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Rapillo CM, Dunet V, Pistocchi S, Salerno A, Darioli V, Bartolini B, Hajdu SD, Michel P, Strambo D. Moving From CT to MRI Paradigm in Acute Ischemic Stroke: Feasibility, Effects on Stroke Diagnosis and Long-Term Outcomes. Stroke 2024; 55:1329-1338. [PMID: 38488367 PMCID: PMC11045552 DOI: 10.1161/strokeaha.123.045154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/24/2024]
Abstract
BACKGROUND The relative value of computed tomography (CT) and magnetic resonance imaging (MRI) in acute ischemic stroke (AIS) is debated. In May 2018, our center transitioned from using CT to MRI as first-line imaging for AIS. This retrospective study aims to assess the effects of this paradigm change on diagnosis and disability outcomes. METHODS We compared all consecutive patients with confirmed diagnosis of AIS admitted to our center during the MRI-period (May 2018-August 2022) and an identical number of patients from the preceding CT-period (December 2012-April 2018). Univariable and multivariable analyses were performed to evaluate outcomes, including the number and delay of imaging exams, the rate of missed strokes, stroke mimics treated with thrombolysis, undetermined stroke mechanisms, length of hospitalization, and 3-month disability. RESULTS The median age of the 2972 included patients was 76 years (interquartile range, 65-84), and 46% were female. In the MRI-period, 80% underwent MRI as first acute imaging. The proportion of patients requiring a second acute imaging modality for diagnostic ± revascularization reasons increased from 2.1% to 5% (Punadj <0.05), but it decreased in the subacute phase from 79.0% to 60.1% (Padj <0.05). In thrombolysis candidates, there was a 2-minute increase in door-to-imaging delay (Padj <0.05). The rates of initially missed AIS diagnosis was similar (3.8% versus 4.4%, Padj=0.32) and thrombolysis in stroke mimics decreased by half (8.6% versus 4.3%; Padj <0.05). Rates of unidentified stroke mechanism at hospital discharge were similar (22.8% versus 28.1%; Padj=0.99). The length of hospitalization decreased from 9 (interquartile range, 6-14) to 7 (interquartile range, 4-12) days (Padj=0.62). Disability at 3 months was similar (common adjusted odds ratio for favorable Rankin shift, 0.98 [95% CI, 0.71-1.36]; Padj=0.91), as well as mortality and symptomatic intracranial hemorrhage. CONCLUSIONS A paradigm shift from CT to MRI as first-line imaging for AIS seems feasible in a comprehensive stroke center, with a minimally increased delay to imaging in thrombolysis candidates. MRI was associated with reduced thrombolysis rates of stroke mimics and subacute neuroimaging needs.
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Affiliation(s)
- Costanza Maria Rapillo
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
- Stroke Unit, Careggi University Hospital, Florence, Italy (C.M.R.)
| | - Vincent Dunet
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Silvia Pistocchi
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Alexander Salerno
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Vincent Darioli
- Emergency Department (V. Darioli) and Interventional Neuroradiological Unit, University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Bruno Bartolini
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Steven David Hajdu
- Neuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology (V. Dunet, S.P., B.B., S.D.H.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Patrik Michel
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Service of Neurology, Department of Clinical Neuroscience (C.M.R., A.S., P.M., D.S.), University Hospital of Lausanne and University of Lausanne, Switzerland
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Kumar M, Beyea S, Hu S, Kamal N. Exploring the role of in-patient magnetic resonance imaging use among admitted ischemic stroke patients in improving patient outcomes and reducing healthcare resource utilization. Front Neurol 2024; 15:1305514. [PMID: 38562429 PMCID: PMC10983768 DOI: 10.3389/fneur.2024.1305514] [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: 10/01/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Despite the diagnostic and etiological significance of in-patient MRI in ischemic stroke (IS), its utilization is considered resource-intensive, expensive, and thus limiting feasibility and relevance. This