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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. Pediatrics 2024; 154:e2024066855. [PMID: 38932719 DOI: 10.1542/peds.2024-066855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging, are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. J Am Coll Radiol 2024; 21:e37-e69. [PMID: 38944445 DOI: 10.1016/j.jacr.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Smiley K, Yoo MJ, Long B. Are the HINTS and HINTS Plus Examinations Accurate for Identifying a Central Cause of Acute Vestibular Syndrome? Ann Emerg Med 2024; 84:60-62. [PMID: 38385911 DOI: 10.1016/j.annemergmed.2024.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/19/2024] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Kyle Smiley
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Michael Jay Yoo
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX
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Lee JH, Choi E, McDougal R, Lytton WW. GPT-4 Performance for Neurologic Localization. Neurol Clin Pract 2024; 14:e200293. [PMID: 38596779 PMCID: PMC11003355 DOI: 10.1212/cpj.0000000000200293] [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: 12/21/2023] [Accepted: 01/23/2024] [Indexed: 04/11/2024]
Abstract
Background and Objectives In health care, large language models such as Generative Pretrained Transformers (GPTs), trained on extensive text datasets, have potential applications in reducing health care disparities across regions and populations. Previous software developed for lesion localization has been limited in scope. This study aims to evaluate the capability of GPT-4 for lesion localization based on clinical presentation. Methods GPT-4 was prompted using history and neurologic physical examination (H&P) from published cases of acute stroke followed by questions for clinical reasoning with answering for "single or multiple lesions," "side," and "brain region" using Zero-Shot Chain-of-Thought and Text Classification prompting. GPT-4 output on 3 separate trials for each of 46 cases was compared with imaging-based localization. Results GPT-4 successfully processed raw text from H&P to generate accurate neuroanatomical localization and detailed clinical reasoning. Performance metrics across trial-based analysis for specificity, sensitivity, precision, and F1-score were 0.87, 0.74, 0.75, and 0.74, respectively, for side; 0.94, 0.85, 0.84, and 0.85, respectively, for brain region. Class labels within the brain region were similarly high for all regions except the cerebellum and were also similar when considering all 3 trials to examine metrics by case. Errors were due to extrinsic causes-inadequate information in the published cases, and intrinsic causes-failures of logic or inadequate knowledge base. Discussion This study reveals capabilities of GPT-4 in the localization of acute stroke lesions, showing a potential future role as a clinical tool in neurology.
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Affiliation(s)
- Jung-Hyun Lee
- Department of Neurology (J-HL, WWL), State University of New York Downstate Health Sciences University; Department of Neurology (J-HL, WWL), Kings County Hospital; Department of Neurology (J-HL), Maimonides Medical Center, Brooklyn; Department of Internal Medicine (EC), Lincoln Medical Center, Bronx, NY; Department of Biostatistics (RM), Yale School of Public Health; Program in Computational Biology and Bioinformatics (RM); Wu-Tsai Institute (RM); Section of Biomedical Informatics and Data Science (RM), Yale School of Medicine, Yale University, New Haven, CT; and Department of Physiology and Pharmacology (WWL), State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Eunhee Choi
- Department of Neurology (J-HL, WWL), State University of New York Downstate Health Sciences University; Department of Neurology (J-HL, WWL), Kings County Hospital; Department of Neurology (J-HL), Maimonides Medical Center, Brooklyn; Department of Internal Medicine (EC), Lincoln Medical Center, Bronx, NY; Department of Biostatistics (RM), Yale School of Public Health; Program in Computational Biology and Bioinformatics (RM); Wu-Tsai Institute (RM); Section of Biomedical Informatics and Data Science (RM), Yale School of Medicine, Yale University, New Haven, CT; and Department of Physiology and Pharmacology (WWL), State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Robert McDougal
- Department of Neurology (J-HL, WWL), State University of New York Downstate Health Sciences University; Department of Neurology (J-HL, WWL), Kings County Hospital; Department of Neurology (J-HL), Maimonides Medical Center, Brooklyn; Department of Internal Medicine (EC), Lincoln Medical Center, Bronx, NY; Department of Biostatistics (RM), Yale School of Public Health; Program in Computational Biology and Bioinformatics (RM); Wu-Tsai Institute (RM); Section of Biomedical Informatics and Data Science (RM), Yale School of Medicine, Yale University, New Haven, CT; and Department of Physiology and Pharmacology (WWL), State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - William W Lytton
- Department of Neurology (J-HL, WWL), State University of New York Downstate Health Sciences University; Department of Neurology (J-HL, WWL), Kings County Hospital; Department of Neurology (J-HL), Maimonides Medical Center, Brooklyn; Department of Internal Medicine (EC), Lincoln Medical Center, Bronx, NY; Department of Biostatistics (RM), Yale School of Public Health; Program in Computational Biology and Bioinformatics (RM); Wu-Tsai Institute (RM); Section of Biomedical Informatics and Data Science (RM), Yale School of Medicine, Yale University, New Haven, CT; and Department of Physiology and Pharmacology (WWL), State University of New York Downstate Health Sciences University, Brooklyn, NY
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Lakhani DA, Balar AB, Salim H, Koneru M, Wen S, Ozkara B, Lu H, Wang R, Hoseinyazdi M, Xu R, Nabi M, Mazumdar I, Cho A, Chen K, Sepehri S, Hyson N, Urrutia V, Luna L, Hillis AE, Heit JJ, Albers GW, Rai AT, Dmytriw AA, Faizy TD, Wintermark M, Nael K, Yedavalli VS. CT Perfusion Derived rCBV < 42% Lesion Volume Is Independently Associated with Followup FLAIR Infarct Volume in Anterior Circulation Large Vessel Occlusion. Diagnostics (Basel) 2024; 14:845. [PMID: 38667490 PMCID: PMC11049259 DOI: 10.3390/diagnostics14080845] [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: 04/03/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Pretreatment CT Perfusion (CTP) parameter rCBV < 42% lesion volume has recently been shown to predict 90-day mRS. In this study, we aim to assess the relationship between rCBV < 42% and a radiographic follow-up infarct volume delineated on FLAIR images. In this retrospective evaluation of our prospectively collected database, we included acute stroke patients triaged by multimodal CT imaging, including CT angiography and perfusion imaging, with confirmed anterior circulation large vessel occlusion between 9 January 2017 and 10 January 2023. Follow-up FLAIR imaging was used to determine the final infarct volume. Student t, Mann-Whitney-U, and Chi-Square tests were used to assess differences. Spearman's rank correlation and linear regression analysis were used to assess associations between rCBV < 42% and follow-up infarct volume on FLAIR. In total, 158 patients (median age: 68 years, 52.5% female) met our inclusion criteria. rCBV < 42% (ρ = 0.56, p < 0.001) significantly correlated with follow-up-FLAIR infarct volume. On multivariable linear regression analysis, rCBV < 42% lesion volume (beta = 0.60, p < 0.001), ASPECTS (beta = -0.214, p < 0.01), mTICI (beta = -0.277, p < 0.001), and diabetes (beta = 0.16, p < 0.05) were independently associated with follow-up infarct volume. The rCBV < 42% lesion volume is independently associated with FLAIR follow-up infarct volume.
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Affiliation(s)
- Dhairya A. Lakhani
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Aneri B. Balar
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Hamza Salim
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Manisha Koneru
- Cooper Medical School, Rowan University, Camden, NJ 08103, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV 26506, USA;
| | - Burak Ozkara
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA (A.E.H.)
| | - Hanzhang Lu
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Richard Wang
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Meisam Hoseinyazdi
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Risheng Xu
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Mehreen Nabi
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Ishan Mazumdar
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Andrew Cho
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Kevin Chen
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Sadra Sepehri
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Nathan Hyson
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Victor Urrutia
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Licia Luna
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD 21218, USA (A.E.H.)
| | - Jeremy J. Heit
- Department of Neurology, Stanford University, Stanford, CA 94305, USA; (J.J.H.); (G.W.A.)
| | - Greg W. Albers
- Department of Neurology, Stanford University, Stanford, CA 94305, USA; (J.J.H.); (G.W.A.)
| | - Ansaar T. Rai
- Department of Neuroradiology, West Virginia University, Morgantown, WV 26506, USA;
| | - Adam A. Dmytriw
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | - Tobias D. Faizy
- Department of Radiology, Neuroendovascular Division, University Medical Center Münster, 48149 Münster, Germany;
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson Medical Center, Houston, TX 77030, USA;
| | - Kambiz Nael
- Division of Neuroradiology, Department of Radiology, University of California San Francisco (UCSF), San Francisco, CA 94143, USA;
| | - Vivek S. Yedavalli
- Department of Radiology and Radiological Sciences, Johns Hopkins University, 600 N. Wolfe St., Phipps B100, Baltimore, MD 21287, USA; (A.B.B.); (H.S.); (H.L.); (R.W.); (M.H.); (R.X.); (M.N.); (I.M.); (A.C.); (K.C.); (S.S.); (N.H.); (V.U.); (L.L.); (V.S.Y.)
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Ladumor H, Vilanilam GK, Ameli S, Pandey I, Vattoth S. CT perfusion in stroke: Comparing conventional and RAPID automated software. Curr Probl Diagn Radiol 2024; 53:201-207. [PMID: 37891080 DOI: 10.1067/j.cpradiol.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/12/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023]
Abstract
CT perfusion (CTP) imaging is increasingly used for routine evaluation of acute ischemic stroke. Knowledge about the different types of CTP software, imaging acquisition and post-processing, and interpretation is crucial for appropriate patient selection for reperfusion therapy. Conventional vendor-provided CTP software differentiates between ischemic penumbra and core infarct using the tiebreaker of critically reduced cerebral blood volume (CBV) values within brain regions showing abnormally elevated time parameters like mean transit time (MTT) or time to peak (TTP). On the other hand, RAPID automated software differentiates between ischemic penumbra and core infarct using the tiebreaker of critically reduced cerebral blood flow (CBF) values within brain regions showing abnormally elevated time to maximum (Tmax). Additionally, RAPID calculates certain indices that confer prognostic value, such as the hypoperfusion and CBV index. In this review, we aim to familiarize the reader with the technical principles of CTP imaging, compare CTP maps generated by conventional and RAPID software, and discuss important thresholds for reperfusion and prognostic indices. Lastly, we discuss common pitfalls to help with the accurate interpretation of CTP imaging.
