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Lee JS, Jung DE, Kwag D, Kim JS, Yoo SW. Ischemic penumbra-induced hemichorea complicated by polycythemia vera: Promotion of thalamic disinhibition. Neurol Sci 2024:10.1007/s10072-024-07804-1. [PMID: 39387953 DOI: 10.1007/s10072-024-07804-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024]
Affiliation(s)
- Ju-Suck Lee
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dar-Eun Jung
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Daehun Kwag
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joong-Seok Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Won Yoo
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Department of Neurology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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2
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Wang M, Farouki Y, Hulscher F, Mine B, Bonnet T, Elens S, Suarez JV, Jodaitis L, Ligot N, Naeije G, Lubicz B, Guenego A. Severely Hypoperfused Brain Tissue Correlates with Final Infarct Volume Despite Recanalization in DMVO Stroke. J Belg Soc Radiol 2023; 107:90. [PMID: 38023296 PMCID: PMC10668880 DOI: 10.5334/jbsr.3269] [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: 07/11/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives We sought to assess whether there were any parameter(s) on baseline computed-tomography-perfusion (CTP) strongly correlating with final-infarct-volume, and infarct volume progression after endovascular recanalization of acute ischemic stroke (AIS) with primary distal, medium vessel occlusion (DMVO). Materials and Methods We performed a retrospective analysis of consecutive AIS patients who were successfully recanalized by thrombectomy for DMVO. By comparing baseline CTP and follow-up MRI, we evaluated the correlation between baseline infarct and hypoperfusion volumes, and final infarct volume and infarct volume progression. We also examined their effect on good clinical outcome at 3 months (defined as an mRS score of 0 to 2). Results Between January 2018 and January 2021, 38 patients met the inclusion criteria (76% [29/38] female, median age 75 [66-86] years). Median final infarct volume and infarct volume progression were 8.4 mL [IQR: 5.2-44.4] and 7.2 mL [IQR: 4.3-29.1] respectively. TMax > 10 sec volume was strongly correlated with both (r = 0.831 and r = 0.771 respectively, p < 0.0001), as well as with good clinical outcome (-0.5, p = 0.001). A higher baseline TMax > 10 sec volume increased the probability of a higher final-infarct-volume (r2 = 0.690, coefficient = 0.83 [0.64-1.00], p < 0.0001), whereas it decreased the probability of good clinical outcome at 3 months (odds ratio = -0.67 [-1.17 to -0.18], p = 0.008). Conclusion TMax > 10 sec volume on baseline CTP correlates strongly with final infarct volume as well as with clinical outcome after mechanical thrombectomy for an AIS with DMVO.
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Affiliation(s)
- Maud Wang
- Department of Radiology, Leuven University Hospital, Leuven, Belgium
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Yousra Farouki
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Franny Hulscher
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Benjamin Mine
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Thomas Bonnet
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Stephanie Elens
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Juan Vazquez Suarez
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Lise Jodaitis
- Department of Neurology, Erasme University Hospital, Brussels, Belgium
| | - Noemie Ligot
- Department of Neurology, Erasme University Hospital, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, Erasme University Hospital, Brussels, Belgium
| | - Boris Lubicz
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Adrien Guenego
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
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3
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Panni P, Lapergue B, Maïer B, Finitsis S, Clarençon F, Richard S, Marnat G, Bourcier R, Sibon I, Dargazanli C, Blanc R, Consoli A, Eugène F, Vannier S, Spelle L, Denier C, Boulanger M, Gauberti M, Saleme S, Macian F, Rosso C, Naggara O, Turc G, Ozkul-Wermester O, Papagiannaki C, Albucher JF, Darcourt J, Le Bras A, Evain S, Wolff V, Pop R, Timsit S, Gentric JC, Bourdain F, Veunac L, Arquizan C, Gory B. Clinical Impact and Predictors of Diffusion Weighted Imaging (DWI) Reversal in Stroke Patients with Diffusion Weighted Imaging Alberta Stroke Program Early CT Score 0-5 Treated by Thrombectomy : Diffusion Weighted Imaging Reversal in Large Volume Stroke. Clin Neuroradiol 2022; 32:939-950. [PMID: 35412044 DOI: 10.1007/s00062-022-01156-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine whether reversal of DWI lesions (DWIr) on the DWI-ASPECTS (diffusion weighted imaging Alberta Stroke Program CT Score) template should serve as a predictor of 90-day clinical outcome in acute ischemic stroke (AIS) patients with pretreatment diffusion-weighted imaging (DWI)-ASPECTS 0-5 treated with thrombectomy, and to determine its predictors in current practice. METHODS We analyzed data of all consecutive patients included in the prospective multicenter national Endovascular Treatment in Ischemic Stroke Registry between 1 January 2015 and 31 December 2020 with a premorbid mRS ≤ 2, who presented with a pretreatment DWI-ASPECTS 0-5 score, underwent thrombectomy and had an available 24 h post-interventional MRI follow-up. Multivariable analyses were performed to evaluate the clinical impact of DWIr on early neurological improvement (ENI), 3‑month modified Rankin scale (mRS) score distribution (shift analysis) and to define independent predictors of DWIr. RESULTS Early neurological improvement was detected in 82/211 (41.7%) of patients while 3‑month functional independence was achieved by 75 (35.5%) patients. The DWI reversal (39/211, 18.9%) resulted an independent predictor of both ENI (aOR 3.6, 95% CI 1.2-7.7; p 0.018) and 3‑month clinical outcome (aOR for mRS shift: 2.2, 95% CI 1-4.6; p 0.030). Only successful recanalization (mTICI 2c-3) independently predicted DWIr in the studied population (aOR 3.3, 95% CI 1.3-7.9; p 0.009). CONCLUSION The DWI reversal occurs in a non-negligible proportion of DWI-ASPECTS 0-5 patients subjected to thrombectomy and significantly influences clinical outcome. The mTICI 2c-3 recanalization emerged as an independent DWIr predictor.
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Affiliation(s)
- Pietro Panni
- Department of Neuroradiology, Division of Interventional Neuroradiology, Department of Neurosurgery, San Raffaele University Hospital, Milan, Italy.
| | - Bertrand Lapergue
- Department of Neurology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - Benjamin Maïer
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Stephanos Finitsis
- AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Sébastien Richard
- CHRU-Nancy, Department of Neurology, Stroke Unit, Université de Lorraine, 54000, Nancy, France.,CIC-P 1433, INSERM U1116, CHRU-Nancy, 54000, Nancy, France
| | - Gaultier Marnat
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Romain Bourcier
- Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Igor Sibon
- Neurology, University Hospital of Bordeaux, Bordeaux, France
| | - Cyril Dargazanli
- Department of Interventional Neuroradiology, CHRU Gui de Chauliac, Montpellier, France
| | - Raphaël Blanc
- Department of Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Versailles Saint-Quentin en Yvelines University, Suresnes, France
| | - François Eugène
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | | | | | | | | | | | | | | | - Charlotte Rosso
- Department of Neurology, CHU Pitié-Salpétrière, Paris, France
| | | | - Guillaume Turc
- Department of Neurology, Hôpital Saint-Anne, Paris, France
| | | | | | | | | | - Anthony Le Bras
- Department of Neuroradiology, CHBA Bretagne Atlantique, Vannes, France
| | - Sarah Evain
- Neurology, CHBA Bretagne Atlantique, Vannes, France
| | - Valérie Wolff
- Department of Neurology, CHU Strasbourg, Strasbourg, France
| | - Raoul Pop
- Neuroradiology, CHU Strasbourg, Strasbourg, France
| | - Serge Timsit
- Department of Neurology, CHU Brest, Brest, France
| | | | | | | | | | - Benjamin Gory
- CHRU-Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, 54000, Nancy, France.,IADI, INSERM U1254, Université de Lorraine, 54000, Nancy, France
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Abstract
Our Japanese colleagues deserve much praise for finishing the first randomized clinical trial of thrombectomy in Alberta Stroke Program Early CT Score 3 to 5 patients showing an impressive therapy effect of thrombectomy. The predominant use of magnetic resonance imaging for patient selection, the low rate of alteplase therapy and its low dose limit direct comparisons with patients treated outside of Japan. Another limitation is the lack of benefit when using the traditional metric–modified Rankin Scale score 0–2. We consider the results of RESCUE-Japan LIMIT encouraging and a clear motivation to continue and complete other studies.
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Affiliation(s)
- Diogo C. Haussen
- Emory University School of Medicine/Grady Memorial Hospital, Atlanta, GA. (D.C.H.)
| | - Jens Fiehler
- Department of Neuroradiology, University Center Hamburg-Eppendorf, Germany (J.F.)
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5
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Prediction of Tissue Damage Using a User-Independent Machine Learning Algorithm vs. Tmax Threshold Maps. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.3390/ctn5030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
(1) Background: To test the accuracy of a fully automated stroke tissue estimation algorithm (FASTER) to predict final lesion volumes in an independent dataset in patients with acute stroke; (2) Methods: Tissue-at-risk prediction was performed in 31 stroke patients presenting with a proximal middle cerebral artery occlusion. FDA-cleared perfusion software using the AHA recommendation for the Tmax threshold delay was tested against a prediction algorithm trained on an independent perfusion software using artificial intelligence (FASTER). Following our endovascular strategy to consequently achieve TICI 3 outcome, we compared patients with complete reperfusion (TICI 3) vs. no reperfusion (TICI 0) after mechanical thrombectomy. Final infarct volume was determined on a routine follow-up MRI or CT at 90 days after the stroke; (3) Results: Compared to the reference standard (infarct volume after 90 days), the decision forest algorithm overestimated the final infarct volume in patients without reperfusion. Underestimation was observed if patients were completely reperfused. In cases where the FDA-cleared segmentation was not interpretable due to improper definitions of the arterial input function, the decision forest provided reliable results; (4) Conclusions: The prediction accuracy of automated tissue estimation depends on (i) success of reperfusion, (ii) infarct size, and (iii) software-related factors introduced by the training sample. A principal advantage of machine learning algorithms is their improved robustness to artifacts in comparison to solely threshold-based model-dependent software. Validation on independent datasets remains a crucial condition for clinical implementations of decision support systems in stroke imaging.
