were evaluated, and 54 of these patients were evaluated by 2 neurologists. Concordance (a patient classified in equivalent categories for both systems) was 63%. The percentage of interobserver agreement was 85.5% for SMASH-U and 87.6% for H-ATOMIC. Inter-rater reliability was similar for SMASH-U (kappa .82) and H-ATOMIC (kappa .76). The range of reliability among neurologists was .66-.93 for SMASH-U and .66-.94 for H-ATOMIC. CONCLUSIONS The percentage agreement among investigators is remarkably high for both classification systems, and the inter-rater reliability is substantial to almost perfect for both systems. However, discrepancies between the 2 systems are frequent (in about one third of the patients) due to different categories and definitions.
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Affiliation(s)
- Joan Martí-Fàbregas
- Biomedical Research Institute Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona Spain.
| | - Luis Prats-Sánchez
- Biomedical Research Institute Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona Spain
| | - Daniel Guisado-Alonso
- Biomedical Research Institute Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona Spain
| | | | - Raquel Delgado-Mederos
- Biomedical Research Institute Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona Spain
| | - Pol Camps-Renom
- Biomedical Research Institute Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona Spain
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McDermott B, Porter E, Jones M, McGinley B, O'Halloran M. Symmetry difference electrical impedance tomography-a novel modality for anomaly detection. Physiol Meas 2018. [PMID: 29533921 DOI: 10.1088/1361-6579/aab656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The theoretical basis, experimental implementation, and proof of concept of a novel electrical impedance tomography (EIT) imaging technique, called symmetry difference EIT, is described. This technique is applicable in situations where there is inherent symmetry in the region being imaged. METHODS The sample scenario of the human head is used to describe the technique. The head is largely symmetrical across the sagittal plane. A unilateral lesion such as a haemorrhage or region of ischaemia distorts that symmetry. This distortion may be visualised using EIT. Measurement sets from a ring of electrodes placed on the boundary in both clockwise and counter-clockwise orientations are compared to detect the anomaly. Computer simulations featuring a hemispherical model of the head and brain are used initially to demonstrate the theory. Then, a more complex numerical model with anatomically accurate finite element models (FEMs) is used to expand on the concept with a more realistic scenario. Finally, tank experiments are performed with phantom lesions to validate the technique in the real world. RESULTS Deviations from normal symmetry, due to the presence of lesions, are detectable using this new modality. The ease of detection improves with larger lesions and those far from the plane of symmetry. Quantitative metrics, as well as an image, help to robustly detect and identify both the presence of an abnormality and the cause (haemorrhagic or ischaemic lesion in the scenarios tested) or indeed indicate where no detection is possible. CONCLUSION Symmetry difference EIT is a valuable new modality that is applicable to cases where the 'normal' features symmetry across a plane. Significantly, a change in the region of interest is not required and hence this technique may be suited to static or quasi-static cases where time difference EIT cannot be used.
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Affiliation(s)
- Barry McDermott
- Translational Medical Device Lab, National University of Ireland Galway, Galway, Ireland
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