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Affiliation(s)
- Heta Ladumor
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St - Slot 556, Little Rock, AR 72205, USA.
| | - George K Vilanilam
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St - Slot 556, Little Rock, AR 72205, USA
| | - Sanaz Ameli
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St - Slot 556, Little Rock, AR 72205, USA
| | | | - Surjith Vattoth
- Deparment of Diagnostic Radiology & Nuclear Medicine, Division of Neuroradiology, Rush University Medical Center, Chicago, IL 60612, USA
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Lu SS. Multiphase MR angiography collateral map in brain stroke: may we shift the time from an absolute to the relative for therapy decisions? Eur Radiol 2024; 34:1409-1410. [PMID: 37814106 DOI: 10.1007/s00330-023-10275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/02/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Shan-Shan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Fan H, Bunker L, Wang Z, Durfee AZ, Lin DDM, Yedavalli V, Ge Y, Zhou XJ, Hillis AE, Lu H. Simultaneous perfusion, diffusion, T 2 *, and T 1 mapping with MR fingerprinting. Magn Reson Med 2024; 91:558-569. [PMID: 37749847 PMCID: PMC10872728 DOI: 10.1002/mrm.29880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/27/2023] [Accepted: 09/12/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Quantitative mapping of brain perfusion, diffusion, T2 *, and T1 has important applications in cerebrovascular diseases. At present, these sequences are performed separately. This study aims to develop a novel MRI technique to simultaneously estimate these parameters. METHODS This sequence to measure perfusion, diffusion, T2 *, and T1 mapping with magnetic resonance fingerprinting (MRF) was based on a previously reported MRF-arterial spin labeling (ASL) sequence, but the acquisition module was modified to include different TEs and presence/absence of bipolar diffusion-weighting gradients. We compared parameters derived from the proposed method to those derived from reference methods (i.e., separate sequences of MRF-ASL, conventional spin-echo DWI, and T2 * mapping). Test-retest repeatability and initial clinical application in two patients with stroke were evaluated. RESULTS The scan time of our proposed method was 24% shorter than the sum of the reference methods. Parametric maps obtained from the proposed method revealed excellent image quality. Their quantitative values were strongly correlated with those from reference methods and were generally in agreement with values reported in the literature. Repeatability assessment revealed that ADC, T2 *, T1 , and B1 + estimation was highly reliable, with voxelwise coefficient of variation (CoV) <5%. The CoV for arterial transit time and cerebral blood flow was 16% ± 3% and 25% ± 9%, respectively. The results from the two patients with stroke demonstrated that parametric maps derived from the proposed method can detect both ischemic and hemorrhagic stroke. CONCLUSION The proposed method is a promising technique for multi-parametric mapping and has potential use in patients with stroke.
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Affiliation(s)
- Hongli Fan
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lisa Bunker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Zihan Wang
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alexandra Zezinka Durfee
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Doris Da May Lin
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Vivek Yedavalli
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yulin Ge
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, Unites States
| | - Xiaohong Joe Zhou
- Center for Magnetic Resonance Research and Department of Radiology, University of Illinois at Chicago, Chicago, IL, United States
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
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Huang M, Gedansky A, Hassett CE, Shoskes A, Duggal A, Uchino K, Cho SM, Buletko AB. Structural Brain Injury on Brain Magnetic Resonance Imaging in Acute Respiratory Distress Syndrome. Neurocrit Care 2024; 40:187-195. [PMID: 37667080 DOI: 10.1007/s12028-023-01823-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/30/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is an acute inflammatory respiratory failure condition that may be associated with brain injury. We aimed to describe the types of structural brain injuries detected by brain magnetic resonance imaging (MRI) among patients with ARDS. METHODS We retrospectively reviewed and collected data on brain injuries as detected by brain MRI during index hospitalization of all patients with ARDS at a single tertiary center in the United States from January 2010 to October 2018 (pre-COVID era). Structural brain injuries were classified as cerebral ischemia (ischemic infarct and hypoxic-ischemic brain injury) or cerebral hemorrhage (intraparenchymal hemorrhage, cerebral microbleeds, subarachnoid hemorrhage, and subdural hematoma). Descriptive statistics were conducted. RESULTS Of the 678 patients with ARDS, 66 (9.7%) underwent brain MRI during their ARDS illness. The most common indication for brain MRI was encephalopathy (45.4%), and the median time from hospital admission to MRI was 10 days (interquartile range 4-17). Of 66 patients, 29 (44%) had MRI evidence of brain injury, including cerebral ischemia in 33% (22 of 66) and cerebral hemorrhage in 21% (14 of 66). Among those with cerebral ischemia, common findings were bilateral globus pallidus infarcts (n = 7, 32%), multifocal infarcts (n = 5, 23%), and diffuse hypoxic-ischemic brain injury (n = 3, 14%). Of those with cerebral hemorrhage, common findings were cerebral microbleeds (n = 12, 86%) and intraparenchymal hemorrhage (n = 2, 14%). Patients with ARDS with cerebral hemorrhage had significantly greater use of rescue therapies, including prone positioning (28.6% vs. 5.8%, p = 0.03), inhaled vasodilator (35.7% vs. 11.5%, p = 0.046), and recruitment maneuver (14.3% vs. 0%, p = 0.04). CONCLUSIONS Structural brain injury was not uncommon among selected patients with ARDS who underwent brain MRI. The majority of brain injuries seen were bilateral globus pallidus infarcts and cerebral microbleeds.
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Affiliation(s)
- Merry Huang
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Aron Gedansky
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine E Hassett
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Aaron Shoskes
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Sung-Min Cho
- Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew B Buletko
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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10
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Jalali R, Zwiernik J, Rotkiewicz E, Zwiernik B, Kern A, Bil J, Jalali A, Manta J, Romaszko J. Predicting Short- and Long-Term Functional Outcomes Based on Serum S100B Protein Levels in Patients with Ischemic Stroke. J Pers Med 2024; 14:80. [PMID: 38248781 PMCID: PMC10817633 DOI: 10.3390/jpm14010080] [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: 11/25/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Ischemic stroke is one of the leading causes of mortality and disability. The neuroimaging methods are the gold standard for diagnostics. Biomarkers of cerebral ischemia are considered to be potentially helpful in the determination of the etiology and prognosis of patients with ischemic stroke. AIM This study aimed to investigate the usefulness of serum S100B protein levels as a short- and long-term prognostic factor in patients with ischemic stroke. STUDY DESIGN AND METHODS The study group comprised 65 patients with ischemic stroke. S100B protein levels were measured by immunoenzymatic assay. Short-term functional outcome was determined by the NIHSS score on day 1 and the difference in the NIHSS scores between day 1 and day 9 (delta NIHSS). Long-term outcome was assessed by the modified Rankin Scale (MRS) at 3 months after the stroke. At the end of the study, patients were divided into groups based on the NIHSS score on day 9 (0-8 "good" and >8 "poor"), the delta NIHSS ("no improvement" ≤0 and >0 "improvement"), and the MRS ("good" 0-2 and >2 "poor"). Differences in S100B levels between groups were analyzed with the ROC curve to establish the optimal cut-off point for S100B. The odds ratio was calculated to determine the strength of association. Correlations between S100B levels at three time points and these variables were evaluated. RESULTS We revealed a statistically significant correlation between S100B levels at each measurement point (<24 h, 24-48 H, 48-72 h) and the NIHSS score on day 9 (R Spearman 0.534, 0.631, and 0.517, respectively) and the MRS score after 3 months (R Spearman 0.620, 0.657, and 0.617, respectively). No statistically significant correlation was found between S100B levels and the delta NIHSS. Analysis of the ROC curve confirmed a high sensitivity and specificity for S100B. The calculated AUC for the NIHSS on day 9 were 90.2%, 95.0%, and 82.2%, respectively, and for the MRS, 83.5%, 83.4%, and 84.0%, respectively. After determining the S100B cut-off, the odds ratio for beneficial effect (NIHSS ≤ 8 at day 9 or MRS 0-2 after 3 months) was determined for each sampling point. CONCLUSION S100B is a useful marker for predicting short- and long-term functional outcomes in patients with ischemic stroke.
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Affiliation(s)
- Rakesh Jalali
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (E.R.)
- Clinical Emergency Department, Regional Specialist Hospital, 10-561 Olsztyn, Poland
| | - Jacek Zwiernik
- Department of Neurology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (J.Z.); (B.Z.)
| | - Ewa Rotkiewicz
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (E.R.)
| | - Beata Zwiernik
- Department of Neurology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (J.Z.); (B.Z.)
| | - Adam Kern
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland;
| | - Jacek Bil
- Department of Invasive Cardiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Anita Jalali
- Students’ Research Group, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Joanna Manta
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland; (E.R.)
- Clinical Emergency Department, Regional Specialist Hospital, 10-561 Olsztyn, Poland
| | - Jerzy Romaszko
- Department of Family Medicine and Infectious Diseases, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland;
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11
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Dammavalam V, Lin S, Nessa S, Daksla N, Stefanowski K, Costa A, Bergese S. Neuroprotection during Thrombectomy for Acute Ischemic Stroke: A Review of Future Therapies. Int J Mol Sci 2024; 25:891. [PMID: 38255965 PMCID: PMC10815099 DOI: 10.3390/ijms25020891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Stroke is a major cause of death and disability worldwide. Endovascular thrombectomy has been impactful in decreasing mortality. However, many clinical results continue to show suboptimal functional outcomes despite high recanalization rates. This gap in recanalization and symptomatic improvement suggests a need for adjunctive therapies in post-thrombectomy care. With greater insight into ischemia-reperfusion injury, recent preclinical testing of neuroprotective agents has shifted towards preventing oxidative stress through upregulation of antioxidants and downstream effectors, with positive results. Advances in multiple neuroprotective therapies, including uric acid, activated protein C, nerinetide, otaplimastat, imatinib, verapamil, butylphthalide, edaravone, nelonemdaz, ApTOLL, regional hypothermia, remote ischemic conditioning, normobaric oxygen, and especially nuclear factor erythroid 2-related factor 2, have promising evidence for improving stroke care. Sedation and blood pressure management in endovascular thrombectomy also play crucial roles in improved stroke outcomes. A hand-in-hand approach with both endovascular therapy and neuroprotection may be the key to targeting disability due to stroke.
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Affiliation(s)
- Vikalpa Dammavalam
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (V.D.); (K.S.)
| | - Sandra Lin
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.L.); (N.D.); (A.C.)
| | - Sayedatun Nessa
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (V.D.); (K.S.)
| | - Neil Daksla
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.L.); (N.D.); (A.C.)
| | - Kamil Stefanowski
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (V.D.); (K.S.)
| | - Ana Costa
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.L.); (N.D.); (A.C.)
| | - Sergio Bergese
- Department of Anesthesiology, Stony Brook University Hospital, Stony Brook, NY 11794, USA; (S.L.); (N.D.); (A.C.)
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12
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Miyamoto N, Ueno Y, Yamashiro K, Hira K, Kijima C, Kitora N, Iwao Y, Okuda K, Mishima S, Takahashi D, Ono K, Asari M, Miyazaki K, Hattori N. Stroke classification and treatment support system artificial intelligence for usefulness of stroke diagnosis. Front Neurol 2023; 14:1295642. [PMID: 38156087 PMCID: PMC10753815 DOI: 10.3389/fneur.2023.1295642] [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: 09/17/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023] Open
Abstract
Background and aims It is important to diagnose cerebral infarction at an early stage and select an appropriate treatment method. The number of stroke-trained physicians is unevenly distributed; thus, a shortage of specialists is a major problem in some regions. In this retrospective design study, we tested whether an artificial intelligence (AI) we built using computer-aided detection/diagnosis may help medical physicians to classify stroke for the appropriate treatment. Methods To build the Stroke Classification and Treatment Support System AI, the clinical data of 231 hospitalized patients with ischemic stroke from January 2016 to December 2017 were used for training the AI. To verify the diagnostic accuracy, 151 patients who were admitted for stroke between January 2018 and December 2018 were also enrolled. Results By utilizing multimodal data, such as DWI and ADC map images, as well as patient examination data, we were able to construct an AI that can explain the analysis results with a small amount of training data. Furthermore, the AI was able to classify with high accuracy (Cohort 1, evaluation data 88.7%; Cohort 2, validation data 86.1%). Conclusion In recent years, the treatment options for cerebral infarction have increased in number and complexity, making it even more important to provide appropriate treatment according to the initial diagnosis. This system could be used for initial treatment to automatically diagnose and classify strokes in hospitals where stroke-trained physicians are not available and improve the prognosis of cerebral infarction.