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Broocks G, McDonough R, Meyer L, Bechstein M, Dipl Ing HK, Schön G, Nawka MT, Fiehler J, Hanning U, Sporns P, Barow E, Minnerup J, Kemmling A. Reversible Ischemic Lesion Hypodensity in Acute Stroke CT Following Endovascular Reperfusion. Neurology 2021; 97:e1075-e1084. [PMID: 34261783 DOI: 10.1212/wnl.0000000000012484] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In acute stroke, early ischemic lesion hypodensity in computed tomography (CT) is considered the imaging hallmark of brain infarction, representing a state of irreversible tissue damage with a continual increase of net water uptake. This dogma is however challenged by rare cases of apparently reversed early lesion hypodensity following complete reperfusion. The purpose of this study was to investigate the occurrence of reversible ischemic edema after endovascular treatment. METHODS 184 acute ischemic anterior circulation stroke patients were included after consecutive screening. Ischemic brain edema was determined using quantitative lesion net water uptake (NWU) in admission-CT and follow-up CT based on CT-densitometry and ΔNWU was calculated as the difference. The association of edema progression to imaging and clinical parameters was investigated. Clinical outcome was assessed using modified Ranking Scale (mRS) scores at day 90. RESULTS 27/184 patients (14.7%) showed edema arrest and 3 patients (1.6%) exhibited significant edema reversibility. Higher degree of recanalization (odds ratio (OR): 2.96, 95%CI: 1.46-6.01, p<0.01) and shorter time from imaging to recanalization (OR/hour: 0.32, 95%CI: 0.18-0.54, p<0.0001) were significantly associated with edema arrest or reversibility. Clinical outcome was significantly better in patients without edema progression (median mRS 2 versus mRS 5, p=0.004). DISCUSSION Albeit rare, lesion hypodensity considered to be representative of early infarct in acute stroke CT may be reversible following complete recanalization. Arrest of edema progression of acute brain infarct lesions may occur after successful rapid vessel recanalization, resulting in improved functional outcome. Future research is needed to investigate conditions where early revascularization may halt or even reverse vasogenic edema of ischemic tissue.
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Affiliation(s)
- Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rosalie McDonough
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep Dipl Ing
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Schön
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf
| | - Marie Teresa Nawka
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Sporns
- Department of Neuroradiology, Universitaetsspital Basel, Basel, Switzerland
| | - Ewgenia Barow
- Department of Neurology, University Medical Center Hamburg-Eppendorf
| | - Jens Minnerup
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andre Kemmling
- Department of Neuroradiology, University Hospital Schleswig-Holstein, Lübeck, Germany.,Department of Neuroradiology, Westpfalzklinikum, Kaiserslautern, Germany
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7
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[Imaging-based patient selection for mechanical thrombectomy based on time since symptom onset]. DER NERVENARZT 2021; 92:733-743. [PMID: 33970286 DOI: 10.1007/s00115-021-01121-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In ischemic stroke due to large vessel occlusion (LVO), the indications for patient selection for endovascular mechanical thrombectomy (MT) are based on findings from brain imaging. Several imaging protocols from computed tomography (CT) or magnetic resonance imaging (MRI) are available to guide treatment decisions. OBJECTIVE To recommend the optimal choice of imaging modalities and protocols for MT with respect to time windows from symptom onset. MATERIAL AND METHODS Evaluation of the results of large randomized placebo-controlled trials regarding imaging-based patient selection in MT categorized by time intervals since symptom onset. We discuss methodological aspects, advantages and caveats of individual stroke imaging protocols. Summary of recommendations for the practice. RESULTS AND CONCLUSION In MT trials CT was mostly used for patient selection. Plain CT combined with CT angiography or additional perfusion imaging is the preferred option. In early time windows CT with CTA is adequate (≤ 6 h for MT, ≤ 4.5 h in cases of accompanying thrombolysis according to exclusion criteria). In later or unknown time windows perfusion imaging is needed for patient selection. Patients presenting with unknown time windows should be examined by MRI as a first-line choice in mild to moderate deficits, in cases of severe deficits CT imaging with perfusion imaging.
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8
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Lampinen B, Lätt J, Wasselius J, van Westen D, Nilsson M. Time dependence in diffusion MRI predicts tissue outcome in ischemic stroke patients. Magn Reson Med 2021; 86:754-764. [PMID: 33755261 PMCID: PMC8445077 DOI: 10.1002/mrm.28743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/18/2022]
Abstract
Purpose: Reperfusion therapy enables effective treatment of ischemic stroke presenting within 4–6 hours. However, tissue progression from ischemia to infarction is variable, and some patients benefit from treatment up until 24 hours. Improved imaging techniques are needed to identify these patients. Here, it was hypothesized that time dependence in diffusion MRI may predict tissue outcome in ischemic stroke. Methods: Diffusion MRI data were acquired with multiple diffusion times in five non-reperfused patients at 2, 9, and 100 days after stroke onset. Maps of “rate of kurtosis change” (k), mean kurtosis, ADC, and fractional anisotropy were derived. The ADC maps defined lesions, normal-appearing tissue, and the lesion tissue that would either be infarcted or remain viable by day 100. Diffusion parameters were compared (1) between lesions and normal-appearing tissue, and (2) between lesion tissue that would be infarcted or remain viable. Results: Positive values of k were observed within stroke lesions on day 2 (P = .001) and on day 9 (P = .023), indicating diffusional exchange. On day 100, high ADC values indicated infarction of 50 ± 20% of the lesion volumes. Tissue infarction was predicted by high k values both on day 2 (P = .026) and on day 9 (P = .046), by low mean kurtosis values on day 2 (P = .043), and by low fractional anisotropy values on day 9 (P = .029), but not by low ADC values. Conclusions: Diffusion time dependence predicted tissue outcome in ischemic stroke more accurately than the ADC, and may be useful for predicting reperfusion benefit.
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Affiliation(s)
- Björn Lampinen
- Clinical Sciences Lund, Medical Radiation Physics, Lund University, Lund, Sweden
| | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skåne University Hospital Lund, Lund, Sweden
| | - Johan Wasselius
- Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
| | | | - Markus Nilsson
- Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
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9
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TASHIRO R, FUJIMURA M, NISHIZAWA T, SAITO A, TOMINAGA T. Cerebral Hyperperfusion and Concomitant Reversible Lesion at the Splenium after Direct Revascularization Surgery for Adult Moyamoya Disease: Possible Involvement of MERS and Watershed Shift Phenomenon. NMC Case Rep J 2021; 8:451-456. [PMID: 35079503 PMCID: PMC8769435 DOI: 10.2176/nmccrj.cr.2020-0337] [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: 10/07/2020] [Accepted: 01/13/2021] [Indexed: 11/20/2022] Open
Abstract
Superficial temporal artery (STA)–middle cerebral artery (MCA) bypass is the standard surgical treatment for moyamoya disease (MMD). Local cerebral hyperperfusion (CHP) is one of the potential complications, which could enhance intrinsic inflammation and oxidative stress in MMD patients and accompany concomitant watershed shift (WS) phenomenon, defined as the paradoxical decrease in the cerebral blood flow (CBF) near the site of CHP. However, CHP and simultaneous remote reversible lesion at the splenium have never been reported. A 22-year-old man with ischemic-onset MMD underwent left STA–MCA bypass. Although asymptomatic, local CHP and a paradoxical CBF decrease at the splenium were evident on N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography 1 day after surgery. The patient was maintained under strict blood pressure control, but he subsequently developed transient delirium 4 days after surgery. MRI revealed a high-signal-intensity lesion with a low apparent diffusion coefficient at the splenium. After continued intensive management, the splenial lesion disappeared 14 days after surgery. The patient was discharged without neurological deficits. Catheter angiography 2 months later confirmed marked regression of posterior-to-anterior collaterals via the posterior pericallosal artery, suggesting dynamic watershed shift between blood flow supplies from the posterior and anterior circulation. Mild encephalitis/encephalopathy with a reversible splenial lesion could explain the pathophysiology of the postoperative splenial lesion in this case, which is associated with generation of oxidative stress, enhanced inflammation, and metabolic abnormalities. Rapid postoperative hemodynamic changes, including local CHP and concomitant WS phenomenon, might participate in the formation of the splenial lesion.
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Affiliation(s)
- Ryosuke TASHIRO
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Miki FUJIMURA
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Taketo NISHIZAWA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Atsushi SAITO
- Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Teiji TOMINAGA
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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10
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Li Y, Wang T, Zhang T, Lin Z, Li Y, Guo R, Zhao Y, Meng Z, Liu J, Yu X, Liang ZP, Nachev P. Fast high-resolution metabolic imaging of acute stroke with 3D magnetic resonance spectroscopy. Brain 2020; 143:3225-3233. [PMID: 33141145 PMCID: PMC7719019 DOI: 10.1093/brain/awaa264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/05/2020] [Accepted: 06/29/2020] [Indexed: 01/24/2023] Open
Abstract
Impaired oxygen and cellular metabolism is a hallmark of ischaemic injury in acute stroke. Magnetic resonance spectroscopic imaging (MRSI) has long been recognized as a potentially powerful tool for non-invasive metabolic imaging. Nonetheless, long acquisition time, poor spatial resolution, and narrow coverage have limited its clinical application. Here we investigated the feasibility and potential clinical utility of rapid, high spatial resolution, near whole-brain 3D metabolic imaging based on a novel MRSI technology. In an 8-min scan, we simultaneously obtained 3D maps of N-acetylaspartate and lactate at a nominal spatial resolution of 2.0 × 3.0 × 3.0 mm3 with near whole-brain coverage from a cohort of 18 patients with acute ischaemic stroke. Serial structural and perfusion MRI was used to define detailed spatial maps of tissue-level outcomes against which high-resolution metabolic changes were evaluated. Within hypoperfused tissue, the lactate signal was higher in areas that ultimately infarcted compared with those that recovered (P < 0.0001). Both lactate (P < 0.0001) and N-acetylaspartate (P < 0.001) differed between infarcted and other regions. Within the areas of diffusion-weighted abnormality, lactate was lower where recovery was observed compared with elsewhere (P < 0.001). This feasibility study supports further investigation of fast high-resolution MRSI in acute stroke.
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Affiliation(s)
- Yao Li
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tianyao Wang
- Radiology Department, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Tianxiao Zhang
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zengping Lin
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yudu Li
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Rong Guo
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Yibo Zhao
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ziyu Meng
- Institute for Medical Imaging Technology, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jun Liu
- Radiology Department, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Xin Yu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Zhi-Pei Liang
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Parashkev Nachev
- High-Dimensional Neurology Group, Institute of Neurology, University College London, London, UK
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11
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McGarry BL, Damion RA, Chew I, Knight MJ, Harston GW, Carone D, Jezzard P, Sitaram A, Muir KW, Clatworthy P, Kauppinen RA. A Comparison of T 2 Relaxation-Based MRI Stroke Timing Methods in Hyperacute Ischemic Stroke Patients: A Pilot Study. J Cent Nerv Syst Dis 2020; 12:1179573520943314. [PMID: 32963473 PMCID: PMC7488882 DOI: 10.1177/1179573520943314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022] Open
Abstract
Background: T2 relaxation-based magnetic resonance imaging (MRI) signals may provide onset time for acute ischemic strokes with an unknown onset. The ability of visual and quantitative MRI-based methods in a cohort of hyperacute ischemic stroke patients was studied. Methods: A total of 35 patients underwent 3T (3 Tesla) MRI (<9-hour symptom onset). Diffusion-weighted (DWI), apparent diffusion coefficient (ADC), T1-weighted (T1w), T2-weighted (T2w), and T2 relaxation time (T2) images were acquired. T2-weighted fluid attenuation inversion recovery (FLAIR) images were acquired for 17 of these patients. Image intensity ratios of the average intensities in ischemic and non-ischemic reference regions were calculated for ADC, DWI, T2w, T2 relaxation, and FLAIR images, and optimal image intensity ratio cut-offs were determined. DWI and FLAIR images were assessed visually for DWI/FLAIR mismatch. Results: The T2 relaxation time image intensity ratio was the only parameter with significant correlation with stroke duration (r = 0.49, P = .003), an area under the receiver operating characteristic curve (AUC = 0.77, P < .0001), and an optimal cut-off (T2 ratio = 1.072) that accurately identified patients within the 4.5-hour thrombolysis treatment window with sensitivity of 0.74 and specificity of 0.74. In the patients with the additional FLAIR, areas under the precision-recall-gain curve (AUPRG) and F1 scores showed that the T2 relaxation time ratio (AUPRG = 0.60, F1 = 0.73) performed considerably better than the FLAIR ratio (AUPRG = 0.39, F1 = 0.57) and the visual DWI/FLAIR mismatch (F1 = 0.25). Conclusions: Quantitative T2 relaxation time is the preferred MRI parameter in the assessment of patients with unknown onset for treatment stratification.