study investigated the utilization of in-patient MRI for IS patients and its impact on patient and healthcare resource utilization outcomes. Methods This retrospective registry-based study analyzed 1,956 IS patients admitted to Halifax's QEII Health Centre between 2015 and 2019. Firstly, temporal trends of MRI and other neuroimaging utilization were evaluated. Secondly, we categorized the cohort into two groups (MRI vs. No MRI; in addition to a non-contrast CT) and investigated adjusted differences in patient outcomes at admission, discharge, and post-discharge using logistic regression. Additionally, we analyzed healthcare resource utilization using Poisson log-linear regression. Furthermore, patient outcomes significantly associated with MRI use underwent subgroup analysis for stroke severity (mild stroke including transient ischemic attack vs. moderate and severe stroke) and any acute stage treatment (thrombolytic or thrombectomy or both vs. no treatment) subgroups, while using an age and sex-adjusted logistic regression model. Results MRI was used in 40.5% patients; non-contrast CT in 99.3%, CT angiogram in 61.8%, and CT perfusion in 50.3%. Higher MRI utilization was associated with male sex, younger age, mild stroke, wake-up stroke, and no thrombolytic or thrombectomy treatment. MRI use was independently associated with lower in-hospital mortality (adjusted OR, 0.23; 95% CI, 0.15-0.36), lower symptomatic neurological status changes (0.64; 0.43-0.94), higher home discharge (1.32; 1.07-1.63), good functional outcomes at discharge (mRS score 0-2) (1.38; 1.11-1.72), lower 30-day stroke re-admission rates (0.48; 0.26-0.89), shorter hospital stays (regression coefficient, 0.92; 95% CI, 0.90-0.94), and reduced direct costs of hospitalization (0.90; 0.89-0.91). Subgroup analysis revealed significantly positive association of MRI use with most patient outcomes in moderate and severe strokes subgroup and non-acutely treated subgroup. Conversely, outcomes in mild strokes (including TIAs) subgroup and acute treatment subgroup were comparable regardless of MRI use. Conclusion A substantial proportion of admitted IS patients underwent MRI, and MRI use was associated with improved patient outcomes and reduced healthcare resource utilization. Considering the multifactorial nature of IS patient outcomes, further randomized controlled trials are suggested to investigate the role of increased MRI utilization in optimizing in-patient IS management.
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Affiliation(s)
- Mukesh Kumar
- Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada
| | - Steven Beyea
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
- IWK Health, Halifax, NS, Canada
| | - Sherry Hu
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Noreen Kamal
- Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Nukovic JJ, Opancina V, Ciceri E, Muto M, Zdravkovic N, Altin A, Altaysoy P, Kastelic R, Velazquez Mendivil DM, Nukovic JA, Markovic NV, Opancina M, Prodanovic T, Nukovic M, Kostic J, Prodanovic N. Neuroimaging Modalities Used for Ischemic Stroke Diagnosis and Monitoring. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1908. [PMID: 38003957 PMCID: PMC10673396 DOI: 10.3390/medicina59111908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
Strokes are one of the global leading causes of physical or mental impairment and fatality, classified into hemorrhagic and ischemic strokes. Ischemic strokes happen when a thrombus blocks or plugs an artery and interrupts or reduces blood supply to the brain tissue. Deciding on the imaging modality which will be used for stroke detection depends on the expertise and availability of staff and the infrastructure of hospitals. Magnetic resonance imaging provides valuable information, and its sensitivity for smaller infarcts is greater, while computed tomography is more extensively used, since it can promptly exclude acute cerebral hemorrhages and is more favorable speed-wise. The aim of this article was to give information about the neuroimaging modalities used for the diagnosis and monitoring of ischemic strokes. We reviewed the available literature and presented the use of computed tomography, CT angiography, CT perfusion, magnetic resonance imaging, MR angiography and MR perfusion for the detection of ischemic strokes and their monitoring in different phases of stroke development.