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Affiliation(s)
- Nobukazu Miyamoto
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenichiro Hira
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Chikage Kijima
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | - Kazuto Ono
- Ohara Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Mika Asari
- PARKINSON Laboratories Co., Ltd., Tokyo, Japan
| | | | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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13
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Hakami F, Alhazmi E, Busayli WM, Althurwi S, Darraj AM, Alamir MA, Hakami A, Othman RA, Moafa AI, Mahasi HA, Madkhali MA. Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke. Cureus 2023; 15:e50577. [PMID: 38107212 PMCID: PMC10723021 DOI: 10.7759/cureus.50577] [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] [Accepted: 12/14/2023] [Indexed: 12/19/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic blood disorder that affects hemoglobin and increases stroke risk, particularly in childhood. This review examines the pathophysiological association between SCD and stroke, the classification of stroke types, risk factors, diagnosis, management, prevention, and prognosis. A comprehensive literature search was conducted via PubMed, Scopus, and Cochrane databases. Relevant studies on SCD and stroke pathophysiology, classification, epidemiology, diagnosis, treatment, and prevention were identified. Sickle cell disease causes red blood cells to become rigid and sickle-shaped, obstructing blood vessels. Recurrent sickling alters cerebral blood flow and damages vessel walls, often leading to ischemic or hemorrhagic strokes (HS). These occur most frequently in childhood, with ischemic strokes (IS) being more common. Key risk factors include a prior transient ischemic attack (TIA), low hemoglobin, and a high leukocyte count. Neuroimaging is essential for diagnosis and determining stroke type. Primary prevention centers on blood transfusions and hydroxyurea for those at high risk. Acute treatment involves promptly restoring blood flow and managing complications. However, significant knowledge gaps remain regarding stroke mechanisms, optimizing screening protocols, and improving long-term outcomes. This review synthesizes current evidence on SCD and stroke to highlight opportunities for further research and standardizing care protocols across institutions. Ultimately, a holistic perspective is critical for mitigating the high risk of debilitating strokes in this vulnerable patient population.
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Affiliation(s)
- Faisal Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Essam Alhazmi
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Wafa M Busayli
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | | | | | - Alyaj Hakami
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Renad A Othman
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | - Amal I Moafa
- Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
| | | | - Mohammed Ali Madkhali
- Internal Medicine, and Hematology and Oncology, Faculty of Medicine, Jazan University, Jazan, SAU
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14
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Tekieli L, Kablak-Ziembicka A, Dabrowski W, Dzierwa K, Moczulski Z, Urbanczyk-Zawadzka M, Mazurek A, Stefaniak J, Paluszek P, Krupinski M, Przewlocki T, Pieniazek P, Musialek P. Imaging modality-dependent carotid stenosis severity variations against intravascular ultrasound as a reference: Carotid Artery intravasculaR Ultrasound Study (CARUS). Int J Cardiovasc Imaging 2023; 39:1909-1920. [PMID: 37603155 PMCID: PMC10589130 DOI: 10.1007/s10554-023-02875-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/14/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE Different non-invasive and invasive imaging modalities are used to determine carotid artery stenosis severity that remains a principal parameter in clinical decision-making. We compared stenosis degree obtained with different modalities against vascular imaging gold standard, intravascular ultrasound, IVUS. METHODS 300 consecutive patients (age 47-83 years, 192 men, 64% asymptomatic) with carotid artery stenosis of " ≥ 50%" referred for potential revascularization received as per study protocol (i) duplex ultrasound (DUS), (ii) computed tomography angiography (CTA), (iii) intraarterial quantitative angiography (iQA) and (iv) and (iv) IVUS. Correlation of measurements with IVUS (r), proportion of those concordant (within 10%) and proportion of under/overestimated were calculated along with recipient-operating-characteristics (ROC). RESULTS For IVUS area stenosis (AS) and IVUS minimal lumen area (MLA), there was only a moderate correlation with DUS velocities (peak-systolic, PSV; end-diastolic, EDV; r values of 0.42-0.51, p < 0.001 for all). CTA systematically underestimated both reference area and MLA (80.4% and 92.3% cases) but CTA error was lesser for AS (proportion concordant-57.4%; CTA under/overestimation-12.5%/30.1%). iQA diameter stenosis (DS) was found concordant with IVUS in 41.1% measurements (iQA under/overestimation 7.9%/51.0%). By univariate model, PSV (ROC area-under-the-curve, AUC, 0.77, cutoff 2.6 m/s), EDV (AUC 0.72, cutoff 0.71 m/s) and CTA-DS (AUC 0.83, cutoff 59.6%) were predictors of ≥ 50% DS by IVUS (p < 0.001 for all). Best predictor, however, of ≥ 50% DS by IVUS was stenosis severity evaluation by automated contrast column density measurement on iQA (AUC 0.87, cutoff 68%, p < 0.001). Regarding non-invasive techniques, CTA was the only independent diagnostic modality against IVUS on multivariate model (p = 0.008). CONCLUSION IVUS validation shows significant imaging modality-dependent variations in carotid stenosis severity determination.
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Affiliation(s)
- Lukasz Tekieli
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
- John Paul II Hospital, Krakow, Poland.
| | - Anna Kablak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | - Wladyslaw Dabrowski
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- KCRI Angiographic and IVUS Core Laboratory, Krakow, Poland
| | - Karolina Dzierwa
- John Paul II Hospital, Krakow, Poland
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
| | - Zbigniew Moczulski
- Department of Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland
| | | | - Adam Mazurek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
| | - Justyna Stefaniak
- Data Management and Statistical Analysis (DMSA), Krakow, Poland
- Department of Bioinformatic and Telemedicine, Jagiellonian University, Krakow, Poland
| | - Piotr Paluszek
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Maciej Krupinski
- Department of Radiology and Diagnostic Imaging, John Paul II Hospital, Krakow, Poland
| | - Tadeusz Przewlocki
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Piotr Pieniazek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
- John Paul II Hospital, Krakow, Poland
- Department of Vascular Surgery and Endovascular Interventions, John Paul II Hospital, Krakow, Poland
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
- John Paul II Hospital, Krakow, Poland.
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15
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Tuwar MN, Chen WH, Chiwaya AM, Yeh HL, Nguyen MH, Bai CH. Brain-Derived Neurotrophic Factor (BDNF) and Translocator Protein (TSPO) as Diagnostic Biomarkers for Acute Ischemic Stroke. Diagnostics (Basel) 2023; 13:2298. [PMID: 37443691 DOI: 10.3390/diagnostics13132298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/11/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) interacts with tropomyosin-related kinase B (TrkB) to promote neuronal growth, survival, differentiation, neurotransmitter release, and synaptic plasticity. The translocator protein (TSPO) is known to be found in arterial plaques, which are a symptom of atherosclerosis and a contributory cause of ischemic stroke. This study aims to determine the diagnostic accuracy of plasma BDNF and TSPO levels in discriminating new-onset acute ischemic stroke (AIS) patients from individuals without acute ischemic stroke. A total of 90 AIS patients (61% male, with a mean age of 67.7 ± 12.88) were recruited consecutively in a stroke unit, and each patient was paired with two age- and gender-matched controls. The sensitivity, specificity, and area of the curve between high plasma BDNF and TSPO and having AIS was determined using receiver operating characteristic curves. Furthermore, compared to the controls, AIS patients exhibited significantly higher levels of BDNF and TSPO, blood pressure, HbA1c, and white blood cells, as well as higher creatinine levels. The plasma levels of BDNF and TSPO can significantly discriminate AIS patients from healthy individuals (AUC 0.76 and 0.89, respectively). However, combining the two biomarkers provided little improvement in AUC (0.90). It may be possible to use elevated levels of TSPO as a diagnostic biomarker in patients with acute ischemic stroke upon admission.
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Affiliation(s)
- Mayuri N Tuwar
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 106236, Taiwan
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan
| | - Arthur M Chiwaya
- CLIME Group, Department of Biomedical Sciences, Division of Molecular Biology and Human Genetics, FMHS, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Hsu-Ling Yeh
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 111045, Taiwan
| | - Minh H Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 106236, Taiwan
- School of Medicine, College of Medicine, Taipei Medical University, Taipei 106236, Taiwan
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16
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Sotardi ST, Alves CAPF, Serai SD, Beslow LA, Schwartz ES, Magee R, Vossough A. Magnetic resonance imaging protocols in pediatric stroke. Pediatr Radiol 2023; 53:1324-1335. [PMID: 36604317 DOI: 10.1007/s00247-022-05576-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/30/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
Neuroimaging protocols play an important role in the timely evaluation and treatment of pediatric stroke and its mimics. MRI protocols for stroke in the pediatric population should be guided by the clinical scenario and neurologic examination, with consideration of age, suspected infarct type and underlying risk factors. Acute stroke diagnosis and causes in pediatric age groups can differ significantly from those in adult populations, and delay in stroke diagnosis among children is a common problem. An awareness of pediatric stroke presentations and risk factors among pediatric emergency physicians, neurologists, pediatricians, subspecialists and radiologists is critical to ensuring timely diagnosis. Given special considerations related to unique pediatric stroke risk factors and the need for sedation in some children, expert consensus guidelines for the imaging of suspected pediatric infarct have been proposed. In this article the authors review standard and rapid MRI protocols for the diagnosis of pediatric stroke, as well as the key differences between pediatric and adult stroke imaging.
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Affiliation(s)
- Susan T Sotardi
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Cesar Augusto P F Alves
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lauren A Beslow
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Erin Simon Schwartz
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ralph Magee
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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17
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Nagy SA, Ivic I, Tóth P, Komoly S, Kiss T, Pénzes M, Málnási-Csizmadia A, Dóczi T, Perlaki G, Orsi G. Post-reperfusion acute MR diffusion in stroke is a potential predictor for clinical outcome in rats. Sci Rep 2023; 13:5598. [PMID: 37019923 PMCID: PMC10076321 DOI: 10.1038/s41598-023-32679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
Middle cerebral artery occlusion (MCAO) models show substantial variability in outcome, introducing uncertainties in the evaluation of treatment effects. Early outcome predictors would be essential for prognostic purposes and variability control. We aimed to compare apparent diffusion coefficient (ADC) MRI data obtained during MCAO and shortly after reperfusion for their potentials in acute-phase outcome prediction. Fifty-nine male rats underwent a 45-min MCAO. Outcome was defined in three ways: 21-day survival; 24 h midline-shift and neurological scores. Animals were divided into two groups: rats surviving 21 days after MCAO (survival group, n = 46) and rats dying prematurely (non-survival/NS group, n = 13). At reperfusion, NS group showed considerably larger lesion volume and lower mean ADC of the initial lesion site (p < 0.0001), while during occlusion there were no significant group differences. At reperfusion, each survival animal showed decreased lesion volume and increased mean ADC of the initial lesion site compared to those during occlusion (p < 10-6), while NS group showed a mixed pattern. At reperfusion, lesion volume and mean ADC of the initial lesion site were significantly associated with 24 h midline-shift and neurological scores. Diffusion MRI performed soon after reperfusion has a great impact in early-phase outcome prediction, and it works better than the measurement during occlusion.