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Affiliation(s)
- Bryony L McGarry
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Robin A Damion
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Isabel Chew
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Michael J Knight
- School of Psychological Science, University of Bristol, Bristol, UK
| | - George Wj Harston
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Davide Carone
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Jezzard
- Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Amith Sitaram
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Keith W Muir
- Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, UK
| | - Philip Clatworthy
- Stroke Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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12
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Shan Y, Xu BY, Li S, Fan Y, Liu YB, Zhang M, Ma QF, Gao JH, Lu J. Assessment of MRI-based anomalous diffusion changes in brain ischemic stroke with a fractional motion model. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2020; 317:106795. [PMID: 32712547 DOI: 10.1016/j.jmr.2020.106795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
The actual diffusion process in human brain has been shown to be anomalous comparing to that predicted with traditional diffusion MRI (dMRI) theory. Recently, dMRI based on fractional motion (FM) model has demonstrated the potential to accurately describe anomalous diffusion in vivo. In this work, we explored the potential value of FM model-based dMRI in quantificational identification of ischemic stroke and compared that with the traditional apparent diffusion coefficient (ADC). We included 23 acute stroke patients, 8 of whom finished a follow-up scan, and 22 matched healthy controls. The dMRI images were acquired by using a Stejskal-Tanner single-shot spin-echo echo-planar-imaging sequence (diffusion gradients were applied in three orthogonal directions with 25 non-zero b values ranging from 248 to 4474 s/mm2) at 3.0 T MRI. We calculated the coefficient of variation (CV) for FM-related parameters in stroke lesions, and compared the mean values for FM-related parameters and ADC by using two-sample t-tests. Correlation analysis was achieved using Pearson correlation coefficient test. In acute stroke lesions, CV for FM-related parameters showed significant increase compared with normal tissues (P < 0.01), while those of ADC didn't appear statistical difference. Mean values for FM-related parameters showed significant decrease in acute lesion (P < 0.01) and their changing pattern during follow-up was positively correlated with ADC (P < 0.005). Our results initially verified the utility of the FM-model in detecting ischemic stroke compared with traditional dMRI.
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Affiliation(s)
- Yi Shan
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Bo-Yan Xu
- Beijing City Key Lab for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, No. 5 Yiheyuan Road, Beijing 100871, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, No. 5 Yiheyuan Road, Beijing 100871, China
| | - Shuang Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yang Fan
- Beijing Intelligent Brain Cloud, Inc., Integrated Science Building, No. 5 Yiheyuan Road, Beijing 100871, China
| | - Yi-Bing Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Miao Zhang
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qing-Feng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China
| | - Jia-Hong Gao
- Beijing City Key Lab for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, No. 5 Yiheyuan Road, Beijing 100871, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, No. 5 Yiheyuan Road, Beijing 100871, China; McGovern Institute for Brain Research, Peking University, No. 5 Yiheyuan Road, Beijing 100871, China
| | - Jie Lu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China; Department of Nuclear Medicine, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China.
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13
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Technical considerations of multi-parametric tissue outcome prediction methods in acute ischemic stroke patients. Sci Rep 2019; 9:13208. [PMID: 31519923 PMCID: PMC6744509 DOI: 10.1038/s41598-019-49460-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/23/2019] [Indexed: 12/31/2022] Open
Abstract
Decisions regarding acute stroke treatment rely heavily on imaging, but interpretation can be difficult for physicians. Machine learning methods can assist clinicians by providing tissue outcome predictions for different treatment approaches based on acute multi-parametric imaging. To produce such clinically viable machine learning models, factors such as classifier choice, data normalization, and data balancing must be considered. This study gives comprehensive consideration to these factors by comparing the agreement of voxel-based tissue outcome predictions using acute imaging and clinical parameters with manual lesion segmentations derived from follow-up imaging. This study considers random decision forest, generalized linear model, and k-nearest-neighbor machine learning classifiers in conjunction with three data normalization approaches (non-normalized, relative to contralateral hemisphere, and relative to contralateral VOI), and two data balancing strategies (full dataset and stratified subsampling). These classifier settings were evaluated based on 90 MRI datasets from acute ischemic stroke patients. Distinction was made between patients recanalized using intraarterial and intravenous methods, as well as those without successful recanalization. For primary quantitative comparison, the Dice metric was computed for each voxel-based tissue outcome prediction and its corresponding follow-up lesion segmentation. It was found that the random forest classifier outperformed the generalized linear model and the k-nearest-neighbor classifier, that normalization did not improve the Dice score of the lesion outcome predictions, and that the models generated lesion outcome predictions with higher Dice scores when trained with balanced datasets. No significant difference was found between the treatment groups (intraarterial vs intravenous) regarding the Dice score of the tissue outcome predictions.
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14
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Hsia AW, Luby M, Cullison K, Burton S, Armonda R, Liu AH, Leigh R, Nadareishvili Z, Benson RT, Lynch JK, Latour LL. Rapid Apparent Diffusion Coefficient Evolution After Early Revascularization. Stroke 2019; 50:2086-2092. [PMID: 31238830 DOI: 10.1161/strokeaha.119.025784] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- In this era of endovascular therapy (EVT) with early, complete recanalization and reperfusion, we have observed an even more rapid apparent diffusion coefficient (ADC) normalization within the acute ischemic lesion compared with the natural history or IV-tPA-treated patient. In this study, we aimed to evaluate the effect of revascularization on ADC evolution within the core lesion in the first 24 hours in acute ischemic stroke patients. Methods- This retrospective study included anterior circulation acute ischemic stroke patients treated with EVT with or without intravenous tPA (IVT) from 2015 to 2017 compared with a consecutive cohort of IVT-only patients treated before 2015. Diffusion-weighted imaging and ADC maps were used to quantify baseline core lesions. Median ADC value change and core reversal were determined at 24 hours. Diffusion-weighted imaging lesion growth was measured at 24 hours and 5 days. Good clinical outcome was defined as modified Rankin Scale score of 0 to 2 at 90 days. Results- Twenty-five patients (50%) received IVT while the other 25 patients received EVT (50%) with or without IVT. Between these patient groups, there were no differences in age, sex, baseline National Institutes of Health Stroke Scale, interhospital transfer, or IVT rates. Thirty-two patients (64%) revascularized with 69% receiving EVT. There was a significant increase in median ADC value of the core lesion at 24 hours in patients who revascularized compared with further ADC reduction in nonrevascularization patients. Revascularization patients had a significantly higher rate of good clinical outcome at 90 days, 63% versus 9% (P=0.003). Core reversal at 24 hours was significantly higher in revascularization patients, 69% versus 22% (P=0.002). Conclusions- ADC evolution in acute ischemic stroke patients with early, complete revascularization, now more commonly seen with EVT, is strikingly different from our historical understanding. The early ADC normalization we have observed in this setting may include a component of secondary injury and serve as a potential imaging biomarker for the development of future adjunctive therapies. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00009243.
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Affiliation(s)
- Amie W Hsia
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.).,MedStar Washington Hospital Center Comprehensive Stroke Center, Washington, DC (A.W.H., S.B., R.T.B.)
| | - Marie Luby
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Kaylie Cullison
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Shannon Burton
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.).,MedStar Washington Hospital Center Comprehensive Stroke Center, Washington, DC (A.W.H., S.B., R.T.B.)
| | - Rocco Armonda
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | | | - Richard Leigh
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Zurab Nadareishvili
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.).,MedStar Washington Hospital Center Comprehensive Stroke Center, Washington, DC (A.W.H., S.B., R.T.B.)
| | - Richard T Benson
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - John K Lynch
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
| | - Lawrence L Latour
- From the NIH/National Institute of Neurological Disorders and Stroke, Stroke Branch, Bethesda, MD (A.W.H., M.L., K.C., S.B., R.L., Z.N., R.T.B., J.K.L., L.L.L.)
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15
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Stone AJ, Harston GWJ, Carone D, Okell TW, Kennedy J, Blockley NP. Prospects for investigating brain oxygenation in acute stroke: Experience with a non-contrast quantitative BOLD based approach. Hum Brain Mapp 2019; 40:2853-2866. [PMID: 30860660 PMCID: PMC6563088 DOI: 10.1002/hbm.24564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
Metabolic markers of baseline brain oxygenation and tissue perfusion have an important role to play in the early identification of ischaemic tissue in acute stroke. Although well established MRI techniques exist for mapping brain perfusion, quantitative imaging of brain oxygenation is poorly served. Streamlined-qBOLD (sqBOLD) is a recently developed technique for mapping oxygenation that is well suited to the challenge of investigating acute stroke. In this study a noninvasive serial imaging protocol was implemented, incorporating sqBOLD and arterial spin labelling to map blood oxygenation and perfusion, respectively. The utility of these parameters was investigated using imaging based definitions of tissue outcome (ischaemic core, infarct growth and contralateral tissue). Voxel wise analysis revealed significant differences between all tissue outcomes using pairwise comparisons for the transverse reversible relaxation rate (R 2 '), deoxygenated blood volume (DBV) and deoxyghaemoglobin concentration ([dHb]; p < 0.01 in all cases). At the patient level (n = 9), a significant difference was observed for [dHb] between ischaemic core and contralateral tissue. Furthermore, serial analysis at the patient level (n = 6) revealed significant changes in R 2 ' between the presentation and 1 week scans for both ischaemic core (p < 0.01) and infarct growth (p < 0.05). In conclusion, this study presents evidence supporting the potential of sqBOLD for imaging oxygenation in stroke.