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Affiliation(s)
- Jasmin J. Nukovic
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Valentina Opancina
- Department of Radiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Diagnostic Imaging and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, 80131 Naples, Italy
| | - Elisa Ciceri
- Diagnostic Imaging and Interventional Neuroradiology Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology Unit, A.O.R.N. Cardarelli, 80131 Naples, Italy
| | - Nebojsa Zdravkovic
- Department of Biomedical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ahmet Altin
- Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Turkey
| | - Pelin Altaysoy
- Faculty of Medicine, Bahcesehir University, Istanbul 34349, Turkey
| | - Rebeka Kastelic
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Jusuf A. Nukovic
- Faculty of Pharmacy and Health Travnik, University of Travnik, 72270 Travnik, Bosnia and Herzegovina
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Nenad V. Markovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Miljan Opancina
- Department of Biomedical Statistics and Informatics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Military Medical Academy, Faculty of Medicine, University of Defense, 11000 Belgrade, Serbia
| | - Tijana Prodanovic
- Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Merisa Nukovic
- Department of Radiology, General Hospital Novi Pazar, 36300 Novi Pazar, Serbia
| | - Jelena Kostic
- Department of Radiology, Medical Faculty, University of Belgrade, 11120 Beograd, Serbia
| | - Nikola Prodanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Goyal MS, Vo KD. Beyond the AJR: Does MRI in Addition to CT Improve Outcomes in Patients With Established Stroke? AJR Am J Roentgenol 2023; 220:611. [PMID: 36043608 DOI: 10.2214/ajr.22.28428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Manu S Goyal
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
| | - Katie D Vo
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110
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5
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Gerbasi A, Konduri P, Tolhuisen M, Cavalcante F, Rinkel L, Kappelhof M, Wolff L, Coutinho JM, Emmer BJ, Costalat V, Arquizan C, Hofmeijer J, Uyttenboogaart M, van Zwam W, Roos Y, Quaglini S, Bellazzi R, Majoie C, Marquering H. Prognostic Value of Combined Radiomic Features from Follow-Up DWI and T2-FLAIR in Acute Ischemic Stroke. J Cardiovasc Dev Dis 2022; 9:jcdd9120468. [PMID: 36547465 PMCID: PMC9786822 DOI: 10.3390/jcdd9120468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
The biological pathways involved in lesion formation after an acute ischemic stroke (AIS) are poorly understood. Despite successful reperfusion treatment, up to two thirds of patients with large vessel occlusion remain functionally dependent. Imaging characteristics extracted from DWI and T2-FLAIR follow-up MR sequences could aid in providing a better understanding of the lesion constituents. We built a fully automated pipeline based on a tree ensemble machine learning model to predict poor long-term functional outcome in patients from the MR CLEAN-NO IV trial. Several feature sets were compared, considering only imaging, only clinical, or both types of features. Nested cross-validation with grid search and a feature selection procedure based on SHapley Additive exPlanations (SHAP) was used to train and validate the models. Considering features from both imaging modalities in combination with clinical characteristics led to the best prognostic model (AUC = 0.85, 95%CI [0.81, 0.89]). Moreover, SHAP values showed that imaging features from both sequences have a relevant impact on the final classification, with texture heterogeneity being the most predictive imaging biomarker. This study suggests the prognostic value of both DWI and T2-FLAIR follow-up sequences for AIS patients. If combined with clinical characteristics, they could lead to better understanding of lesion pathophysiology and improved long-term functional outcome prediction.
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Affiliation(s)
- Alessia Gerbasi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 PV Pavia, Italy
- Correspondence:
| | - Praneeta Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Manon Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Fabiano Cavalcante
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Leon Rinkel
- Department of Neurology, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Lennard Wolff
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, 3015 Rotterdam, The Netherlands
| | - Jonathan M. Coutinho
- Department of Neurology, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Bart J. Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Vincent Costalat
- Department of Neuroradiology, Centre Hospitalier Universitaire de Montpellier, 34400 Montpellier, France
| | - Caroline Arquizan
- Department of Neurology, Centre Hospitalier Universitaire de Montpellier, 34400 Montpellier, France
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, 6836 BH Arnhem, The Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology and Department of Medical Imaging Center, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Yvo Roos
- Department of Neurology, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 PV Pavia, Italy
| | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 PV Pavia, Italy
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Henk Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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6