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Affiliation(s)
- Szilvia Anett Nagy
- ELKH-PTE Clinical Neuroscience MR Research Group, Ret Str. 2, 7623, Pecs, Hungary.
- Pecs Diagnostic Centre, Rét Street 2, 7623, Pecs, Hungary.
- Structural Neurobiology Research Group, Szentágothai Research Centre, University of Pecs, Ifjúság Street 20, 7624, Pecs, Hungary.
- Department of Neurology, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary.
| | - Ivan Ivic
- Pecs Diagnostic Centre, Rét Street 2, 7623, Pecs, Hungary
- Selvita d.o.o., Prilaz Baruna Filipovića 29, 10000, Zagreb, Croatia
| | - Péter Tóth
- ELKH-PTE Clinical Neuroscience MR Research Group, Ret Str. 2, 7623, Pecs, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary
| | - Sámuel Komoly
- Department of Neurology, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary
| | - Tamás Kiss
- Szentágothai Research Centre, University of Pecs, Ifjúság Street 20, Pecs, Hungary
| | - Máté Pénzes
- Department of Biochemistry, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117, Budapest, Hungary
- Motorpharma Ltd., Szilágyi E. Fasor 27, 1026, Budapest, Hungary
| | - András Málnási-Csizmadia
- Motorpharma Ltd., Szilágyi E. Fasor 27, 1026, Budapest, Hungary
- ELKH-ELTE Motor Pharmacology Research Group, Department of Biochemistry, Eötvös Loránd University, Pázmány Péter Sétány 1/C, 1117, Budapest, Hungary
| | - Tamás Dóczi
- Pecs Diagnostic Centre, Rét Street 2, 7623, Pecs, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary
| | - Gábor Perlaki
- ELKH-PTE Clinical Neuroscience MR Research Group, Ret Str. 2, 7623, Pecs, Hungary
- Pecs Diagnostic Centre, Rét Street 2, 7623, Pecs, Hungary
- Department of Neurology, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary
| | - Gergely Orsi
- ELKH-PTE Clinical Neuroscience MR Research Group, Ret Str. 2, 7623, Pecs, Hungary
- Pecs Diagnostic Centre, Rét Street 2, 7623, Pecs, Hungary
- Department of Neurology, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary
- Department of Neurosurgery, Medical School, University of Pecs, Rét Street 2, 7623, Pecs, Hungary
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18
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Andrée D, Thanabalasingam A, Teubner J, Fahrni M, Potthast S. Diagnostic Value of Computed Tomography Angiography in Suspected Acute Ischemic Stroke Patients With Respect to National Institutes of Health Stroke Scale Score. J Comput Assist Tomogr 2023; Publish Ahead of Print:00004728-990000000-00162. [PMID: 37380153 DOI: 10.1097/rct.0000000000001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Noncontrast computed tomography (NCCT) plus computed tomography angiography (CTA) is the standard imaging modality for acute stroke. We investigated whether there is an additional diagnostic value of supra-aortic CTA in relation to National Institutes of Health Stroke Scale (NIHSS) and resultant effective radiation dose. METHODS In this observational study, 788 patients with suspected acute stroke were included and divided into 3 NIHSS groups: group 1, NIHSS 0-2; group 2, NIHSS 3-5; and group 3, NIHSS ≥ 6.Computed tomography scans were assessed for findings of acute ischemic stroke and vascular pathologies in 3 regions. Final diagnosis was obtained from medical records. Effective radiation dose was calculated based on the dose-length product. RESULTS Seven hundred forty-one patients were included. Group 1 had 484 patients, group 2 had 127 patients, and group 3 had 130 patients. Computed tomography diagnosis of acute ischemic stroke was made in 76 patients. In 37 patients, a diagnosis of acute stroke was made based on pathologic CTA findings in case of an unremarkable NCCT. Stroke occurrence was the lowest in groups 1 and 2, with 3.6% and 6.3%, respectively, compared with 12.7% in group 3. If both NCCT and CTA were positive, the patient was discharged with a stroke diagnosis. Male sex had the highest effect on the final stroke diagnosis. The mean effective radiation dose was 2.6 mSv. CONCLUSIONS In female patients with NIHSS 0-2, additional CTA rarely contains relevant additional findings decisive for treatment decisions or overall patient outcomes; therefore, CTA in this patient group might yield less impactful findings, and the applied radiation dose could be lowered by approximately 35%.
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Affiliation(s)
- Daniel Andrée
- From the Institute of Radiology, Limmattal Hospital, Schlieren, Switzerland
| | | | - Jonas Teubner
- Institute of Neurology, Limmattal Hospital, Schlieren, Switzerland
| | - Markus Fahrni
- From the Institute of Radiology, Limmattal Hospital, Schlieren, Switzerland
| | - Silke Potthast
- From the Institute of Radiology, Limmattal Hospital, Schlieren, Switzerland
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19
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Grau García M, Pérez Bea M, Angulo Saiz A, Díez Fontaneda V, Cintora Leon E. Update on imaging in Code Stroke. RADIOLOGÍA (ENGLISH EDITION) 2023; 65 Suppl 1:S3-S10. [PMID: 37024228 DOI: 10.1016/j.rxeng.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/31/2022] [Indexed: 04/08/2023]
Abstract
"Code Stroke" is a multidisciplinary procedure designed to detect acute ischemic strokes and transfer patients for early reperfusion. Selecting these patients requires multimodal imaging with either CT or MRI. 1) Conventional studies without contrast material are obligatory to detect bleeding. Applying the ASPECTS scale, these studies can also identify and quantify areas of early infarction. 2) In candidates for mechanical thrombectomy, angiographic studies are necessary to identify stenoses and obstructions and to evaluate the collateral circulation. 3) Patients with known onset between 6 and 24h or with unknown onset require perfusion studies to distinguish between infracted tissue and recoverable ischemic tissue. Semi-automatic software facilitates diagnosis, but radiologists must interpret its output.
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Affiliation(s)
- M Grau García
- Médico adjunto de Radiodiagnóstico, Sección Urgencias, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain.
| | - M Pérez Bea
- Médico adjunto de Radiodiagnóstico, Sección Urgencias, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - A Angulo Saiz
- Médico adjunto de Radiodiagnóstico, Sección Urgencias, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - V Díez Fontaneda
- Médico residente de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - E Cintora Leon
- Jefa de Servicio de Radiodiagnóstico, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
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20
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Takahashi EA, Schwamm LH, Adeoye OM, Alabi O, Jahangir E, Misra S, Still CH. An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e558-e568. [PMID: 36373541 DOI: 10.1161/cir.0000000000001107] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Telehealth enables the remote delivery of health care through telecommunication technologies and has substantially affected the evolving medical landscape. The COVID-19 pandemic accelerated the utilization of telehealth as health care professionals were forced to limit face-to-face in-person visits. It has been shown that information delivery, diagnosis, disease monitoring, and follow-up care can be conducted remotely, resulting in considerable changes specific to cardiovascular disease management. Despite increasing telehealth utilization, several factors such as technological infrastructure, reimbursement, and limited patient digital literacy can hinder the adoption of remote care. This scientific statement reviews definitions pertinent to telehealth discussions, summarizes the effect of telehealth utilization on cardiovascular and peripheral vascular disease care, and identifies obstacles to the adoption of telehealth that need to be addressed to improve health care accessibility and equity.
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21
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Fully automatic identification of post-treatment infarct lesions after endovascular therapy based on non-contrast computed tomography. Neural Comput Appl 2022. [DOI: 10.1007/s00521-022-08094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Jansen van Vuuren JM, Pillay S, Naidoo A. The burden of suspected strokes in uMgungundlovu – Can biomarkers aid prognostication? Health SA 2022. [DOI: 10.4102/hsag.v27i0.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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23
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Chen W, Wu J, Wei R, Wu S, Xia C, Wang D, Liu D, Zheng L, Zou T, Li R, Qi X, Zhang X. Improving the diagnosis of acute ischemic stroke on non-contrast CT using deep learning: a multicenter study. Insights Imaging 2022; 13:184. [PMID: 36471022 PMCID: PMC9723089 DOI: 10.1186/s13244-022-01331-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to develop a deep learning (DL) model to improve the diagnostic performance of EIC and ASPECTS in acute ischemic stroke (AIS). METHODS Acute ischemic stroke patients were retrospectively enrolled from 5 hospitals. We proposed a deep learning model to simultaneously segment the infarct and estimate ASPECTS automatically using baseline CT. The model performance of segmentation and ASPECTS scoring was evaluated using dice similarity coefficient (DSC) and ROC, respectively. Four raters participated in the multi-reader and multicenter (MRMC) experiment to fulfill the region-based ASPECTS reading under the assistance of the model or not. At last, sensitivity, specificity, interpretation time and interrater agreement were used to evaluate the raters' reading performance. RESULTS In total, 1391 patients were enrolled for model development and 85 patients for external validation with onset to CT scanning time of 176.4 ± 93.6 min and NIHSS of 5 (IQR 2-10). The model achieved a DSC of 0.600 and 0.762 and an AUC of 0.876 (CI 0.846-0.907) and 0.729 (CI 0.679-0.779), in the internal and external validation set, respectively. The assistance of the DL model improved the raters' average sensitivities and specificities from 0.254 (CI 0.22-0.26) and 0.896 (CI 0.884-0.907), to 0.333 (CI 0.301-0.345) and 0.915 (CI 0.904-0.926), respectively. The average interpretation time of the raters was reduced from 219.0 to 175.7 s (p = 0.035). Meanwhile, the interrater agreement increased from 0.741 to 0.980. CONCLUSIONS With the assistance of our proposed DL model, radiologists got better performance in the detection of AIS lesions on NCCT.