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Affiliation(s)
- Alan J Stone
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - George W J Harston
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Davide Carone
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas W Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James Kennedy
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P Blockley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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16
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Alegiani AC, MacLean S, Braass H, Gellißen S, Cho TH, Derex L, Hermier M, Berthezene Y, Nighoghossian N, Gerloff C, Fiehler J, Thomalla G. Dynamics of Water Diffusion Changes in Different Tissue Compartments From Acute to Chronic Stroke-A Serial Diffusion Tensor Imaging Study. Front Neurol 2019; 10:158. [PMID: 30863361 PMCID: PMC6399390 DOI: 10.3389/fneur.2019.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/07/2019] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose: The immediate decrease of the apparent diffusion coefficient (ADC) is the main characteristic change of water diffusion in acute ischemic stroke. There is only limited information on the time course of diffusion parameters in different tissue compartments of cerebral ischemia. Materials and Methods: In a longitudinal study, we examined 21 patients with acute ischemic stroke by diffusion tensor imaging within 5 h after symptom onset, 3 h later, 2 days, and 1 month after symptom onset. Acute diffusion lesion and the fluid-attenuated inversion recovery (FLAIR) after 2 days were used as volumes of interest to define persistent core, lesion growth, and reversible acute diffusion lesion. For all diffusion parameters ratios between the stroke lesion VOIs and the mirror VOIs were calculated for each time point. ADC ratio, fractional anisotropy ratios, and eigenvalues ratios were measured in these volumes of interest and in contralateral mirror regions at each time points. Results: In the persistent core, ADC ratio (0.772) and all eigenvalues ratios were reduced on admission up to 1 day after stroke and increased after 1 month (ADC ratio 1.067). Within the region of infarct growth time course of diffusion parameter changes was similar, but delayed. In the brain area with reversible diffusion lesion, a partial normalization of diffusion parameters over the time was observed, while after 1 month diffusion parameters did not show the signature of healthy brain tissue. There were significantly different trends for all parameters over time between the three tissue compartments. Conclusion: Diffusion tensor imaging displays characteristic changes of water diffusion in different tissue compartments over time in acute ischemic stroke. Even regions with reversible diffusion lesion show diffusion signatures of persisting tissue alterations.
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Affiliation(s)
| | - Simon MacLean
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hanna Braass
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Gellißen
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon, Lyon, France
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon, Lyon, France
| | - Marc Hermier
- Department of Neuroradiology, Université Lyon, Lyon, France
| | | | | | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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17
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Donahue MJ, Dlamini N, Bhatia A, Jordan LC. Neuroimaging Advances in Pediatric Stroke. Stroke 2019; 50:240-248. [PMID: 30661496 PMCID: PMC6450544 DOI: 10.1161/strokeaha.118.020478] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/29/2018] [Indexed: 12/18/2022]
Affiliation(s)
| | - Nomazulu Dlamini
- Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aashim Bhatia
- Radiology, Vanderbilt Medical Center, Nashville, TN, USA
| | - Lori C. Jordan
- Pediatrics–Division of Pediatric Neurology, Vanderbilt Medical Center, Nashville, TN, USA
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18
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Ji Y, Paulsen J, Zhou IY, Lu D, Machado P, Qiu B, Song YQ, Sun PZ. In vivo microscopic diffusional kurtosis imaging with symmetrized double diffusion encoding EPI. Magn Reson Med 2019; 81:533-541. [PMID: 30260504 PMCID: PMC6258297 DOI: 10.1002/mrm.27419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/31/2018] [Accepted: 06/03/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Diffusional kurtosis imaging (DKI) measures the deviation of the displacement probability from a normal distribution, complementing the data commonly acquired by diffusion MRI. It is important to elucidate the sources of kurtosis contrast, particularly in biological tissues where microscopic kurtosis (intrinsic kurtosis) and diffusional heterogeneity may co-exist. METHODS We have developed a technique for microscopic kurtosis MRI, dubbed microscopic diffusional kurtosis imaging (µDKI), using a symmetrized double diffusion encoding (s-DDE) EPI sequence. We compared this newly developed µDKI to conventional DKI methods in both a triple compartment phantom and in vivo. RESULTS Our results showed that whereas conventional DKI and µDKI provided similar measurements in a compartment of monosphere beads, kurtosis measured by µDKI was significantly less than that measured by conventional DKI in a compartment of mixed Gaussian pools. For in vivo brain imaging, µDKI showed small yet significantly lower kurtosis measurement in regions of the cortex, CSF, and internal capsule compared to the conventional DKI approach. CONCLUSIONS Our study showed that µDKI is less susceptible than conventional DKI to sub-voxel diffusional heterogeneity. Our study also provided important preliminary demonstration of our technique in vivo, warranting future studies to investigate its diagnostic use in examining neurological disorders.
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Affiliation(s)
- Yang Ji
- Center for Biomedical Engineering, Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA USA
| | | | - Iris Yuwen Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA USA
| | - Dongshuang Lu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA USA
| | - Patrick Machado
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA USA
- Schlumberger-Doll Research Center, Cambridge, MA USA
- Department of Chemical and Petroleum Engineering, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Bensheng Qiu
- Center for Biomedical Engineering, Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, China
| | - Yi-Qiao Song
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA USA
- Schlumberger-Doll Research Center, Cambridge, MA USA
| | - Phillip Zhe Sun
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA USA
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta GA USA
- Department of Radiology, Emory University School of Medicine, Atlanta GA USA
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19
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Leigh R, Knutsson L, Zhou J, van Zijl PC. Imaging the physiological evolution of the ischemic penumbra in acute ischemic stroke. J Cereb Blood Flow Metab 2018; 38:1500-1516. [PMID: 28345479 PMCID: PMC6125975 DOI: 10.1177/0271678x17700913] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We review the hemodynamic, metabolic and cellular parameters affected during early ischemia and their changes as a function of approximate cerebral blood flow ( CBF) thresholds. These parameters underlie the current practical definition of an ischemic penumbra, namely metabolically affected but still viable brain tissue. Such tissue is at risk of infarction under continuing conditions of reduced CBF, but can be rescued through timely intervention. This definition will be useful in clinical diagnosis only if imaging techniques exist that can rapidly, and with sufficient accuracy, visualize the existence of a mismatch between such a metabolically affected area and regions that have suffered cell depolarization. Unfortunately, clinical data show that defining the outer boundary of the penumbra based solely on perfusion-related thresholds may not be sufficiently accurate. Also, thresholds for CBF and cerebral blood volume ( CBV) differ for white and gray matter and evolve with time for both inner and outer penumbral boundaries. As such, practical penumbral imaging would involve parameters in which the physiology is immediately displayed in a manner independent of baseline CBF or CBF threshold, namely pH, oxygen extraction fraction ( OEF), diffusion constant and mean transit time ( MTT). Suitable imaging technologies will need to meet this requirement in a 10-20 min exam.
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Affiliation(s)
- Richard Leigh
- 1 National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, USA
| | - Linda Knutsson
- 2 Department of Medical Radiation Physics, Lund University, Lund, Sweden.,3 Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jinyuan Zhou
- 3 Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.,4 F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter Cm van Zijl
- 3 Department of Radiology, Johns Hopkins University, Baltimore, MD, USA.,4 F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
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20
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Donahue MJ, Achten E, Cogswell PM, De Leeuw FE, Derdeyn CP, Dijkhuizen RM, Fan AP, Ghaznawi R, Heit JJ, Ikram MA, Jezzard P, Jordan LC, Jouvent E, Knutsson L, Leigh R, Liebeskind DS, Lin W, Okell TW, Qureshi AI, Stagg CJ, van Osch MJP, van Zijl PCM, Watchmaker JM, Wintermark M, Wu O, Zaharchuk G, Zhou J, Hendrikse J. Consensus statement on current and emerging methods for the diagnosis and evaluation of cerebrovascular disease. J Cereb Blood Flow Metab 2018; 38:1391-1417. [PMID: 28816594 PMCID: PMC6125970 DOI: 10.1177/0271678x17721830] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/26/2017] [Accepted: 06/10/2017] [Indexed: 01/04/2023]
Abstract
Cerebrovascular disease (CVD) remains a leading cause of death and the leading cause of adult disability in most developed countries. This work summarizes state-of-the-art, and possible future, diagnostic and evaluation approaches in multiple stages of CVD, including (i) visualization of sub-clinical disease processes, (ii) acute stroke theranostics, and (iii) characterization of post-stroke recovery mechanisms. Underlying pathophysiology as it relates to large vessel steno-occlusive disease and the impact of this macrovascular disease on tissue-level viability, hemodynamics (cerebral blood flow, cerebral blood volume, and mean transit time), and metabolism (cerebral metabolic rate of oxygen consumption and pH) are also discussed in the context of emerging neuroimaging protocols with sensitivity to these factors. The overall purpose is to highlight advancements in stroke care and diagnostics and to provide a general overview of emerging research topics that have potential for reducing morbidity in multiple areas of CVD.
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Affiliation(s)
- Manus J Donahue
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, TN, USA
| | - Eric Achten
- Department of Radiology and Nuclear Medicine, Universiteit Gent, Gent, Belgium
| | - Petrice M Cogswell
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank-Erik De Leeuw
- Radboud University, Nijmegen Medical Center, Donders Institute Brain Cognition & Behaviour, Center for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Colin P Derdeyn
- Department of Radiology and Neurology, University of Iowa, Iowa City, IA, USA
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Audrey P Fan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Rashid Ghaznawi
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeremy J Heit
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Peter Jezzard
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric Jouvent
- Department of Neurology, AP-HP, Lariboisière Hospital, Paris, France
| | - Linda Knutsson
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Richard Leigh
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | | | - Weili Lin
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas W Okell
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Adnan I Qureshi
- Department of Neurology, Zeenat Qureshi Stroke Institute, St. Cloud, MN, USA
| | - Charlotte J Stagg
- Oxford Centre for Human Brain Activity, University of Oxford, Oxford, UK
| | | | - Peter CM van Zijl
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jennifer M Watchmaker
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Max Wintermark
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Greg Zaharchuk
- Department of Radiology, Neuroimaging and Neurointervention Division, Stanford University, CA, USA
| | - Jinyuan Zhou
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Gomez CR. Time Is Brain: The Stroke Theory of Relativity. J Stroke Cerebrovasc Dis 2018; 27:2214-2227. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 01/24/2023] Open
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22
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Yin J, Sun H, Wang Z, Ni H, Shen W, Sun PZ. Diffusion Kurtosis Imaging of Acute Infarction: Comparison with Routine Diffusion and Follow-up MR Imaging. Radiology 2018; 287:651-657. [PMID: 29558293 DOI: 10.1148/radiol.2017170553] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the relationship between diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) in patients with acute stroke at admission and the tissue outcome 1 month after onset of stroke. Materials and Methods Patients with stroke underwent DWI (b values = 0, 1000 sec/mm2 along three directions) and DKI (b values = 0, 1000, 2000 sec/mm2 along 20 directions) within 24 hours after symptom onset and 1 month after symptom onset. For large lesions (diameter ≥ 1 cm), acute lesion volumes at DWI and DKI were compared with those at follow-up T2-weighted imaging by using Spearman correlation analysis. For small lesions (diameter < 1 cm), the number of acute lesions at DWI and DKI and follow-up T2-weighted imaging was counted and compared by using the McNemar test. Results Thirty-seven patients (mean age, 58 years; range, 35-82 years) were included. There were 32 large lesions and 138 small lesions. For large lesions, the volumes of acute lesions on kurtosis maps showed no difference from those on 1-month follow-up T2-weighted images (P = .532), with a higher correlation coefficient than those on the apparent diffusion coefficient and mean diffusivity maps (R2 = 0.730 vs 0.479 and 0.429). For small lesions, the number of acute lesions on DKI, but not on DWI, images was consistent with that on the follow-up T2-weighted images (P = .125). Conclusion DKI complements DWI for improved prediction of outcome of acute ischemic stroke. © RSNA, 2018.
