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Xue J, Peng Y, Zhang Y, Chen W, Pan Y, Qi Y, Hao L, Gu W, Wang N, Gao P. Preliminary application of CT perfusion source images for evaluating regional collateral circulation in unilateral Moyamoya disease. Quant Imaging Med Surg 2019; 9:615-624. [PMID: 31143652 DOI: 10.21037/qims.2019.04.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Collateral flow is associated with clinical outcomes for patients with Moyamoya disease and served as a parameter for patient selection of therapeutic strategies. Therefore, we explored whether a noninvasive imaging modality, computed tomography perfusion (CTP) source images (CTP-Sis), could be used to identify the presence and intensity of collateral flow using digital subtraction angiography (DSA) as a gold standard for collateral flow. Methods CTP-Sis and DSA were performed for 24 patients with unilateral Moyamoya disease. A collateral grading system was developed based on arterial and venous phase CTP-Sis, imitating the DSA score system. Two neuroradiologists scored the DSA images using a collateral grading scale for the regions of interest corresponding to the Alberta Stroke Program Early computed tomography Score (ASPECTS) methodology. Another two neuroradiologists scored CTP-Sis in a similar manner. Agreement between the CTP-Sis and DSA consensus scores was determined, including kappa statistics. Results The agreement between the CTP-Sis and DSA consensus readings was moderate to strong, with a weighted kappa value of 0.768 [95% confidence interval (CI), 0.703-0.832], but there was a better agreement for readers of CTP-Sis, as compared with those of DSA. The sensitivity and specificity for identifying collaterals with CTP-Sis were 0.714 (95% CI, 0.578-0.851) and 0.995 (95% CI, 0.985-1.000), respectively. Conclusions CTP-Sis could help identify in a noninvasive manner the presence and intensity of collateral flow in patients with unilateral Moyamoya disease using DSA as a gold standard. Further study with a large number of cases is warranted. Further application of this method to other cerebrovascular diseases including acute ischemic stroke can also be warranted.
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Affiliation(s)
- Jing Xue
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Beijing Neurosurgical Institute, Beijing 100070, China
| | - Yujing Peng
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yanan Zhang
- Department of Radiology, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yu Qi
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Lina Hao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Weibin Gu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Peiyi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Beijing Neurosurgical Institute, Beijing 100070, China
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Menon BK, Qazi E, Nambiar V, Foster LD, Yeatts SD, Liebeskind D, Jovin TG, Goyal M, Hill MD, Tomsick TA, Broderick JP, Demchuk AM. Differential Effect of Baseline Computed Tomographic Angiography Collaterals on Clinical Outcome in Patients Enrolled in the Interventional Management of Stroke III Trial. Stroke 2015; 46:1239-44. [PMID: 25791716 DOI: 10.1161/strokeaha.115.009009] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/23/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE In the Interventional Management of Stroke (IMS) III trial, we sought to demonstrate evidence of a differential treatment effect of endovascular treatment of acute ischemic stroke compared with intravenous tissue-type plasminogen activator, according to baseline collateral status measured using computed tomographic angiography. METHODS Of 656 patients enrolled in Interventional Management of Stroke III trial, 306 had baseline computed tomographic angiography. Of these, 185 patients had M1 middle cerebral artery ± intracranial internal carotid artery occlusion, where baseline collateral status could be measured. Collateral status was assessed by consensus using 3 different ordinal scales and categorized as good, intermediate, and poor. Multivariable modeling was used to assess the effect of collateral status and treatment type on clinical outcome by modified Rankin Scale (mRS 0-2, mRS 0-1, and the ordinal mRS). RESULTS Of 185 patients, 126 randomized to endovascular therapy (87.6% recanalized, 41.3% 90-day mRS 0-2) and 59 to intravenous tissue-type plasminogen activator only (60.5% recanalized, 30.5% 90-day mRS 0-2). In multivariable modeling, collateral status was a significant predictor of all clinical outcomes (P<0.05). Maximal benefit with endovascular treatment across all clinical outcomes was seen in patients with intermediate collaterals, some benefit in patients with good collaterals, and none in patients with poor collaterals, although small sample size limited the power of the analysis to show a statistically significant interaction between collateral status and treatment type (P>0.05). CONCLUSION Using data from a large randomized controlled trial (IMS III), we show that baseline computed tomographic angiography collaterals are a robust determinant of final clinical outcome and could be used to select patients for endovascular therapy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov/ct2/show/. Unique identifier: 0020NCT00359424.