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Affiliation(s)
- Weidao Chen
- grid.13402.340000 0004 1759 700XInterdisciplinary Institute of Neuroscience and Technology, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027 Zhejiang China ,Infervision Institute of Research, Beijing, 100025 China
| | - Jiangfen Wu
- grid.11135.370000 0001 2256 9319Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China ,Infervision Institute of Research, Beijing, 100025 China
| | - Ren Wei
- Infervision Institute of Research, Beijing, 100025 China
| | - Shuang Wu
- Infervision Institute of Research, Beijing, 100025 China
| | - Chen Xia
- Infervision Institute of Research, Beijing, 100025 China
| | - Dawei Wang
- Infervision Institute of Research, Beijing, 100025 China
| | - Daliang Liu
- grid.415912.a0000 0004 4903 149XLiaocheng People’s Hospital, Liaocheng, 252000 Shandong China
| | - Longmei Zheng
- Medical Imaging Center, Ankang Central Hospital, Ankang, 725000 Shanxi China
| | - Tianyu Zou
- grid.478119.20000 0004 1757 8159Weihai Municipal Hospital, Weihai, 264200 Shandong China
| | - Ruijiang Li
- grid.168010.e0000000419368956Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94304 USA
| | - Xianrong Qi
- grid.11135.370000 0001 2256 9319School of Pharmaceutical Sciences, Peking University, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System, School of Pharmaceutical Sciences, Peking University, Beijing, 100191 China
| | - Xiaotong Zhang
- grid.13402.340000 0004 1759 700XInterdisciplinary Institute of Neuroscience and Technology, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027 Zhejiang China ,grid.13402.340000 0004 1759 700XCollege of Electrical Engineering, Zhejiang University, Hangzhou, 310000 Zhejiang China ,grid.13402.340000 0004 1759 700XMOE Frontier Science Center for Brain Science & Brain-machine Integration, Zhejiang University, Hangzhou, 310000 Zhejiang China
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24
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Zhang J, Wang S, Chen Y, Li C, Wang L. Neck-brain integrated ultrasound as a noninvasive screening tool to identify morphological features of middle cerebral artery disease. Atherosclerosis 2022; 363:85-93. [PMID: 36210242 DOI: 10.1016/j.atherosclerosis.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Endovascular treatment is suitable for middle cerebral artery (MCA) with focal lesion. Therefore, accurate evaluation of the morphological features of MCA disease is critical. Ultrasonography is commonly used to screen for MCA lesions. However, there are few studies on lesion length. Using ultrasonography, we aimed to prospectively evaluate MCA disease with focal stenosis, long stenosis, focal occlusion, and long occlusion. METHODS Patients with symptomatic MCA disease scheduled for digital subtraction angiography were enrolled. The ultrasonic parameters recorded included mean flow velocity at MCA (VMCA) and extracranial internal carotid artery (VICA), bilateral VMCA ratio, bilateral VICA ratio, and MCA flow continuity. RESULTS A total of 278 MCAs were included. Compared to normal vessels, the bilateral VMCA ratio increased in the focal stenosis group and decreased in the long lesion and focal occlusion groups (all p < 0.05); the VICA and bilateral VICA ratio decreased in the long lesion group (all p < 0.01), and there was no significant difference in the focal lesion group (all p > 0.05). The optimal cut-offs were bilateral VMCA ratio <0.80 to predict long lesions and focal occlusions (sensitivity: 0.898, specificity: 0.975), and bilateral VICA ratio <0.84 to predict long lesions (sensitivity: 0.704, specificity: 0.879). The sensitivity and specificity to predict long occlusions were 96.7% and 94.8%, respectively, in the absence of MCA flow continuity. CONCLUSIONS Neck-brain integrated ultrasound is an appropriate screening method for identifying MCA lesions with different morphologies. Endovascular treatment might not be recommended when bilateral VICA ratio <0.84 in patients with MCA lesions.
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Affiliation(s)
- Jie Zhang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Shouchun Wang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Ying Chen
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Cong Li
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China
| | - Lijuan Wang
- Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Jilin University, Changchun, China.
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25
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Grau García M, Pérez Bea M, Angulo Saiz A, Díez Fontaneda V, Cintora Leon E. Actualización del código ictus en urgencias. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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26
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Murdoch R, Stotesbury H, Kawadler JM, Saunders DE, Kirkham FJ, Shmueli K. Quantitative susceptibility mapping (QSM) and R2 * of silent cerebral infarcts in sickle cell anemia. Front Neurol 2022; 13:1000889. [PMID: 36341122 PMCID: PMC9632444 DOI: 10.3389/fneur.2022.1000889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Silent cerebral infarction (SCI) is the most commonly reported radiological abnormality in patients with sickle cell anemia (SCA) and is associated with future clinical stroke risk. To date, there have been few histological and quantitative MRI studies of SCI and multiple radiological definitions exist. As a result, the tissue characteristics and composition of SCI remain elusive. The objective of this work was therefore to investigate the composition of segmented SCI lesions using quantitative MRI for R2 * and quantitative magnetic susceptibility mapping (QSM). 211 SCI lesions were segmented from 32 participants with SCA and 6 controls. SCI were segmented according to two definitions (FLAIR+/-T1w-based threshold) using a semi-automated pipeline. Magnetic susceptibility (χ) and R2 * maps were calculated from a multi-echo gradient echo sequence and mean SCI values were compared to an equivalent region of interest in normal appearing white matter (NAWM). SCI χ and R2 * were investigated as a function of SCI definition, patient demographics, anatomical location, and cognition. Compared to NAWM, SCI were significantly less diamagnetic (χ = -0.0067 ppm vs. -0.0153 ppm, p < 0.001) and had significantly lower R2 * (16.7 s-1 vs. 19.2 s-1, p < 0.001). SCI definition had a significant effect on the mean SCI χ and R2 * , with lesions becoming significantly less diamagnetic and having significantly lower R2 * after the application of a more stringent T1w-based threshold. SCI-NAWM R2 * decrease was significantly greater in patients with SCA compared with controls (-2.84 s-1 vs. -0.64 s-1, p < 0.0001). No significant association was observed between mean SCI-NAWM χ or R2* differences and subject age, lesion anatomical location, or cognition. The increased χ and decreased R2 * in SCI relative to NAWM observed in both patients and controls is indicative of lower myelin or increased water content within the segmented lesions. The significant SCI-NAWM R2 * differences observed between SCI in patients with SCA and controls suggests there may be differences in tissue composition relative to NAWM in SCI in the two populations. Quantitative MRI techniques such as QSM and R2 * mapping can be used to enhance our understanding of the pathophysiology and composition of SCI in patients with SCA as well as controls.
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Affiliation(s)
- Russell Murdoch
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jamie M. Kawadler
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Dawn E. Saunders
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fenella J. Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- University Hospital Southampton NHS Foundation Trust, and Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom
| | - Karin Shmueli
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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27
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Gollamudi J, Sartain SE, Navaei AH, Aneja S, Kaur Dhawan P, Tran D, Joshi J, Gidudu J, Gollamudi J, Chiappini E, Varricchio F, Law B, Munoz FM. Thrombosis and thromboembolism: Brighton collaboration case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2022; 40:6431-6444. [PMID: 36150973 DOI: 10.1016/j.vaccine.2022.09.001] [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: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/27/2023]
Abstract
This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.
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Affiliation(s)
- Jahnavi Gollamudi
- Department of Medicine, Section of Hematology, Baylor College of Medicine, Houston, TX, USA
| | - Sarah E Sartain
- Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Amir Hassan Navaei
- Pediatric Critical Care, Transfusion Medicine & Coagulation, Pediatrics and Pathology & Immunology Departments, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St, Suite WB110, Houston 77021, TX, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Gr Noida, India
| | | | - Dat Tran
- Oregon Health Authority, Public Health Division, Acute and Communicable Disease Prevention Section, Portland, OR, USA
| | - Jyoti Joshi
- International Centre for Antimicrobial Resistance Solutions (ICARS), Orestads Boulevard 5, 2300 Copenhagen, Denmark
| | - Jane Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Elena Chiappini
- Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | | | - Barbara Law
- SPEAC, Brighton Collaboration, Independent Consultant, Vancouver, BC, Canada
| | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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28
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Zhang R, Meng J, Wang X, Pu L, Zhao T, Huang Y, Han L. Metabolomics of ischemic stroke: insights into risk prediction and mechanisms. Metab Brain Dis 2022; 37:2163-2180. [PMID: 35612695 DOI: 10.1007/s11011-022-01011-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Ischemic stroke (IS) is the most prevalent type of stroke. The early diagnosis and prognosis of IS are crucial for successful therapy and early intervention. Metabolomics, a tool in systems biology based on several innovative technologies, can be used to identify disease biomarkers and unveil underlying pathophysiological processes. Accordingly, in recent years, an increasing number of studies have identified metabolites from cerebral ischemia patients and animal models that could improve the diagnosis of IS and prediction of its outcome. In this paper, metabolomic research is comprehensively reviewed with a focus on describing the metabolic changes and related pathways associated with IS. Most clinical studies use biofluids (e.g., blood or plasma) because their collection is minimally invasive and they are ideal for analyzing changes in metabolites in patients of IS. We review the application of animal models in metabolomic analyses aimed at investigating potential mechanisms of IS and developing novel therapeutic approaches. In addition, this review presents the strengths and limitations of current metabolomic studies on IS, providing a reference for future related studies.
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Affiliation(s)
- Ruijie Zhang
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
| | - Jiajia Meng
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
- Xihu District Center for Disease Control and Prevention, Hangzhou, 310013, Zhejiang, China
| | - Xiaojie Wang
- Department of Neurology, Shenzhen Qianhai Shekou Free Trade Zone Hospital, Shenzhen, 518067, Guangdong, China
| | - Liyuan Pu
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
| | - Tian Zhao
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China
| | - Yi Huang
- Department of Neurosurgery, Ningbo First Hospital, Ningbo, 315010, Zhejiang, China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, 315010, Zhejiang, China.
- Medical Research Center, Ningbo First Hospital, Ningbo, 315010, Zhejiang, China.
| | - Liyuan Han
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China.
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315010, Zhejiang, China.
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29
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When Can an Emergency CTA Be Dispensed with for TIA Patients? J Clin Med 2022; 11:jcm11195686. [PMID: 36233554 PMCID: PMC9573404 DOI: 10.3390/jcm11195686] [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: 08/10/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient’s risk of further ischemic events. Purpose: With the help of this retrospective study, we aim to determine for which TIA patients a CT angiography (CTA) is not immediately necessary in order to reduce radiation exposure and nephrotoxicity. Material and Methods: Clinical and imaging data from patients who presented as an emergency case with a suspected diagnosis of TIA at a teaching hospital between January 2016 and December 2021 were evaluated. The included 1526 patients were divided into two groups—group 1, with major pathologic vascular findings in the CTA, and group 2, with minor vascular pathologies. Results: Out of 1821 patients with suspected TIA on admission, 1526 met the inclusion criteria. In total, 336 (22%) had major vascular pathologies on CTA, and 1190 (78%) were unremarkable. The majority of patients with major vascular pathologies were male and had a history of arterial hypertension, coronary heart disease, myocardial infarction, ischemic stroke, TIA, atherosclerotic peripheral vascular disease, smoking, antiplatelet medication, had a lower duration of TIA symptoms, and had lower ABCD2 scores. Conclusions: We were able to demonstrate a direct correlation between major CTA pathologies and a history of smoking, age, hyperlipidemia, history of peripheral arterial disease, and a history of stroke and TIA. We were able to prove that the ABCD2 score is even reciprocal to CTA pathology. This means that TIA patients without described risk factors do not immediately require a CTA and could be clarified in the course of treatment with ultrasound or MRI.
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Uniken Venema SM, Dankbaar JW, van der Lugt A, Dippel DWJ, van der Worp HB. Cerebral Collateral Circulation in the Era of Reperfusion Therapies for Acute Ischemic Stroke. Stroke 2022; 53:3222-3234. [PMID: 35938420 DOI: 10.1161/strokeaha.121.037869] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical outcomes of patients with acute ischemic stroke depend in part on the extent of their collateral circulation. A good collateral circulation has also been associated with greater benefit of intravenous thrombolysis and endovascular treatment. Treatment decisions for these reperfusion therapies are increasingly guided by a combination of clinical and imaging parameters, particularly in later time windows. Computed tomography and magnetic resonance imaging enable a rapid assessment of both the collateral extent and cerebral perfusion. Yet, the role of the collateral circulation in clinical decision-making is currently limited and may be underappreciated due to the use of rather coarse and rater-dependent grading methods. In this review, we discuss determinants of the collateral circulation in patients with acute ischemic stroke, report on commonly used and emerging neuroimaging techniques for assessing the collateral circulation, and discuss the therapeutic and prognostic implications of the collateral circulation in relation to reperfusion therapies for acute ischemic stroke.