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Affiliation(s)
- Jianzhong Yin
- From the Departments of Radiology (J.Y., H.N., W.S.) and Neurology (Z.W.), Tianjin First Central Hospital, Tianjin, China; Department of Medicine, Tianjin Medical University, Tianjin, China (H.S.); and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Room 2301 CNY, Charlestown, MA 02129 (P.Z.S.)
| | - Haizhen Sun
- From the Departments of Radiology (J.Y., H.N., W.S.) and Neurology (Z.W.), Tianjin First Central Hospital, Tianjin, China; Department of Medicine, Tianjin Medical University, Tianjin, China (H.S.); and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Room 2301 CNY, Charlestown, MA 02129 (P.Z.S.)
| | - Zhiyun Wang
- From the Departments of Radiology (J.Y., H.N., W.S.) and Neurology (Z.W.), Tianjin First Central Hospital, Tianjin, China; Department of Medicine, Tianjin Medical University, Tianjin, China (H.S.); and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Room 2301 CNY, Charlestown, MA 02129 (P.Z.S.)
| | - Hongyan Ni
- From the Departments of Radiology (J.Y., H.N., W.S.) and Neurology (Z.W.), Tianjin First Central Hospital, Tianjin, China; Department of Medicine, Tianjin Medical University, Tianjin, China (H.S.); and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Room 2301 CNY, Charlestown, MA 02129 (P.Z.S.)
| | - Wen Shen
- From the Departments of Radiology (J.Y., H.N., W.S.) and Neurology (Z.W.), Tianjin First Central Hospital, Tianjin, China; Department of Medicine, Tianjin Medical University, Tianjin, China (H.S.); and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Room 2301 CNY, Charlestown, MA 02129 (P.Z.S.)
| | - Phillip Zhe Sun
- From the Departments of Radiology (J.Y., H.N., W.S.) and Neurology (Z.W.), Tianjin First Central Hospital, Tianjin, China; Department of Medicine, Tianjin Medical University, Tianjin, China (H.S.); and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Room 2301 CNY, Charlestown, MA 02129 (P.Z.S.)
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23
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Havsteen I, Ovesen C, Willer L, Nybing JD, Ægidius K, Marstrand J, Meden P, Rosenbaum S, Folke MN, Christensen H, Christensen A. Comparison of 3- and 20-Gradient Direction Diffusion-Weighted Imaging in a Clinical Subacute Cohort of Patients with Transient Ischemic Attack: Application of Standard Vendor Protocols for Lesion Detection and Final Infarct Size Projection. Front Neurol 2017; 8:691. [PMID: 29326651 PMCID: PMC5741597 DOI: 10.3389/fneur.2017.00691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Diffusion tensor imaging may aid brain ischemia assessment but is more time consuming than conventional diffusion-weighted imaging (DWI). We compared 3-gradient direction DWI (3DWI) and 20-gradient direction DWI (20DWI) standard vendor protocols in a hospital-based prospective cohort of patients with transient ischemic attack (TIA) for lesion detection, lesion brightness, predictability of persisting infarction, and final infarct size. Methods We performed 3T-magnetic resonance imaging including diffusion and T2-fluid attenuated inversion recovery (FLAIR) within 72 h and 8 weeks after ictus. Qualitative lesion brightness was assessed by visual inspection. We measured lesion area and brightness with manual regions of interest and compared with homologous normal tissue. Results 117 patients with clinical TIA showed 78 DWI lesions. 2 lesions showed only on 3DWI. No lesions were uniquely 20DWI positive. 3DWI was visually brightest for 34 lesions. 12 lesions were brightest on 20DWI. The median 3DWI lesion area was larger for lesions equally bright, or brightest on 20DWI [median (IQR) 39 (18–95) versus 18 (10–34) mm2, P = 0.007]. 3DWI showed highest measured relative lesion signal intensity [median (IQR) 0.77 (0.48–1.17) versus 0.58 (0.34–0.81), P = 0.0006]. 3DWI relative lesion signal intensity was not correlated to absolute signal intensity, but 20DWI performed less well for low-contrast lesions. 3DWI lesion size was an independent predictor of persistent infarction. 3-gradient direction apparent diffusion coefficient areas were closest to 8-week FLAIR infarct size. Conclusion 3DWI detected more lesions and had higher relative lesion SI than 20DWI. 20DWI appeared blurred and did not add information. Clinical Trial Registration http://www.clinicaltrials.gov. Unique Identifier NCT01531946.
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Affiliation(s)
- Inger Havsteen
- Department of Radiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Ovesen
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lasse Willer
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus Damm Nybing
- Department of Radiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen Ægidius
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Marstrand
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Meden
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Marie Norsker Folke
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Christensen
- Department of Radiology, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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Comprehensive analysis of early fractional anisotropy changes in acute ischemic stroke. PLoS One 2017; 12:e0188318. [PMID: 29190762 PMCID: PMC5708650 DOI: 10.1371/journal.pone.0188318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/03/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Cerebral ischemia leads to a rapid decrease of the apparent diffusion coefficient. For fractional anisotropy both increase and decrease have been reported in acute ischemic stroke. Aim of this study was to characterize early water diffusion changes in a homogenous group of acute stroke patients and to clarify the issue of early fractional anisotropy changes and their relation to time from symptom onset. METHODS MRI data of patients with acute ischemic stroke examined by diffusion tensor imaging within 8h after symptom were analyzed. We calculated fractional anisotropy, eigenvalues and the isotropic and anisotropic components of the diffusion tensor. The values were calculated as ratios between the ischemic lesion and a mirror region in the unaffected side and correlated with clinical parameters. RESULTS We included 63 patients: 49% female, mean age 69 ± 14 years, median NIHSS on admission 9 (IQR 4-14). For the whole sample, mean fractional anisotropy was increased (ratio: 1.083 ± 0.168), while all other diffusion parameters were decreased. Both the isotropic and anisotropic component of the diffusion tensor were decreased with a more pronounced decrease of the isotropic component (ratios: isotropic = 0.730 ± 0.106, anisotropic = 0.788 ± 0.127; p<0.001). There was no correlation of fractional anisotropy with time from symptom onset. Looking at individual patients, fractional anisotropy was increased in 70%. There were no differences in clinical characteristics between patients with increased and decreased fractional anisotropy. CONCLUSION Fractional anisotropy increase in acute stroke results from a more pronounced decrease of the isotropic diffusion component and is not related to time from symptom onset. Thus, fractional anisotropy is not helpful as a surrogate marker of lesion age in the very first hours of stroke.
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Copen WA, Yoo AJ, Rost NS, Morais LT, Schaefer PW, González RG, Wu O. In patients with suspected acute stroke, CT perfusion-based cerebral blood flow maps cannot substitute for DWI in measuring the ischemic core. PLoS One 2017; 12:e0188891. [PMID: 29190675 PMCID: PMC5708772 DOI: 10.1371/journal.pone.0188891] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 09/25/2017] [Indexed: 12/02/2022] Open
Abstract
Background Neuroimaging may guide acute stroke treatment by measuring the volume of brain tissue in the irreversibly injured “ischemic core.” The most widely accepted core volume measurement technique is diffusion-weighted MRI (DWI). However, some claim that measuring regional cerebral blood flow (CBF) with CT perfusion imaging (CTP), and labeling tissue below some threshold as the core, provides equivalent estimates. We tested whether any threshold allows reliable substitution of CBF for DWI. Methods 58 patients with suspected stroke underwent DWI and CTP within six hours of symptom onset. A neuroradiologist outlined DWI lesions. In CBF maps, core pixels were defined by thresholds ranging from 0%-100% of normal, in 1% increments. Replicating prior studies, we used receiver operating characteristic (ROC) curves to select thresholds that optimized sensitivity and specificity in predicting DWI-positive pixels, first using only pixels on the side of the brain where infarction was clinically suspected (“unilateral” method), then including both sides (“bilateral”). We quantified each method and threshold’s accuracy in estimating DWI volumes, using sums of squared errors (SSE). For the 23 patients with follow-up studies, we assessed whether CBF-derived volumes inaccurately exceeded follow-up infarct volumes. Results The areas under the ROC curves were 0.89 (unilateral) and 0.90 (bilateral). Various metrics selected optimum CBF thresholds ranging from 29%-32%, with sensitivities of 0.79–0.81, and specificities of 0.83–0.85. However, for the unilateral and bilateral methods respectively, volume estimates derived from all CBF thresholds above 28% and 22% were less accurate than disregarding imaging and presuming every patient’s core volume to be zero. The unilateral method with a 30% threshold, which recent clinical trials have employed, produced a mean core overestimation of 65 mL (range: –82–191), and exceeded follow-up volumes for 83% of patients, by up to 191 mL. Conclusion CTP-derived CBF maps cannot substitute for DWI in measuring the ischemic core.
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Affiliation(s)
- William A. Copen
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Albert J. Yoo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Neurointervention, Texas Stroke Institute, Fort Worth, Texas, United States of America
| | - Natalia S. Rost
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Lívia T. Morais
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Pamela W. Schaefer
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - R. Gilberto González
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ona Wu
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
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Abbott AL, Silvestrini M, Topakian R, Golledge J, Brunser AM, de Borst GJ, Harbaugh RE, Doubal FN, Rundek T, Thapar A, Davies AH, Kam A, Wardlaw JM. Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice. Front Neurol 2017; 8:537. [PMID: 29104559 PMCID: PMC5654955 DOI: 10.3389/fneur.2017.00537] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/25/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Until now, stroke and transient ischemic attack (TIA) have been clinically based terms which describe the presence and duration of characteristic neurological deficits attributable to intrinsic disorders of particular arteries supplying the brain, retina, or (sometimes) the spinal cord. Further, infarction has been pathologically defined as death of neural tissue due to reduced blood supply. Recently, it has been proposed we shift to definitions of stroke and TIA determined by neuroimaging results alone and that neuroimaging findings be equated with infarction. METHODS We examined the scientific validity and clinical implications of these proposals using the existing published literature and our own experience in research and clinical practice. RESULTS We found that the proposals to change to imaging-dominant definitions, as published, are ambiguous and inconsistent. Therefore, they cannot provide the standardization required in research or its application in clinical practice. Further, we found that the proposals are scientifically incorrect because neuroimaging findings do not always correlate with the clinical status or the presence of infarction. In addition, we found that attempts to use the proposals are disrupting research, are otherwise clinically unhelpful and do not solve the problems they were proposed to solve. CONCLUSION We advise that the proposals must not be accepted. In particular, we explain why the clinical focus of the definitions of stroke and TIA should be retained with continued sub-classification of these syndromes depending neuroimaging results (with or without other information) and that infarction should remain a pathological term. We outline ways the established clinically based definitions of stroke and TIA, and use of them, may be improved to encourage better patient outcomes in the modern era.