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Affiliation(s)
- Bijoy K Menon
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Emmad Qazi
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Vivek Nambiar
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Lydia D Foster
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Sharon D Yeatts
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - David Liebeskind
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Tudor G Jovin
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Mayank Goyal
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Michael D Hill
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Thomas A Tomsick
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Joseph P Broderick
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.)
| | - Andrew M Demchuk
- From the Calgary Stroke Program and the Department of Clinical Neurosciences (B.K.M., E.Q., V.N., M.G., M.D.H., A.M.D.), Department of Radiology (B.K.M., M.G., M.D.H., A.M.D.), University of Calgary, Calgary, Canada; Department of Public Health Sciences, Medical University of South Carolina, Charleston (L.D.F., S.D.Y.); Department of Neurosciences, University of California, Los Angeles (D.L.); Department of Neurosciences, University of Pittsburgh Medical Center, PA (T.G.J.); Department of Community Health Sciences, University of Calgary, Calgary, Canada (M.D.H.); Department of Radiology (T.A.T.), Department of Neurology (J.P.B.), University of Cincinnati, OH; and Hotchkiss Brain Institute, Calgary, Canada (B.K.M., M.G., M.D.H., A.M.D.).
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6
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Tóth M, Little P, Arnberg F, Häggkvist J, Mulder J, Halldin C, Gulyás B, Holmin S. Acute neuroinflammation in a clinically relevant focal cortical ischemic stroke model in rat: longitudinal positron emission tomography and immunofluorescent tracking. Brain Struct Funct 2015; 221:1279-90. [PMID: 25601153 DOI: 10.1007/s00429-014-0970-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/14/2014] [Indexed: 01/17/2023]
Abstract
Adequate estimation of neuroinflammatory processes following ischemic stroke is essential for better understanding of disease mechanisms, and for the development of treatment strategies. With the TSPO (18 kDa translocator protein) positron emission tomography (PET) radioligand [(11)C]PBR28, we monitored longitudinally the inflammatory response post-transient cerebral ischemia in rats, using a recently developed rat stroke model that produces isolated focal cortical infarcts with clinical relevance in size and pathophysiology. Six Sprague-Dawley rats were subjected to 90 min transient endovascular occlusion of the M2 segment of the middle cerebral artery (M2CAO). Animals were imaged with a nanoScan(®) PET/MRI system at 1, 4, 7 and 14 days after M2CAO with a bolus injection of [(11)C]PBR28. In the infarct region, we found a significantly increased uptake of [(11)C]PBR28 on day 4, 7 and 14 compared to day 1 as well as compared to the contralateral cortex. No significant increase was detected in the contralateral cortex during the 14 days of imaging. The activation in the infarct region gradually decreased between day 4 and day 14. In an additional group of animals (n = 26), immunofluorescence studies were performed with antibodies for activated microglia/monocytes (Cd11b), phagocytes (Cd68), astrocytes (glial fibrillary acidic protein) and TSPO. The TSPO immunofluorescence signal indicated reactive microgliosis post injury, corresponding to PET findings. The present clinically relevant animal model and TSPO PET ligand appear to be well suited for studies on neuroinflammation after ischemic stroke.
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Affiliation(s)
- Miklós Tóth
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Philip Little
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Fabian Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Jenny Häggkvist
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Jan Mulder
- Science for Life Laboratory, Department of Neuroscience, Karolinska Institutet, 17165, Stockholm, Sweden
| | - Christer Halldin
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden.,Imperial College - NTU, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 639798, Singapore
| | - Balázs Gulyás
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden. .,Imperial College - NTU, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 639798, Singapore. .,Imperial College London, Faculty of Medicine, Division of Brain Sciences, London, SW7 2AZ, UK.
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet, 171 76, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, 171 76, Stockholm, Sweden
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