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Affiliation(s)
- Simone M Uniken Venema
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands. (S.M.U.V., H.B.v.d.W.)
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands. (J.W.D.)
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center Rotterdam, the Netherlands. (A.v.d.L.)
| | - Diederik W J Dippel
- Department of Neurology, Erasmus Medical Center Rotterdam, the Netherlands. (D.W.J.D.)
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands. (S.M.U.V., H.B.v.d.W.)
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Song X, Fan Y, Jia Y, Li G, Liu M, Xu Y, Zhang J, Li C. A novel aGAPSS-based nomogram for the prediction of ischemic stroke in patients with antiphospholipid syndrome. Front Immunol 2022; 13:930087. [PMID: 35967319 PMCID: PMC9372272 DOI: 10.3389/fimmu.2022.930087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ischemic stroke (IS) is the most common and life-threatening arterial manifestation of antiphospholipid syndrome (APS). It is related to high mortality and severe permanent disability in survivors. Thus, it is essential to identify patients with APS at high risk of IS and adopt individual-level preventive measures. This study was conducted to identify risk factors for IS in patients with APS and to develop a nomogram specifically for IS prediction in these patients by combining the adjusted Global Anti-Phospholipid Syndrome Score (aGAPSS) with additional clinical and laboratory data. Methods A total of 478 consecutive patients with APS were enrolled retrospectively. All patients were randomly assigned to the training and validation cohorts. Univariate and multivariate binary logistic analyses were conducted to identify predictors of IS in the training cohort. Then, a nomogram was developed based on these predictors. The predictive performance of the nomogram for the training and validation cohorts was evaluated by determining areas under the receiver operating characteristic curve (AUROC) and creating calibration plots. A decision curve analysis (DCA) was conducted to compare the potential net benefits of the nomogram with those of the aGAPSS. Results During a mean follow-up period of 2.7 years, 26.9% (129/478) of the patients were diagnosed with IS. Binary logistic regression analysis revealed that five risk factors were independent clinical predictors of IS: age (P < 0.001), diabetes (P = 0.030), hyperuricemia (P < 0.001), the platelet count (P = 0.001), and the aGAPSS (P = 0.001). These predictors were incorporated into the nomogram, named the aGAPSS-IS. The nomogram showed satisfactory performance in the training [AUROC = 0.853 (95% CI, 0.802–0.896] and validation [AUROC = 0.793 (95% CI, 0.737–0.843)] cohorts. Calibration curves showed good concordance between observed and nomogram-predicted probability in the training and validation cohorts. The DCA confirmed that the aGAPSS-IS provided more net benefits than the aGAPSS in both cohorts. Conclusion Age, diabetes, hyperuricemia, the platelet count, and the aGAPSS were risk factors for IS in patients with APS. The aGAPSS-IS may be a good tool for IS risk stratification for patients with APS based on routinely available data.
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Affiliation(s)
- Xiaodong Song
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Yangyi Fan
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Yuan Jia
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
| | - Gongming Li
- Department of Rheumatology and Immunology, Linyi Traditional Chinese Medicine Hospital, Linyi, China
| | - Meige Liu
- Department of Neurology, Peking University People’s Hospital, Beijing, China
| | - Yicheng Xu
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Chun Li, ; Jun Zhang,
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China
- *Correspondence: Chun Li, ; Jun Zhang,
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Qi B, Zhang Y, Xu B, Zhang Y, Fei G, Lin L, Li Q. Metabolomic Characterization of Acute Ischemic Stroke Facilitates Metabolomic Biomarker Discovery. Appl Biochem Biotechnol 2022; 194:5443-5455. [DOI: 10.1007/s12010-022-04024-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
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Practice Variation among Canadian Stroke Prevention Clinics: Pre, During and Post-COVID-19. Can J Neurol Sci 2022:1-10. [PMID: 35707914 DOI: 10.1017/cjn.2022.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Artificially-reconstructed brain images with stroke lesions from non-imaging data: modeling in categorized patients based on lesion occurrence and sparsity. Sci Rep 2022; 12:10116. [PMID: 35710703 PMCID: PMC9203453 DOI: 10.1038/s41598-022-14249-z] [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: 12/26/2021] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
Brain imaging is necessary for understanding disease symptoms, including stroke. However, frequent imaging procedures encounter practical limitations. Estimating the brain information (e.g., lesions) without imaging sessions is beneficial for this scenario. Prospective estimating variables are non-imaging data collected from standard tests. Therefore, the current study aims to examine the variable feasibility for modelling lesion locations. Heterogeneous variables were employed in the multivariate logistic regression. Furthermore, patients were categorized (i.e., unsupervised clustering through k-means method) by the charasteristics of lesion occurrence (i.e., ratio between the lesioned and total regions) and sparsity (i.e., density measure of lesion occurrences across regions). Considering those charasteristics in models improved estimation performances. Lesions (116 regions in Automated Anatomical Labeling) were adequately predicted (sensitivity: 80.0-87.5% in median). We confirmed that the usability of models was extendable to different resolution levels in the brain region of interest (e.g., lobes, hemispheres). Patients' charateristics (i.e., occurrence and sparsity) might also be explained by the non-imaging data as well. Advantages of the current approach can be experienced by any patients (i.e., with or without imaging sessions) in any clinical facilities (i.e., with or without imaging instrumentation).
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Gao J, Wang Y, Ding Q. Comparison of the clinical value of transcranial Doppler ultrasound and computed tomography angiography for diagnosing ischemic cerebrovascular disease. J Int Med Res 2022; 50:3000605211047718. [PMID: 35735011 PMCID: PMC9237922 DOI: 10.1177/03000605211047718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the clinical value of transcranial Doppler (TCD) ultrasound and computed tomography angiography (CTA) for diagnosing ischemic cerebrovascular disease. Methods A retrospective clinical study was conducted in 142 patients with ischemic cerebrovascular disease who were initially diagnosed by digital subtraction angiography. Under the single-blind condition, the patients were diagnosed by using TCD ultrasound and CTA independently. The accuracy of these two methods was compared. Results The accuracy of diagnosing bilateral middle cerebral artery, bilateral vertebral artery and bilateral internal carotid artery lesions with a TCD examination was significantly higher than that with a CTA examination. There were no significant differences in the accuracy of diagnosing bilateral anterior cerebral artery, bilateral posterior cerebral artery or basilar artery lesions between TCD ultrasound and CTA. The accuracy of diagnosing all cerebral arterial ischemic lesions was significantly higher with a TCD examination (87.39%) than with a CTA examination (69.75%). The accuracy of diagnosing all cerebral arteries that cause ischemic encephalopathy (cerebrovascular + cervical blood vessels) was significantly higher with a TCD examination (88.03%) than with a CTA examination (69.01%). Conclusions TCD ultrasound has several advantages over CTA. Therefore, TCD ultrasound is better for diagnosing ischemic encephalopathy than CTA.
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Affiliation(s)
- Jun Gao
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yu Wang
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qian Ding
- Department of Diagnostic Ultrasound, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Huang X, Wang D, Zhang Q, Ma Y, Li S, Zhao H, Deng J, Yang J, Ren J, Xu M, Xi H, Li F, Zhang H, Xie Y, Yuan L, Hai Y, Yue M, Zhou Q, Zhou J. Development and Validation of a Clinical-Based Signature to Predict the 90-Day Functional Outcome for Spontaneous Intracerebral Hemorrhage. Front Aging Neurosci 2022; 14:904085. [PMID: 35615596 PMCID: PMC9125153 DOI: 10.3389/fnagi.2022.904085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/15/2022] [Indexed: 11/23/2022] Open
Abstract
We aimed to develop and validate an objective and easy-to-use model for identifying patients with spontaneous intracerebral hemorrhage (ICH) who have a poor 90-day prognosis. This three-center retrospective study included a large cohort of 1,122 patients with ICH who presented within 6 h of symptom onset [training cohort, n = 835; internal validation cohort, n = 201; external validation cohort (center 2 and 3), n = 86]. We collected the patients’ baseline clinical, radiological, and laboratory data as well as the 90-day functional outcomes. Independent risk factors for prognosis were identified through univariate analysis and multivariate logistic regression analysis. A nomogram was developed to visualize the model results while a calibration curve was used to verify whether the predictive performance was satisfactorily consistent with the ideal curve. Finally, we used decision curves to assess the clinical utility of the model. At 90 days, 714 (63.6%) patients had a poor prognosis. Factors associated with prognosis included age, midline shift, intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), hypodensities, ICH volume, perihematomal edema (PHE) volume, temperature, systolic blood pressure, Glasgow Coma Scale (GCS) score, white blood cell (WBC), neutrophil, and neutrophil-lymphocyte ratio (NLR) (p < 0.05). Moreover, age, ICH volume, and GCS were identified as independent risk factors for prognosis. For identifying patients with poor prognosis, the model showed an area under the receiver operating characteristic curve of 0.874, 0.822, and 0.868 in the training cohort, internal validation, and external validation cohorts, respectively. The calibration curve revealed that the nomogram showed satisfactory calibration in the training and validation cohorts. Decision curve analysis showed the clinical utility of the nomogram. Taken together, the nomogram developed in this study could facilitate the individualized outcome prediction in patients with ICH.
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Affiliation(s)
- Xiaoyu Huang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Dan Wang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Qiaoying Zhang
- Department of Radiology, Xi’an Central Hospital, Xi’an, China
| | - Yaqiong Ma
- Second Clinical School, Lanzhou University, Lanzhou, China
- Department of Radiology, Gansu Provincial Hospital, Lanzhou, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Hui Zhao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Juan Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jingjing Yang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | | | - Min Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Fukai Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Hongyu Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Yijing Xie
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Long Yuan
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Yucheng Hai
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Mengying Yue
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
- *Correspondence: Junlin Zhou,
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Clinical Significance of PAC-1, CD62P, and Platelet-Leukocyte Aggregates in Acute Ischemic Stroke. Bull Exp Biol Med 2022; 172:543-548. [DOI: 10.1007/s10517-022-05429-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Indexed: 10/18/2022]
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Wang Y, Zhu J, Zhao J, Li W, Zhang X, Meng X, Chen T, Li M, Ye M, Hu R, Dou S, Hao H, Zhao X, Wu X, Hu W, Li C, Fan X, Jiang L, Lu X, Yan F. Deep Learning-Enabled Clinically Applicable CT Planbox for Stroke With High Accuracy and Repeatability. Front Neurol 2022; 13:755492. [PMID: 35359626 PMCID: PMC8961979 DOI: 10.3389/fneur.2022.755492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Computed tomography (CT) plays an essential role in classifying stroke, quantifying penumbra size and supporting stroke-relevant radiomics studies. However, it is difficult to acquire standard, accurate and repeatable images during follow-up. Therefore, we invented an intelligent CT to evaluate stroke during the entire follow-up. Methods We deployed a region proposal network (RPN) and V-Net to endow traditional CT with intelligence. Specifically, facial detection was accomplished by identifying adjacent jaw positions through training and testing an RPN on 76,382 human faces using a preinstalled 2-dimensional camera; two regions of interest (ROIs) were segmented by V-Net on another training set with 295 subjects, and the moving distance of scanning couch was calculated based on a pre-generated calibration table. Multiple cohorts including 1,124 patients were used for performance validation under three clinical scenarios. Results Cranial Automatic Planbox Imaging Towards AmeLiorating neuroscience (CAPITAL)-CT was invented. RPN model had an error distance of 4.46 ± 0.02 pixels with a success rate of 98.7% in the training set and 100% with 2.23 ± 0.10 pixels in the testing set. V-Net-derived segmentation maintained a clinically tolerable distance error, within 3 mm on average, and all lines presented with a tolerable angle error, within 3° on average in all boundaries. Real-time, accurate, and repeatable automatic scanning was accomplished with and a lower radiation exposure dose (all P < 0.001). Conclusions CAPITAL-CT generated standard and reproducible images that could simplify the work of radiologists, which would be of great help in the follow-up of stroke patients and in multifield research in neuroscience.