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Affiliation(s)
- Anne L. Abbott
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- The Neurology Department, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, QLD, Australia
| | - Alejandro M. Brunser
- Cerebrovascular Program, Neurology Service, Department of Medicine, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Centre of Utrecht, Utrecht, Netherlands
| | - Robert E. Harbaugh
- Department of Neurosurgery, Penn State University, State College, PA, United States
| | - Fergus N. Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Department of Medicine, Elderly Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, Miami, FL, United States
| | - Ankur Thapar
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College, London, United Kingdom
| | - Alun H. Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Anthony Kam
- Department of Radiology, Alfred Health, Melbourne, VIC, Australia
| | - Joanna M. Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, United Kingdom
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Wang E, Wu Y, Cheung JS, Zhou IY, Igarashi T, Zhang X, Sun PZ. pH imaging reveals worsened tissue acidification in diffusion kurtosis lesion than the kurtosis/diffusion lesion mismatch in an animal model of acute stroke. J Cereb Blood Flow Metab 2017; 37:3325-3333. [PMID: 28752790 PMCID: PMC5624397 DOI: 10.1177/0271678x17721431] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diffusion weighted imaging (DWI) has been commonly used in acute stroke examination, yet a portion of DWI lesion may be salvageable. Recently, it has been shown that diffusion kurtosis imaging (DKI) defines the most severely damaged DWI lesion that does not renormalize following early reperfusion. We postulated that the diffusion and kurtosis lesion mismatch experience heterogeneous hemodynamic and/or metabolic injury. We investigated tissue perfusion, pH, diffusion, kurtosis and relaxation from regions of the contralateral normal area, diffusion lesion, kurtosis lesion and their mismatch in an animal model of acute stroke. Our study revealed significant kurtosis and diffusion lesion volume mismatch (19.7 ± 10.7%, P < 0.01). Although there was no significant difference in perfusion and diffusion between the kurtosis lesion and kurtosis/diffusion lesion mismatch, we showed lower pH in the kurtosis lesion (pH = 6.64 ± 0.12) from that of the kurtosis/diffusion lesion mismatch (6.84 ± 0.11, P < 0.05). Moreover, pH in the kurtosis lesion and kurtosis/diffusion mismatch agreed well with literature values for regions of ischemic core and penumbra, respectively. Our work documented initial evidence that DKI may reveal the heterogeneous metabolic derangement within the commonly used DWI lesion.
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Affiliation(s)
- Enfeng Wang
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,2 Department of Radiology, Third Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Yin Wu
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,3 Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jerry S Cheung
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Iris Yuwen Zhou
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Takahiro Igarashi
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - XiaoAn Zhang
- 2 Department of Radiology, Third Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Phillip Zhe Sun
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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McGarry BL, Jokivarsi KT, Knight MJ, Grohn OHJ, Kauppinen RA. Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia. J Vis Exp 2017; 2017. [PMID: 28979652 PMCID: PMC5624498 DOI: 10.3791/55277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
MRI provides a sensitive and specific imaging tool to detect acute ischemic stroke by means of a reduced diffusion coefficient of brain water. In a rat model of ischemic stroke, differences in quantitative T1 and T2 MRI relaxation times (qT1 and qT2) between the ischemic lesion (delineated by low diffusion) and the contralateral non-ischemic hemisphere increase with time from stroke onset. The time dependency of MRI relaxation time differences is heuristically described by a linear function and thus provides a simple estimate of stroke onset time. Additionally, the volumes of abnormal qT1 and qT2 within the ischemic lesion increase linearly with time providing a complementary method for stroke timing. A (semi)automated computer routine based on the quantified diffusion coefficient is presented to delineate acute ischemic stroke tissue in rat ischemia. This routine also determines hemispheric differences in qT1 and qT2 relaxation times and the location and volume of abnormal qT1 and qT2 voxels within the lesion. Uncertainties associated with onset time estimates of qT1 and qT2 MRI data vary from ± 25 min to ± 47 min for the first 5 hours of stroke. The most accurate onset time estimates can be obtained by quantifying the volume of overlapping abnormal qT1 and qT2 lesion volumes, termed 'Voverlap' (± 25 min) or by quantifying hemispheric differences in qT2 relaxation times only (± 28 min). Overall, qT2 derived parameters outperform those from qT1. The current MRI protocol is tested in the hyperacute phase of a permanent focal ischemia model, which may not be applicable to transient focal brain ischemia.
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Affiliation(s)
- Bryony L McGarry
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
| | - Kimmo T Jokivarsi
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Michael J Knight
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
| | - Olli H J Grohn
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Risto A Kauppinen
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
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Simpkins AN, Dias C, Norato G, Kim E, Leigh R. Early Change in Stroke Size Performs Best in Predicting Response to Therapy. Cerebrovasc Dis 2017; 44:141-149. [PMID: 28683442 DOI: 10.1159/000477945] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/31/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Reliable imaging biomarkers of response to therapy in acute stroke are needed. The final infarct volume and percent of early reperfusion have been used for this purpose. Early fluctuation in stroke size is a recognized phenomenon, but its utility as a biomarker for response to therapy has not been established. This study examined the clinical relevance of early change in stroke volume and compared it with the final infarct volume and percent of early reperfusion in identifying early neurologic improvement (ENI). METHODS Acute stroke patients, enrolled between 2013 and 2014 with serial magnetic resonance imaging (MRI) scans (pretreatment baseline, 2 h post, and 24 h post), who received thrombolysis were included in the analysis. Early change in stroke volume, infarct volume at 24 h on diffusion, and percent of early reperfusion were calculated from the baseline and 2 h MRI scans were compared. ENI was defined as ≥4 point decrease in National Institutes of Health Stroke Scales within 24 h. Logistic regression models and receiver operator characteristics analysis were used to compare the efficacy of 3 imaging biomarkers. RESULTS Serial MRIs of 58 acute stroke patients were analyzed. Early change in stroke volume was significantly associated with ENI by logistic regression analysis (OR 0.93, p = 0.048) and remained significant after controlling for stroke size and severity (OR 0.90, p = 0.032). Thus, for every 1 mL increase in stroke volume, there was a 10% decrease in the odds of ENI, while for every 1 mL decrease in stroke volume, there was a 10% increase in the odds of ENI. Neither infarct volume at 24 h nor percent of early reperfusion were significantly associated with ENI by logistic regression. Receiver-operator characteristic analysis identified early change in stroke volume as the only biomarker of the 3 that performed significantly different than chance (p = 0.03). CONCLUSIONS Early fluctuations in stroke size may represent a more reliable biomarker for response to therapy than the more traditional measures of final infarct volume and percent of early reperfusion.
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Affiliation(s)
- Alexis Nétis Simpkins
- Neuro Vascular Brain Imaging Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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Shinoda N, Hori S, Mikami K, Bando T, Shimo D, Kuroyama T, Kuramoto Y, Matsumoto M, Hirai O, Ueno Y. Utility of relative ADC ratio in patient selection for endovascular revascularization of large vessel occlusion. J Neuroradiol 2017; 44:185-191. [DOI: 10.1016/j.neurad.2016.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/19/2016] [Accepted: 12/30/2016] [Indexed: 10/19/2022]
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Sato A, Shimizu Y, Koyama J, Hongo K. A new threshold of apparent diffusion coefficient values in white matter after successful tissue plasminogen activator treatment for acute brain ischemia. J Neuroradiol 2017; 44:223-226. [DOI: 10.1016/j.neurad.2016.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/02/2015] [Accepted: 12/21/2016] [Indexed: 11/16/2022]
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Domi T, Vossough A, Stence NV, Felling RJ, Leung J, Krishnan P, Watson CG, Grant PE, Kassner A. The Potential for Advanced Magnetic Resonance Neuroimaging Techniques in Pediatric Stroke Research. Pediatr Neurol 2017; 69:24-36. [PMID: 28237248 DOI: 10.1016/j.pediatrneurol.2016.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND This article was written to provide clinicians and researchers with an overview of a number of advanced neuroimaging techniques in an effort to promote increased utility and the design of future studies using advanced neuroimaging in childhood stroke. The current capabilities of advanced magnetic resonance imaging techniques provide the opportunity to build on our knowledge of the consequences of stroke on the developing brain. These capabilities include providing information about the physiology, metabolism, structure, and function of the brain that are not routinely evaluated in the clinical setting. METHODS During the Proceedings of the Stroke Imaging Laboratory for Children Workshop in Toronto in June 2015, a subgroup of clinicians and imaging researchers discussed how the application of advanced neuroimaging techniques could further our understanding of the mechanisms of stroke injury and repair in the pediatric population. This subgroup was established based on their interest and commitment to design collaborative, advanced neuroimaging studies in the pediatric stroke population. RESULTS In working toward this goal, we first sought to describe here the magnetic resonance imaging techniques that are currently available for use, and how they have been applied in other stroke populations (e.g., adult and perinatal stroke). CONCLUSIONS With the continued improvement in advanced neuroimaging techniques, including shorter acquisition times, there is an opportunity to apply these techniques to their full potential in the research setting and learn more about the effects of stroke in the developing brain.