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Cabral Frade H, Wilson SE, Beckwith A, Powers WJ. Comparison of Outcomes of Ischemic Stroke Initially Imaged With Cranial Computed Tomography Alone vs Computed Tomography Plus Magnetic Resonance Imaging. JAMA Netw Open 2022; 5:e2219416. [PMID: 35862046 PMCID: PMC9305377 DOI: 10.1001/jamanetworkopen.2022.19416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE Patients with acute ischemic stroke often undergo magnetic resonance imaging (MRI) in addition to computed tomography (CT), but its association with clinical outcomes is uncertain. OBJECTIVE To assess whether clinical outcomes of patients with acute ischemic stroke with initial CT alone were noninferior to those with additional MRI. DESIGN, SETTING, AND PARTICIPANTS A retrospective observational propensity score-matched cohort study of clinical outcomes at discharge and 1 year for patients hospitalized with acute ischemic stroke was conducted at an academic medical center between January 2015 and December 2017. Data collection from an electronic medical record system performed from May 2020 through January 2022 was not completely blinded. Noninferiority margins were based on the designs of previous randomized clinical trials of ischemic stroke treatments. Statistical analysis was performed in January 2022. Participants were adults hospitalized with acute ischemic stroke with admission diagnosis based on CT. Exclusion criteria were primarily missing data. From 508 eligible patients, all 123 cases with additional MRI were propensity-score matched to 123 controls without. EXPOSURE MRI after initial diagnosis. MAIN OUTCOMES AND MEASURES Death or dependence at hospital discharge (modified Rankin Scale score of 3-6) and stroke or death occurring in survivors within 1 year after discharge. RESULTS Among 246 participants, the median age was 68 years (IQR, 58-78.8 years) and 131 (53.0%) were men. Death or dependence at discharge occurred more often in patients with additional MRI (59 of 123 [48.0%]) than in those with CT alone (52 of 123 [42.3%]; absolute difference, 5.7%; 95% CI, -6.7% to 18.1%), meeting the -7.50% criterion for noninferiority. Stroke or death within 1 year after discharge determined for 225 of 235 (96%) survivors occurred more often in patients with additional MRI (22 of 113 [19.5%]) than in those with CT alone (14 of 112 [12.5%]; relative risk, 1.14; 95% CI, 0.86-1.50), meeting the 0.725 relative risk criterion for noninferiority. CONCLUSIONS AND RELEVANCE This propensity score-matched cohort study of patients hospitalized with acute ischemic stroke found that a diagnostic imaging strategy of initial CT alone was noninferior to initial CT plus additional MRI with regard to clinical outcomes at discharge and at 1 year. Further research is needed to determine which patients hospitalized with acute ischemic stroke benefit from MRI.
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Affiliation(s)
- Heitor Cabral Frade
- Department of Neurology, the University of Texas Medical Branch at Galveston
| | - Susan E. Wilson
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill
| | - Anne Beckwith
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill
| | - William J. Powers
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill
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7
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Teitcher M, Biller J. Understanding the Value of Diagnostic Imaging in Ischemic Stroke Outcomes. JAMA Netw Open 2022; 5:e2223077. [PMID: 35862050 DOI: 10.1001/jamanetworkopen.2022.23077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michael Teitcher
- Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Jose Biller
- Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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8
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Zhang X, Wu Q, Wang Z, Li H, Dai J. Keap1-Nrf2/ARE signal pathway activated by butylphthalide in the treatment of ischemic stroke. Am J Transl Res 2022; 14:2637-2646. [PMID: 35559381 PMCID: PMC9091106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/27/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the clinical efficacy and possible mechanism of butylphthalide in treatment of acute ischemic stroke. METHODS In this retrospective study, 127 patients with ischemic stroke, hospitalized during Jan. 2019 to Jan. 2021, were enrolled and as assigned to observation group (n=65) and control group (n=62) according to treatment methods. The control group received routine treatment, and the observation group was treated with butylphthalide injection in addition to conventional cure. The treatments lasted for 2 weeks in both groups. Subsequently, the recovery of neurological deficits (NIHSS) and Barthel index (BI) of the two groups of patients, cerebrovascular vascular reserve function (CVR) values and pulsation index (PI) before and after treatment, and the levels of brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF) and recombinant basic fibroblast growth factor (bFGF) were detected. The expression of Keap1-Nrf2/ARE signaling pathway related molecules was detected by ELISA. RESULTS The overall response rate (ORR) of observation group was remarkably superior to that of control group (P<0.05). NIHSS score obviously decreased while BI remarkably increased in both groups after treatment (all P<0.05); and the observation group showed an significantly higher BI score but significantly lower NIHSS score compared with the control group (all P<0.05). The CVR of the two groups of patients after treatment was significantly higher than that before treatment (P<0.05), while PI was significantly lower than before treatment (P<0.05); The CVR of observation-group after treatment was substantially higher than that of control-group (P<0.05), while PI was lower than control-group (P<0.05). Serum Keap1 levels of the two groups of patients after treatment were significantly higher than that before treatment (P<0.05), while serum levels of NQO1, Nrf2, and ARE were significantly lower than that before treatment (P<0.05). The serum level of Keap1 in the observation group was remarkably higher than that of the control group (P<0.05), while the serum levels of NQO1, Nrf2 and ARE were evidently lower than those in the control group (P<0.05). The two groups had insignificant difference in incidence of adverse reactions (P>0.05). CONCLUSION The butylphthalide can effectively improve the clinical efficacy of acute ischemic stroke, and promote patients' neurological function and activities of daily living. The mechanism may be that butylphthalide improves the CVR of patients, enhances the establishment of collateral compensatory vessels, and changes the expression of the Keap1-Nrf2/ARE signaling pathway, thereby exerting the neuroprotective effect. Clinically, butylphthalide may have good safety in adjuvant therapy of acute ischemic stroke.