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Affiliation(s)
- Yang Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Junkai Zhu
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jinli Zhao
- Department of Radiology, The Affiliated Hospital of Nantong University, Nantong, China
| | - Wenyi Li
- Department of Endocrinology, Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Zhang
- Department of Neurology, Drum Tower Hospital, Medical School and The State Key Laboratory of Pharmaceutical Biotechnology, Institute of Brain Science, Nanjing University, Nanjing, China
| | - Xiaolin Meng
- Research & Advanced Algorithm Department of HSW BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Taige Chen
- Medical School of Nanjing University, Nanjing, China
| | - Ming Li
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Meiping Ye
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Renfang Hu
- Calibration Physical Algorithm Department of CT BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Shidan Dou
- Research & Advanced Algorithm Department of HSW BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Huayin Hao
- Research & Advanced Algorithm Department of HSW BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Xiaofen Zhao
- Clinical Workflow and Clinical Verification Department of CT BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Xiaoming Wu
- Clinical Workflow and Clinical Verification Department of CT BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Wei Hu
- Department of CT BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Cheng Li
- Research & Advanced Algorithm Department of HSW BU, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Xiaole Fan
- Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Liyun Jiang
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaofan Lu
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
- *Correspondence: Xiaofan Lu
| | - Fangrong Yan
- State Key Laboratory of Natural Medicines, Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing, China
- Fangrong Yan
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Khandare P, Saluja A, Solanki RS, Singh R, Vani K, Garg D, Dhamija RK. Serum S100B and NSE Levels Correlate With Infarct Size and Bladder-Bowel Involvement Among Acute Ischemic Stroke Patients. J Neurosci Rural Pract 2022; 13:218-225. [PMID: 35694066 PMCID: PMC9187393 DOI: 10.1055/s-0042-1743214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Objectives Stroke is a major global health concern. Due to limited availability of neuroimaging particularly in rural and regional areas in India as well as its limitation, the interest in use of biochemical markers for stroke diagnosis, severity, and prognosis is increasing. Only a handful of studies on stroke biomarkers have been conducted in India. Hence, this study was conducted to investigate the correlation of serum neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) levels with stroke severity according to infarct size in acute ischemic stroke patients.
Material and Methods Sixty stroke patients were recruited for the study and were evaluated. Noncontrast computed tomography (CT) scan of the brain was performed for all patients within 48 hours of onset of symptoms. Infarct volume was measured by evaluating dimensions in three planes on CT head. Serum NSE and S100B levels were measured by commercially available immunoassay kits. Continuous data was represented as mean ± standard deviation. Categorical data was expressed in terms of percentages and proportions. Pearson's correlation coefficient was applied to assess correlation between NSE and S100B and infarct size. Infarct size was classified arbitrarily into three groups according to infarct volume (low, moderate, and large) and analysis of variance was applied for comparing mean S100B and NSE levels in the three groups. To assess the independent predictors of infarct size among stroke cases, multivariate logistic regression analysis was used. Association between serum S100B or NSE levels and clinical features was done by the Mann–Whitney U test.
Results Correlation between serum S100B protein levels and NSE with larger infarct volume was highly significant (r(S100B) = 0.611, p (S100B) < 0.0001; r(NSE) = 0.258, p(NSE) = 0.047). Using multivariate regression analysis, bladder and bowel involvement, prior stroke history, and dyslipidemia among stroke patients correlated with a larger infarct size. Mann–Whitney U test showed both NSE and S100B levels were significantly associated with bladder bowel involvement among stroke cases.
Conclusion There was a positive correlation between serum S100B and NSE levels with infarct size. In addition, bladder-bowel involvement among stroke patients was associated with increased S100B levels. Therefore, levels of protein S100B and NSE may serve as indicator of infarct size and may be predictors of severe clinical presentations of acute ischemic stroke.
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Affiliation(s)
- Pravin Khandare
- Department of Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Alvee Saluja
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
| | - Ravi S. Solanki
- Department of Radiodiagnosis, Lady Hardinge Medical College, New Delhi, India
| | - Ritu Singh
- Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India
| | - Kavita Vani
- Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Divyani Garg
- Department of Neurology, Lady Hardinge Medical College, New Delhi, India
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Advances in computed tomography-based prognostic methods for intracerebral hemorrhage. Neurosurg Rev 2022; 45:2041-2050. [DOI: 10.1007/s10143-022-01760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
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Vajpeyee A, Tiwari S, Yadav LB, Mal N, Vyas K, Juangco DN, Hendrani SD, Vajpeyee M. Comparative analysis of functional outcome for CT-based versus MRI-based evaluation in acute ischemic stroke prior to mechanical thrombectomy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Background
This study aims to compare functional outcome for Computed tomography (CT)-based versus Magnetic resonance imaging (MRI)-based evaluation in acute ischemic stroke patients prior to Mechanical thrombectomy (MT) in less than 6-h window period in anterior circulation stroke. Participants were patients admitted from September 2, 2018 to September 2, 2020 with an acute ischemic stroke who underwent mechanical thrombectomy treatment. Total duration of MRI stroke protocol and CT scan with Computed tomography angiography (CTA) was 12 min 57 s, and 9 min 23 s, respectively. Follow-up for periodic Modified Rankin Scale (MRS) was performed at 3 months.
Results
Number of patients included in the study were 152 with mean age of 54.6 (range 22–80) years with male predominance (n = 102). Mean GCS on admission was 12 (4–15) and 13(4–14) in CT and MRI group, respectively. National Institute of Health stroke scale (NIHSS) on admission was 17 (4–30) and 16(4–30) and at discharge was 7 (2–23) and 6(2–22) in CT-based group and MRI-based group, respectively. In the MRI group 65.5% had good outcome with mRS (0–2) at 3-month follow-up compared to 35.51% in CT group.
Conclusion
The current standard neuroimaging in acute ischemic stroke patients is CT and CTA brain. Using MRI over CT scan for acute ischemic stroke may improve clinical outcomes for the subgroup of patients who have an unclear diagnosis and who have higher risk of complications with MT. Even though MRI and MRA take longer period to acquire, patient’s clinical outcome was better in MRI group in comparison to CT group and was comparable to that of the five major endovascular trials.
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Tatlisumak T, Putaala J. General Stroke Management and Stroke Units. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00055-7] [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]
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Wagle KC, Ivan CS. Cerebrovascular Disease. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Akbarzadeh MA, Sanaie S, Kuchaki Rafsanjani M, Hosseini MS. Role of imaging in early diagnosis of acute ischemic stroke: a literature review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00432-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AbstractStroke is a serious health condition that is responsible for more than 5% of total deaths. Near 20% of patients experiencing stroke die every year, resulting in the stroke being at the top of the list of preventable causes of death. Once an acute stroke is suspected, a golden hour of less than an hour is available to prevent the undesirable consequences. Since neuroimaging is mandatory in the diagnosis of stroke, the proper use of neuroimaging could help saving time and planning the right treatment for the patient. Some of the available imaging methods help us with rapid results, while others benefit us from a more accurate diagnosis. Hereby, we aim to provide a clinical review of the advantages and disadvantages of different available neuroimaging methods in approaching acute stroke to help clinicians choose the best method according to the settings.
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Ariyada K, Shibahashi K, Fujika N, Sakakura Y, Hanakawa K, Murao M. Posterior Communicating Artery Hypoplasia: A Risk Factor for Vertebral Artery Dissection Causing Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis 2021; 31:106224. [PMID: 34839234 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106224] [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: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Subarachnoid hemorrhage due to vertebral artery dissection is often fatal; however, its anatomical predictors remain unclear. We conducted a retrospective hospital-based case-control study to evaluate whether variations in the posterior communicating artery are associated with the risk of vertebral artery dissection with subarachnoid hemorrhage. MATERIALS AND METHODS We obtained data from patients who underwent computed tomography angiography at our hospital between April 2010 and March 2020. Based on the connection between the anterior and posterior circulation of the arterial circle of Willis, the patients were categorized into a separated group (posterior communicating artery hypoplasia) and a connected group (all others). We evaluated the association between the development of posterior communicating artery and subarachnoid hemorrhage due to vertebral artery dissection using multivariate logistic regression analysis. RESULTS Thirty-eight patients had subarachnoid hemorrhage due to vertebral artery dissection and 76 were identified as age- and sex-matched controls. In conditional multivariate logistic regression analysis, the separated group showed a significant association with subarachnoid hemorrhage due to vertebral artery dissection, with an adjusted odds ratio of 2.8 (95% confidence interval, 1.2-6.5; P = 0.021). CONCLUSIONS The present study demonstrates that posterior communicating artery hypoplasia may be associated with subarachnoid hemorrhage due to vertebral artery dissection. Our results highlight the importance of anatomical variations in the cerebral artery and provide evidence to help develop preventive measures against strokes.
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Affiliation(s)
- Kenichi Ariyada
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan.
| | - Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Naoshi Fujika
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Yuya Sakakura
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Kazuo Hanakawa
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
| | - Masahiko Murao
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
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Dodig D, Matana Kaštelan Z, Bartolović N, Jurković S, Miletić D, Rumboldt Z. Virtual monoenergetic dual-energy CT reconstructions at 80 keV are optimal non-contrast CT technique for early stroke detection. Neuroradiol J 2021; 35:337-345. [PMID: 34550827 DOI: 10.1177/19714009211047449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Virtual monoenergetic (VM) dual-energy computed tomography (DE-CT) enables grey-to-white matter contrast-to-noise ratio optimization, potentially increasing ischaemic brain oedema visibility. The aim of this study was to compare the diagnostic accuracy of VM and standard DE-CT reconstructions for early stroke detection. METHODS Consecutive patients with non-contrast DE-CT of the brain scanned within 12 h of stroke symptom onset were prospectively included in the study. Patients with other significant brain pathology were excluded. Two radiologists jointly evaluated standard and VM reconstructions (from 40 to 190 keV at increments of 10 keV) for early stroke signs on a four-point Likert scale: (a) stroke definitely present, (b) stroke probably present, (c) probably no stroke, and (d) definitely no stroke. Follow-up imaging and clinical data served as the standard of reference. Diagnostic accuracy was evaluated by receiver operating characteristic analysis. RESULTS Stroke incidence among 184 patients was 76%. In 64 patients follow-up imaging served as the standard of reference: ischemic brain oedema detection was significantly more accurate on VM reconstructions at 80 keV compared with standard DE-CT reconstructions (area under the curve (AUC) = 0.821 vs. AUC = 0.672, p = 0.002). The difference was most prominent within the first 3 h after symptom onset (at 11%, AUC = 0.819 vs. AUC = 0.709, p = 0.17) and in patients with National Institutes of Health Stroke Scale above 16 (at 37.5%, AUC = 1 vs. AUC = 0.625, p = 0.14). CONCLUSION VM DE-CT reconstructions at 80 keV appear to be the optimal non-contrast CT technique for diagnosing early ischaemic stroke, particularly within the first 3 h after symptom onset and in severely ill patients.