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Affiliation(s)
- Trish Domi
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas V Stence
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan J Felling
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jackie Leung
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Department of Neuroradiology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christopher G Watson
- Department of Computational Neuroscience, Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, Massachusetts; Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - P Ellen Grant
- Division of Newborn Medicine, Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrea Kassner
- Department of Physiology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Experimental Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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Abdelgawad EA, Higazi MM, Abdelbaky AO, Abdelghany HS. Diagnostic performance of CT cerebral blood volume colour maps for evaluation of acute infarcts; comparison with diffusion-weighted MRI within 12hours of major stroke onset. J Neuroradiol 2017; 44:10-16. [DOI: 10.1016/j.neurad.2016.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 08/10/2016] [Accepted: 10/17/2016] [Indexed: 01/19/2023]
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Zhou IY, Guo Y, Igarashi T, Wang Y, Mandeville E, Chan ST, Wen L, Vangel M, Lo EH, Ji X, Sun PZ. Fast diffusion kurtosis imaging (DKI) with Inherent COrrelation-based Normalization (ICON) enhances automatic segmentation of heterogeneous diffusion MRI lesion in acute stroke. NMR IN BIOMEDICINE 2016; 29:1670-1677. [PMID: 27696558 PMCID: PMC5123902 DOI: 10.1002/nbm.3617] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 05/05/2023]
Affiliation(s)
- Iris Yuwen Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
| | - Yingkun Guo
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
- Department of Radiology; West China Second University Hospital, Sichuan University; Chengdu Sichuan China
| | - Takahiro Igarashi
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
| | - Yu Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
- China-America Joint Neuroscience Institute, Xuanwu Hospital; Capital Medical University; Beijing China
| | - Emiri Mandeville
- Neuroprotection Research Laboratory, Department of Radiology and Neurology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
| | - Lingyi Wen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
- Department of Radiology; West China Second University Hospital, Sichuan University; Chengdu Sichuan China
| | - Mark Vangel
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
| | - Eng H. Lo
- Neuroprotection Research Laboratory, Department of Radiology and Neurology; Massachusetts General Hospital and Harvard Medical School; Charlestown Massachusetts USA
| | - Xunming Ji
- China-America Joint Neuroscience Institute, Xuanwu Hospital; Capital Medical University; Beijing China
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Harston GWJ, Okell TW, Sheerin F, Schulz U, Mathieson P, Reckless I, Shah K, Ford GA, Chappell MA, Jezzard P, Kennedy J. Quantification of Serial Cerebral Blood Flow in Acute Stroke Using Arterial Spin Labeling. Stroke 2016; 48:123-130. [PMID: 27879446 PMCID: PMC5175999 DOI: 10.1161/strokeaha.116.014707] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 12/31/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Perfusion-weighted imaging is used to select patients with acute ischemic stroke for intervention, but knowledge of cerebral perfusion can also inform the understanding of ischemic injury. Arterial spin labeling allows repeated measurement of absolute cerebral blood flow (CBF) without the need for exogenous contrast. The aim of this study was to explore the relationship between dynamic CBF and tissue outcome in the month after stroke onset. Methods— Patients with nonlacunar ischemic stroke underwent ≤5 repeated magnetic resonance imaging scans at presentation, 2 hours, 1 day, 1 week, and 1 month. Imaging included vessel-encoded pseudocontinuous arterial spin labeling using multiple postlabeling delays to quantify CBF in gray matter regions of interest. Receiver–operator characteristic curves were used to predict tissue outcome using CBF. Repeatability was assessed in 6 healthy volunteers and compared with contralateral regions of patients. Diffusion-weighted and T2-weighted fluid attenuated inversion recovery imaging were used to define tissue outcome. Results— Forty patients were included. In contralateral regions of patients, there was significant variation of CBF between individuals, but not between scan times (mean±SD: 53±42 mL/100 g/min). Within ischemic regions, mean CBF was lowest in ischemic core (17±23 mL/100 g/min), followed by regions of early (21±26 mL/100 g/min) and late infarct growth (25±35 mL/100 g/min; ANOVA P<0.0001). Between patients, there was marked overlap in presenting and serial CBF values. Conclusions— Knowledge of perfusion dynamics partially explained tissue fate. Factors such as metabolism and tissue susceptibility are also likely to influence tissue outcome.
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Affiliation(s)
- George W J Harston
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.).
| | - Thomas W Okell
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Fintan Sheerin
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Ursula Schulz
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Phil Mathieson
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Ian Reckless
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Kunal Shah
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Gary A Ford
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Michael A Chappell
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - Peter Jezzard
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
| | - James Kennedy
- From the Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, United Kingdom (G.W.J.H., J.K.); Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (T.W.O., M.A.C., P.J.); Department of Neuroradiology (F.S.) and Acute Stroke Service (U.S., P.M., I.R., K.S., G.A.F., J.K.), Oxford University Hospitals NHS Foundation Trust, United Kingdom; Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, United Kingdom (M.A.C.)
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Cheng Q, Xu X, Zu Q, Lu S, Yu J, Liu X, Wang B, Shi H, Teng G, Liu S. High b value DWI in evaluation of the hyperacute cerebral ischemia at 3T: A comparative study in an embolic canine stroke model. Exp Ther Med 2016; 12:951-956. [PMID: 27446301 PMCID: PMC4950572 DOI: 10.3892/etm.2016.3403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 05/05/2016] [Indexed: 01/23/2023] Open
Abstract
Previous studies have indicated that the temporal change of relative diffusion weighted imaging (rDWI) signal intensity may help to determine the onset time of a stroke. Furthermore, several studies have indicated that high b value DWI offered improved detection rates for hyper-acute ischemic lesions compared with standard b value DWI. However, the temporal changes of the rDWI on high b value DWI remain unclear. Therefore, based on our embolic canine stroke model, we evaluated the temporal evolution of rDWI on high b value DWI, and further compared its diagnostic value in predicting the onset time of ischemic stroke with rDWI on standard b value DWI. Twelve canine MCAO models were established, and DWI was performed at 1, 2, 3, 4, 5 and 6 h after MCAO, with 3 b values of 1,000, 2,000 and 3,000. High b value DWI detected all ischemic lesions after 1 h, while standard b value did not detect the ischemic lesions in one dog at 1 h. With all three of the tested b values, rDWIs increased continuously within 6 h, while relative apparent diffusion coefficient (rADC) values rapidly decreased in 1 h, then became relatively stable. The area under the curve values for rDWI with b value of 1,000, 2,000 and 3,000, in predicting ischemic lesions within 3 h were 0.897, 0.929 and 0.938, while for rADC were 0.645, 0.583 and 0.599, respectively. Therefore, the results indicated that the rDWI was helpful in aging hyper-acute ischemic stroke, while rADC appeared not to be. High b value DWI had a higher detection rate for ischemic lesions and better predictive efficacy in determining the onset time of hyper-acute stroke.
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Affiliation(s)
- Qiguang Cheng
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiaoquan Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Qingquan Zu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Shanshan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Jing Yu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xinglong Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Bin Wang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Haibin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Gaojun Teng
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu 210029, P.R. China
| | - Sheng Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Lopez-Mejia M, Roldan-Valadez E. Comparisons of Apparent Diffusion Coefficient Values in Penumbra, Infarct, and Normal Brain Regions in Acute Ischemic Stroke: Confirmatory Data Using Bootstrap Confidence Intervals, Analysis of Variance, and Analysis of Means. J Stroke Cerebrovasc Dis 2016; 25:515-22. [PMID: 26654670 DOI: 10.1016/j.jstrokecerebrovasdis.2015.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/20/2015] [Accepted: 10/31/2015] [Indexed: 02/08/2023] Open
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Hassen WB, Tisserand M, Turc G, Charron S, Seners P, Edjlali M, Legrand L, Lion S, Calvet D, Naggara O, Mas JL, Meder JF, Baron JC, Oppenheim C. Comparison between voxel-based and subtraction methods for measuring diffusion-weighted imaging lesion growth after thrombolysis. Int J Stroke 2016; 11:221-8. [DOI: 10.1177/1747493015616636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Infarct growth (IG) is used as surrogate end-point in therapeutic trials. For practical reasons, infarct growth is commonly assessed using simple subtraction of acute from follow-up diffusion-weighted imaging (DWI) lesion volumes. However, the volume subtraction method will underestimate true infarct growth in case of diffusion-weighted imaging lesion reversal. Aim To measure the size of the difference between true infarct growth on voxel-based coregistration and infarct growth approximated with simple volume subtraction. Methods We retrospectively analyzed 322 consecutive stroke patients (median (IQR) age: 70 years (57–80), National Institute of Health Stroke Score at admission 14 (8–19)), who underwent a magnetic resonance imaging before (DWI1) and ≈24 h (DWI2) after IV-thrombolysis. IGvoxel-based was defined as the volume of signal changes on DWI2 that did not overlap with that on coregistered DWI1. This was compared with simply subtracting DWI1 from DWI2 lesion volume (IGsubtracted). We also compared these two metrics for the prediction of three-month unfavorable outcome (mRS ≥ 2) using c-statistics of multivariable models, adjusted for age, and National Institute of Health Stroke Score. Results Infarct growth volume metrics were strongly correlated (ρ = 0.94), but IGsubtracted substantially underestimated IGvoxel-based (median (IQR): 9.52 (0.23–38.9) vs. 16.98 (4.4–45.4) mL). Of the 75 patients with shrinking or stable diffusion-weighted imaging lesion using volume subtraction, IGvoxel-based was ≥5 mL in 20 (27% of the subset, 6.2% of the whole population). Moreover, IGvoxel-based better predicted unfavorable outcome than IGsubtracted (c-statistics = 0.86 (95% CI, 0.82–0.90) vs. 0.82 (0.78–0.87), P = 0.003). Conclusion At early post-thrombolysis time points, the simple subtraction of lesion volumes masked substantial diffusion-weighted imaging lesion growth in 6.2% of patients. Although more time-consuming, the voxel-based method may impact results of trials that use infarct growth attenuation as an end-point.
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Affiliation(s)
- Wajih Ben Hassen
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Marie Tisserand
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Guillaume Turc
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Sylvain Charron
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Pierre Seners
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Myriam Edjlali
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Laurence Legrand
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Stéphanie Lion
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - David Calvet
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Olivier Naggara
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Jean-Louis Mas
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Jean-François Meder
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
| | - Jean-Claude Baron
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
- Department of Neurology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
| | - Catherine Oppenheim
- Department of Radiology, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Paris, France
- Centre de Psychiatrie et Neurosciences, INSERM S894, DHU Neurovasc, Paris, France
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Abstract
Acute ischemic stroke is common and often treatable, but treatment requires reliable information on the state of the brain that may be provided by modern neuroimaging. Critical information includes: the presence of hemorrhage; the site of arterial occlusion; the size of the early infarct "core"; and the size of underperfused, potentially threatened brain parenchyma, commonly referred to as the "penumbra." In this chapter we review the major determinants of outcomes in ischemic stroke patients, and the clinical value of various advanced computed tomography and magnetic resonance imaging methods that may provide key physiologic information in these patients. The focus is on major strokes due to occlusions of large arteries of the anterior circulation, the most common cause of a severe stroke syndrome. The current evidence-based approach to imaging the acute stroke patient at the Massachusetts General Hospital is presented, which is applicable for all stroke types. We conclude with new information on time and stroke evolution that imaging has revealed, and how it may open the possibilities of treating many more patients.
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Affiliation(s)
- R Gilberto González
- Neuroradiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Pham M, Nordmeyer H, Weber R, Chapot R. Complete Reversal of Severe ADC Lesion in Left M1 Occlusion. Int J Stroke 2015; 10:E16-7. [DOI: 10.1111/ijs.12413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. Pham
- Department of Neuroradiology, Alfried Krupp Hospital, Essen, Germany
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - H. Nordmeyer
- Department of Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - R. Weber
- Department of Neurology, Alfried Krupp Hospital, Essen, Germany
| | - R. Chapot
- Department of Neuroradiology, Alfried Krupp Hospital, Essen, Germany
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Sun PZ, Wang Y, Mandeville E, Chan ST, Lo EH, Ji X. Validation of fast diffusion kurtosis MRI for imaging acute ischemia in a rodent model of stroke. NMR IN BIOMEDICINE 2014; 27:1413-8. [PMID: 25208309 PMCID: PMC4201862 DOI: 10.1002/nbm.3188] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/05/2014] [Accepted: 07/13/2014] [Indexed: 05/22/2023]
Abstract
Diffusion-weighted imaging (DWI) captures ischemic tissue that is likely to infarct, and has become one of the most widely used acute stroke imaging techniques. Diffusion kurtosis imaging (DKI) has lately been postulated as a complementary MRI method to stratify the heterogeneously damaged DWI lesion. However, the conventional DKI acquisition time is relatively long, limiting its use in the acute stroke setting. Recently, a fast kurtosis mapping method has been demonstrated in fixed brains and control subjects. The fast DKI approach provides mean diffusion and kurtosis measurements under substantially reduced scan time, making it amenable to acute stroke imaging. Because it is not practical to obtain and compare different means of DKI to test whether the fast DKI method can reliably detect diffusion and kurtosis lesions in acute stroke patients, our study investigated its diagnostic value using an animal model of acute stroke, a critical step before fast DKI acquisition can be routinely applied in the acute stroke setting. We found significant correlation, per voxel, between the diffusion and kurtosis coefficients measured using the fast and conventional DKI protocols. In acute stroke rats, the two DKI methods yielded diffusion and kurtosis lesions that were in good agreement. Importantly, substantial kurtosis-diffusion lesion mismatch was observed using the conventional (26 ± 13%, P < 0.01) and fast DKI methods (23 ± 8%, P < 0.01). In addition, regression analysis showed that the kurtosis-diffusion lesion mismatches obtained using conventional and fast DKI methods were substantially correlated (R(2) = 0.57, P = 0.02). Our results confirmed that the recently proposed fast DKI method is capable of capturing heterogeneous diffusion and kurtosis lesions in acute ischemic stroke, and thus is suitable for translational applications in the acute stroke clinical setting.