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Affiliation(s)
- Xiaofeng Zhang
- Department of Neurology, Cangzhou Central HospitalCangzhou 061001, Hebei, China
| | - Qiang Wu
- Department of Neurology, Cangzhou Central HospitalCangzhou 061001, Hebei, China
| | - Zhihui Wang
- Department of Neurology, Cangzhou Central Hospital Hejian DistrictCangzhou 061001, Hebei, China
| | - Haimei Li
- Department of Neurology, Cangzhou Central HospitalCangzhou 061001, Hebei, China
| | - Jie Dai
- Department of Neurology, Cangzhou Central HospitalCangzhou 061001, Hebei, China
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9
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Chalet L, Boutelier T, Christen T, Raguenes D, Debatisse J, Eker OF, Becker G, Nighoghossian N, Cho TH, Canet-Soulas E, Mechtouff L. Clinical Imaging of the Penumbra in Ischemic Stroke: From the Concept to the Era of Mechanical Thrombectomy. Front Cardiovasc Med 2022; 9:861913. [PMID: 35355966 PMCID: PMC8959629 DOI: 10.3389/fcvm.2022.861913] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 01/01/2023] Open
Abstract
The ischemic penumbra is defined as the severely hypoperfused, functionally impaired, at-risk but not yet infarcted tissue that will be progressively recruited into the infarct core. Early reperfusion aims to save the ischemic penumbra by preventing infarct core expansion and is the mainstay of acute ischemic stroke therapy. Intravenous thrombolysis and mechanical thrombectomy for selected patients with large vessel occlusion has been shown to improve functional outcome. Given the varying speed of infarct core progression among individuals, a therapeutic window tailored to each patient has recently been proposed. Recent studies have demonstrated that reperfusion therapies are beneficial in patients with a persistent ischemic penumbra, beyond conventional time windows. As a result, mapping the penumbra has become crucial in emergency settings for guiding personalized therapy. The penumbra was first characterized as an area with a reduced cerebral blood flow, increased oxygen extraction fraction and preserved cerebral metabolic rate of oxygen using positron emission tomography (PET) with radiolabeled O2. Because this imaging method is not feasible in an acute clinical setting, the magnetic resonance imaging (MRI) mismatch between perfusion-weighted imaging and diffusion-weighted imaging, as well as computed tomography perfusion have been proposed as surrogate markers to identify the penumbra in acute ischemic stroke patients. Transversal studies comparing PET and MRI or using longitudinal assessment of a limited sample of patients have been used to define perfusion thresholds. However, in the era of mechanical thrombectomy, these thresholds are debatable. Using various MRI methods, the original penumbra definition has recently gained a significant interest. The aim of this review is to provide an overview of the evolution of the ischemic penumbra imaging methods, including their respective strengths and limitations, as well as to map the current intellectual structure of the field using bibliometric analysis and explore future directions.