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Affiliation(s)
- Doris Dodig
- Radiology Department, Clinical Hospital Centre Rijeka, Croatia
| | - Zrinka Matana Kaštelan
- Radiology Department, Clinical Hospital Centre Rijeka, Croatia.,Department of Radiology, University of Rijeka, Croatia
| | - Nina Bartolović
- Radiology Department, Clinical Hospital Centre Rijeka, Croatia
| | - Slaven Jurković
- Department of Medical Physics and Biophysics, University of Rijeka, Croatia.,Department for Medical Physics and Radiation Protection, Clinical Hospital Centre Rijeka, Croatia
| | - Damir Miletić
- Radiology Department, Clinical Hospital Centre Rijeka, Croatia.,Department of Radiology, University of Rijeka, Croatia
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Torres C, Lum C, Puac-Polanco P, Stotts G, Shamy MCF, Blacquiere D, Lun R, Dave P, Bharatha A, Menon BK, Thornhill R, Momoli F, Dowlatshahi D. Differentiating Carotid Free-Floating Thrombus From Atheromatous Plaque Using Intraluminal Filling Defect Length on CTA: A Validation Study. Neurology 2021; 97:e785-e793. [PMID: 34426550 DOI: 10.1212/wnl.0000000000012368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/26/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To validate a previously proposed filling defect length threshold of >3.8 mm on CT angiography (CTA) to discriminate between free-floating thrombus (FFT) and plaque of atheroma. METHODS This was a prospective multicenter observational study of 100 participants presenting with TIA/stroke symptoms and a carotid intraluminal filling defect on initial CTA. Follow-up CTA was obtained within 1 week and at weeks 2 and 4 if the intraluminal filling defect was unchanged in length. Resolution or decreased length was diagnostic of FFT, whereas its static appearance after 4 weeks was indicative of plaque. Diagnostic accuracy of FFT length was assessed by receiver operating characteristic analysis. RESULTS Ninety-five participants (mean [SD] age 68 [13] years, 61 men, 83 participants with FFT, 12 participants with a plaque) were evaluated. The >3.8-mm threshold had a sensitivity of 88% (73 of 83) (95% confidence interval [CI] 78%-94%) and specificity of 83% (10 of 12) (95% CI 51%-97%) (area under the curve 0.91, p < 0.001) for the diagnosis of FFT. The optimal length threshold was >3.64 mm with a sensitivity of 89% (74 of 83) (95% CI 80%-95%) and specificity of 83% (10 of 12) (95% CI 51%-97%). Adjusted logistic regression showed that every 1-mm increase in intraluminal filling defect length is associated with an increase in odds of FFT of 4.6 (95% CI 1.9-11.1, p = 0.01). CONCLUSION CTA enables accurate differentiation of FFT vs plaque using craniocaudal length thresholds. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov Identifier: NCT02405845. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in patients with TIA/stroke symptoms, the presence of CTA-identified filling defects of lengths >3.8 mm accurately discriminates FFT from atheromatous plaque.
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Affiliation(s)
- Carlos Torres
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada.
| | - Cheemun Lum
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Paulo Puac-Polanco
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Grant Stotts
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Michel Christopher Frank Shamy
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Dylan Blacquiere
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Ronda Lun
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Prasham Dave
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Aditya Bharatha
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Bijoy K Menon
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Rebecca Thornhill
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Franco Momoli
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
| | - Dar Dowlatshahi
- From the Division of Neuroradiology (C.T., P.P.-P.), Department of Radiology, Division of Neurology (G.S., M.C.F.S., D.B., R.L., P.D., D.D.), Department of Medicine, Division of Medical Physics (R.T.), Department of Radiology, and School of Epidemiology and Public Health (F.M.), University of Ottawa; Neuroscience Program (C.T., G.S., M.C.F.S., D.B., D.D.), The Ottawa Hospital Research Institute; Division of Neuroradiology (A.B.), Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Ontario; and Departments of Clinical Neurosciences, Radiology, and Community Health Sciences (B.K.M.), University of Calgary, Foothills Medical Centre, Alberta, Canada
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Faust O, En Wei Koh J, Jahmunah V, Sabut S, Ciaccio EJ, Majid A, Ali A, Lip GYH, Acharya UR. Fusion of Higher Order Spectra and Texture Extraction Methods for Automated Stroke Severity Classification with MRI Images. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8059. [PMID: 34360349 PMCID: PMC8345794 DOI: 10.3390/ijerph18158059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022]
Abstract
This paper presents a scientific foundation for automated stroke severity classification. We have constructed and assessed a system which extracts diagnostically relevant information from Magnetic Resonance Imaging (MRI) images. The design was based on 267 images that show the brain from individual subjects after stroke. They were labeled as either Lacunar Syndrome (LACS), Partial Anterior Circulation Syndrome (PACS), or Total Anterior Circulation Stroke (TACS). The labels indicate different physiological processes which manifest themselves in distinct image texture. The processing system was tasked with extracting texture information that could be used to classify a brain MRI image from a stroke survivor into either LACS, PACS, or TACS. We analyzed 6475 features that were obtained with Gray-Level Run Length Matrix (GLRLM), Higher Order Spectra (HOS), as well as a combination of Discrete Wavelet Transform (DWT) and Gray-Level Co-occurrence Matrix (GLCM) methods. The resulting features were ranked based on the p-value extracted with the Analysis Of Variance (ANOVA) algorithm. The ranked features were used to train and test four types of Support Vector Machine (SVM) classification algorithms according to the rules of 10-fold cross-validation. We found that SVM with Radial Basis Function (RBF) kernel achieves: Accuracy (ACC) = 93.62%, Specificity (SPE) = 95.91%, Sensitivity (SEN) = 92.44%, and Dice-score = 0.95. These results indicate that computer aided stroke severity diagnosis support is possible. Such systems might lead to progress in stroke diagnosis by enabling healthcare professionals to improve diagnosis and management of stroke patients with the same resources.
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Affiliation(s)
- Oliver Faust
- Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Joel En Wei Koh
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
| | - Vicnesh Jahmunah
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
| | - Sukant Sabut
- School of Electronics Engineering, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha 751024, India;
| | - Edward J. Ciaccio
- Department of Medicine-Cardiology, Columbia University, New York, NY 10027, USA;
| | - Arshad Majid
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield S10 2HQ, UK;
| | - Ali Ali
- Sheffield Teaching Hospitals NIHR Biomedical Research Centre, Sheffield S10 2JF, UK;
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L69 7TX, UK;
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - U. Rajendra Acharya
- School of Electronics and Computer Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore; (J.E.W.K.); (V.J.); (U.R.A.)
- School of Science and Technology, Singapore University of Social Sciences, 463 Clementi Road, Singapore 599494, Singapore
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
- International Research Organization for Advanced Science and Technology (IROAST), Kumamoto University, Kumamoto 860-8555, Japan
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Chumachenko MS, Waseem TV, Fedorovich SV. Metabolomics and metabolites in ischemic stroke. Rev Neurosci 2021; 33:181-205. [PMID: 34213842 DOI: 10.1515/revneuro-2021-0048] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/09/2021] [Indexed: 12/27/2022]
Abstract
Stroke is a major reason for disability and the second highest cause of death in the world. When a patient is admitted to a hospital, it is necessary to identify the type of stroke, and the likelihood for development of a recurrent stroke, vascular dementia, and depression. These factors could be determined using different biomarkers. Metabolomics is a very promising strategy for identification of biomarkers. The advantage of metabolomics, in contrast to other analytical techniques, resides in providing low molecular weight metabolite profiles, rather than individual molecule profiles. Technically, this approach is based on mass spectrometry and nuclear magnetic resonance. Furthermore, variations in metabolite concentrations during brain ischemia could alter the principal neuronal functions. Different markers associated with ischemic stroke in the brain have been identified including those contributing to risk, acute onset, and severity of this pathology. In the brain, experimental studies using the ischemia/reperfusion model (IRI) have shown an impaired energy and amino acid metabolism and confirmed their principal roles. Literature data provide a good basis for identifying markers of ischemic stroke and hemorrhagic stroke and understanding metabolic mechanisms of these diseases. This opens an avenue for the successful use of identified markers along with metabolomics technologies to develop fast and reliable diagnostic tools for ischemic and hemorrhagic stroke.
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Affiliation(s)
- Maria S Chumachenko
- Department of Biochemistry, Faculty of Biology, Belarusian State University, Kurchatova St., 10, Minsk220030, Belarus
| | | | - Sergei V Fedorovich
- Department of Biochemistry, Faculty of Biology, Belarusian State University, Kurchatova St., 10, Minsk220030, Belarus
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Zameer S, Siddiqui AS, Riaz R. Multimodality Imaging in Acute Ischemic Stroke. Curr Med Imaging 2021; 17:567-577. [PMID: 33256582 DOI: 10.2174/1573405616666201130094948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 09/22/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
Stroke is the most common cause of mortality and morbidity worldwide. The prognosis of stroke depends upon the area affected and its early treatment. Time is of the essence in the care of stroke patients as it is estimated that approximately 1.9 million neurons, 14 billion synapses, and 12 km myelinated nerve fibers are lost per minute. Therefore, early diagnosis and prompt treatment are necessary. The primary goal of imaging in acute stroke is to diagnose the underlying cause, estimate the area affected, predict response towards thrombolytic therapy and to exclude the conditions mimicking stroke. With advancements in radiology, multiple imaging modalities are available for diagnosis and predicting prognosis. None of them is considered alone to be perfect. In this era of multimodality imaging, the decision of choosing appropriate techniques depends upon purpose and availability. Non-Contrast Computed Tomography is time effective, and helps in excluding other causes, Trans Cranial Doppler is time-effective and cost-effective with wide availability, however, is operator dependent and less sensitive. It holds a great future in sonothrombolysis. Magnetic Resonance Imaging is so far considered to be the most superior one in terms of early diagnosis, planning for interventional treatment and predicting the response of treatment. However, it is limited due to high cost and lack of availability. The current review gives a detailed account of all imaging modalities available for imaging stroke and their associated pros and cons.
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Affiliation(s)
- Shahla Zameer
- Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | - Ramish Riaz
- Department of Radiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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