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Affiliation(s)
- Phillip Zhe Sun
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Yu Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Emiri Mandeville
- Neuroprotection Research Laboratory, Department of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Suk-Tak Chan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Eng H Lo
- Neuroprotection Research Laboratory, Department of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Xunming Ji
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
- Correspondence Author: Dr. Xunming Ji Cerebrovascular Diseases Research Institute Xuanwu Hospital of Capital Medical University 45 Changchun Street, Beijing 100053, China Phone: (86) 10-83198952
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Intravoxel incoherent motion perfusion imaging in acute stroke: initial clinical experience. Neuroradiology 2014; 56:629-35. [DOI: 10.1007/s00234-014-1370-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022]
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Inoue M, Mlynash M, Christensen S, Wheeler HM, Straka M, Tipirneni A, Kemp SM, Zaharchuk G, Olivot JM, Bammer R, Lansberg MG, Albers GW. Early diffusion-weighted imaging reversal after endovascular reperfusion is typically transient in patients imaged 3 to 6 hours after onset. Stroke 2014; 45:1024-8. [PMID: 24558095 DOI: 10.1161/strokeaha.113.002135] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to assess the frequency and extent of early diffusion-weighted imaging (DWI) lesion reversal after endovascular therapy and to determine whether early reversal is sustained or transient. METHODS MRI with DWI perfusion imaging was performed before (DWI 1) and within 12 hours after (DWI 2) endovascular treatment; follow-up MRI was obtained on day 5. Both DWIs were coregistered to follow-up MRI. Early DWI reversal was defined as the volume of the DWI 1 lesion that was not superimposed on the DWI 2 lesion. Permanent reversal was the volume of the DWI 1 lesion not superimposed on the day 5 infarct volume. Associations between early DWI reversal and clinical outcomes in patients with and without reperfusion were assessed. RESULTS A total of 110 patients had technically adequate DWI before endovascular therapy (performed median [interquartile range], 4.5 [2.8-6.2] hours after onset); 60 were eligible for this study. Thirty-two percent had early DWI reversal >10 mL; 17% had sustained reversal. The median volume of permanent reversal at 5 days was 3 mL (interquartile range, 1.7-7.0). Only 2 patients (3%) had a final infarct volume that was smaller than their baseline DWI lesion. Early DWI reversal was not an independent predictor of clinical outcome and was not associated with early reperfusion. CONCLUSIONS Early DWI reversal occurred in about one third of patients after endovascular therapy; however, reversal was often transient and was not associated with a significant volume of tissue salvage or favorable clinical outcome.
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Affiliation(s)
- Manabu Inoue
- From the Stanford Stroke Center, Stanford University School of Medicine, CA
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Comparative study of the relative signal intensity on DWI, FLAIR, and T2 images in identifying the onset time of stroke in an embolic canine model. Neurol Sci 2014; 35:1059-65. [PMID: 24493372 DOI: 10.1007/s10072-014-1643-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 01/17/2014] [Indexed: 10/25/2022]
Abstract
In acute stroke magnetic resonance imaging, many attempts have been made to identify the onset time of ischemic events using the simply quantitative judgment of relative signal intensity (rSI) from various MR images. However, no uniform opinion has been achieved broadly till now. The controversy might derive from the potential patients' selection bias of clinical retrospective study, the discrepant MR parameters, and the various sample sizes among different studies. Thus, we evaluated the temporal change of the relative DWI signal intensity (rDWI), relative ADC value (rADC), relative FLAIR signal intensity (rFLAIR), and relative T2 signal intensity (rT2), and further compare their diagnostic value in identifying the hyperacute lesions based on our embolic canine model with clear onset time. Twenty ischemic models were successfully established. All rSI values were linearly correlated to time with significance until 24 h after model establishment (P < 0.05). Paired comparison of ROC curves showed that significant difference was found between rADC and other three rSIs (P < 0.0001). However, no significant difference was found among rDWI, rT2 and rFLAIR. Our results indicated that rDWI, rFLAIR and rT2 may be helpful to predict the onset time of ischemic events with the similar diagnostic value. However, the rADC does not have comparable predictive value in our embolic canine model.
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Tietze A, Blicher J, Mikkelsen IK, Østergaard L, Strother MK, Smith SA, Donahue MJ. Assessment of ischemic penumbra in patients with hyperacute stroke using amide proton transfer (APT) chemical exchange saturation transfer (CEST) MRI. NMR IN BIOMEDICINE 2014; 27:163-74. [PMID: 24288260 PMCID: PMC4019439 DOI: 10.1002/nbm.3048] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 05/08/2023]
Abstract
Chemical exchange saturation transfer (CEST)-derived, pH-weighted, amide proton transfer (APT) MRI has shown promise in animal studies for the prediction of infarction risk in ischemic tissue. Here, APT MRI was translated to patients with acute stroke (1-24 h post-symptom onset), and assessments of APT contrast, perfusion, diffusion, disability and final infarct volume (23-92 days post-stroke) are reported. Healthy volunteers (n = 5) and patients (n = 10) with acute onset of symptoms (0-4 h, n = 7; uncertain onset <24 h, n = 3) were scanned with diffusion- and perfusion-weighted MRI, fluid-attenuated inversion recovery (FLAIR) and CEST. Traditional asymmetry and a Lorentzian-based APT index were calculated in the infarct core, at-risk tissue (time-to-peak, TTP; lengthening) and final infarct volume. On average (mean ± standard deviation), control white matter APT values (asymmetry, 0.019 ± 0.005; Lorentzian, 0.045 ± 0.006) were not significantly different (p > 0.05) from APT values in normal-appearing white matter (NAWM) of patients (asymmetry, 0.022 ± 0.003; Lorentzian, 0.048 ± 0.003); however, ischemic regions in patients showed reduced (p = 0.03) APT effects compared with NAWM. Representative cases are presented, whereby the APT contrast is compared quantitatively with contrast from other imaging modalities. The findings vary between patients; in some patients, a trend for a reduction in the APT signal in the final infarct region compared with at-risk tissue was observed, consistent with tissue acidosis. However, in other patients, no relationship was observed in the infarct core and final infarct volume. Larger clinical studies, in combination with focused efforts on sequence development at clinically available field strengths (e.g. 3.0 T), are necessary to fully understand the potential of APT imaging for guiding the hyperacute management of patients.
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Affiliation(s)
- Anna Tietze
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark
- Corresponding Author: Anna Tietze, tel.: +45 78469953, fax: +45 78463360, , Dept. of Neuroradiology, Nørrebrogade, bldg. 10, 8000 Aarhus C, Denmark
| | - Jakob Blicher
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark
- Hammel Neurorehabilitation and Research Center, Aarhus University Hospital, Hammel, Denmark
| | - Irene Klærke Mikkelsen
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark
| | - Leif Østergaard
- Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
- Center of Functionally Integrative Neuroscience, Aarhus University Hospital, Aarhus, Denmark
| | - Megan K. Strother
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN
| | - Seth A. Smith
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN
- Physics and Astronomy, Vanderbilt University School of Medicine, Nashville, TN
| | - Manus J. Donahue
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN
- Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN
- Department of Neurology, Vanderbilt University School of Medicine, Nashville, TN
- Physics and Astronomy, Vanderbilt University School of Medicine, Nashville, TN
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Stability of ischemic core volume during the initial hours of acute large vessel ischemic stroke in a subgroup of mechanically revascularized patients. Neuroradiology 2014; 56:325-32. [DOI: 10.1007/s00234-014-1329-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
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Ledezma CJ, Fiebach JB, Wintermark M. Modern imaging of the infarct core and the ischemic penumbra in acute stroke patients: CT versus MRI. Expert Rev Cardiovasc Ther 2014; 7:395-403. [DOI: 10.1586/erc.09.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Selective neuronal loss in ischemic stroke and cerebrovascular disease. J Cereb Blood Flow Metab 2014; 34:2-18. [PMID: 24192635 PMCID: PMC3887360 DOI: 10.1038/jcbfm.2013.188] [Citation(s) in RCA: 169] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 01/23/2023]
Abstract
As a sequel of brain ischemia, selective neuronal loss (SNL)-as opposed to pannecrosis (i.e. infarction)-is attracting growing interest, particularly because it is now detectable in vivo. In acute stroke, SNL may affect the salvaged penumbra and hamper functional recovery following reperfusion. Rodent occlusion models can generate SNL predominantly in the striatum or cortex, showing that it can affect behavior for weeks despite normal magnetic resonance imaging. In humans, SNL in the salvaged penumbra has been documented in vivo mainly using positron emission tomography and (11)C-flumazenil, a neuronal tracer validated against immunohistochemistry in rodent stroke models. Cortical SNL has also been documented using this approach in chronic carotid disease in association with misery perfusion and behavioral deficits, suggesting that it can result from chronic or unstable hemodynamic compromise. Given these consequences, SNL may constitute a novel therapeutic target. Selective neuronal loss may also develop at sites remote from infarcts, representing secondary 'exofocal' phenomena akin to degeneration, potentially related to poststroke behavioral or mood impairments again amenable to therapy. Further work should aim to better characterize the time course, behavioral consequences-including the impact on neurological recovery and contribution to vascular cognitive impairment-association with possible causal processes such as microglial activation, and preventability of SNL.
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Abstract
Cerebral ischemia manifests widely in patient symptoms. Along with the clinical examination, imaging serves as a powerful tool throughout the course of ischemia-from acute onset to evolution. A thorough understanding of imaging modalities, their strengths and their limitations, is essential for capitalizing on the benefit of this complementary source of information for understanding the mechanism of disease, making therapeutic decisions, and monitoring patient response over time.
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Affiliation(s)
- May Nour
- Department of Neurology, David Geffen School of Medicine, UCLA Stroke Center, University of California, RNRC, RM 4-126, Los Angeles, CA 90095, USA; Department of Radiology, Division of Interventional Neuroradiology, University of California, Los Angeles, 757 Westwood plaza Suite 2129, Los Angeles, CA 90095, USA
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