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Affiliation(s)
- Lucie Chalet
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Olea Medical, La Ciotat, France
| | | | - Thomas Christen
- Grenoble Institut Neurosciences, INSERM, U1216, Univ. Grenoble Alpes, Grenoble, France
| | | | - Justine Debatisse
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Omer Faruk Eker
- CREATIS, CNRS UMR-5220, INSERM U1206, Université Lyon 1, Villeurbanne, France
- Neuroradiology Department, Hospices Civils of Lyon, Lyon, France
| | - Guillaume Becker
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stroke Department, Hospices Civils of Lyon, Lyon, France
| | - Tae-Hee Cho
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stroke Department, Hospices Civils of Lyon, Lyon, France
| | - Emmanuelle Canet-Soulas
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Laura Mechtouff
- Univ Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Stroke Department, Hospices Civils of Lyon, Lyon, France
- *Correspondence: Laura Mechtouff
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Almansour NSS, Alzamanan HY, Almutared ASM, Almansoor HHA, Alyami IAM, Alajmi SM, Ismail MAA, Abbas MASA. Role of MRI in Diagnosis and Management of Stroke Cases; A Systematic Review. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/lxobuviry5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lee H, Yang Y, Xu J, Ware JB, Liu B. Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality. J Clin Imaging Sci 2021; 11:53. [PMID: 34754593 PMCID: PMC8571198 DOI: 10.25259/jcis_148_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: While magnetic resonance imaging (MRI) has higher sensitivity than computed tomography for certain types of traumatic brain injury (TBI), it remains unknown whether the increased detection of intracranial injuries leads to improved clinical outcomes in acute TBI patients, especially given the resource requirements involved in performing MRI. We leveraged a large national patient database to examine associations between brain MRI utilization and inpatient clinical outcomes in hospitalized TBI patients. Material and Methods: The National Inpatient Sample database was queried to find 3,075 and 340,090 hospitalized TBI patients with and without brain MRI, respectively, between 2012 and 2014 in the United States. Multivariate regression analysis was performed to independently evaluate the association between brain MRI utilization and inpatient mortality rate, complications, and resource requirements. Results: The MRI group had a lower unadjusted mortality rate of 0.75% compared to 2.54% in the non-MRI group. On multivariate regression analysis, inpatient brain MRI was independently associated with lower mortality (adjusted OR 0.32, 95% CI 0.12–0.86), as well as higher rates of intracranial hemorrhage (adjusted OR 2.20, 95% CI 1.27–3.81) and non-home discharge (adjusted OR 1.33, 95% CI 1.07–1.67). Brain MRI was independently associated with 3.4 days (P < 0.001) and $8,934 (P < 0.001) increase in the total length and cost of hospital stay, respectively. Conclusion: We present the first evidence that inpatient brain MRI in TBI patients is associated with lower inpatient mortality, but with increased hospital resource utilization and likelihood of non-home discharge.
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Affiliation(s)
- Hwan Lee
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yifeng Yang
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jiehui Xu
- Division of Biostatistics, New York University Grossman School of Medicine, New York, United States
| | - Jeffrey B Ware
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Baogiong Liu
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Lee H, Yang Y, Liu B, Castro SA, Shi T. Patients With Acute Ischemic Stroke Who Receive Brain Magnetic Resonance Imaging Demonstrate Favorable In-Hospital Outcomes. J Am Heart Assoc 2020; 9:e016987. [PMID: 33043760 PMCID: PMC7763386 DOI: 10.1161/jaha.120.016987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Use of inpatient brain magnetic resonance imaging (MRI) in patients with acute ischemic stroke is highly institution dependent and has been associated with increased length and cost of hospital stay. We examined whether inpatient brain MRI in patients with acute ischemic stroke is associated with improved clinical outcomes to justify its resource requirements. Methods and Results The National Inpatient Sample database was queried retrospectively to find 94 003 patients who were admitted for acute ischemic stroke and then received inpatient brain MRI between 2012 and 2014. Multivariable regression analysis was performed with respect to a control group to assess for differences in the rates of inpatient mortality and complications, as well as the length and cost of hospital stay based on brain MRI use. Inpatient brain MRI was independently associated with lower rates of inpatient mortality (1.67% versus 3.09%; adjusted odds ratio [OR], 0.60; 95% CI, 0.53–0.68; P<0.001), gastrostomy (2.28% versus 2.89%; adjusted OR, 0.82; 95% CI, 0.73–0.93; P<0.001), and mechanical ventilation (1.97% versus 2.82%; adjusted OR, 0.68; 95% CI, 0.60–0.77; P<0.001). Brain MRI was independently associated with ≈0.32 days (8%) and $1131 (11%) increase in the total length (P<0.001) and cost (P<0.001) of hospital stay, respectively. Conclusions Inpatient brain MRI in patients with acute ischemic stroke is associated with substantial decrease in the rates of inpatient mortality and complications, at the expense of marginally increased length and cost of hospitalization.
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Affiliation(s)
- Hwan Lee
- Department of Radiology University of Pennsylvania Perelman School of Medicine Philadelphia PA.,Department of Medicine St. Vincent's Medical Center Bridgeport CT
| | - Yifeng Yang
- Department of Medicine St. Vincent's Medical Center Bridgeport CT
| | - Baoqiong Liu
- Department of Medicine Florida Hospital Medical Group Orlando FL
| | - Simon A Castro
- Department of Medicine St. Vincent's Medical Center Bridgeport CT
| | - Tiantian Shi
- Department of Medicine Bridgeport Hospital-Yale New Haven Health Bridgeport CT
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