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Chen P, Pan Y, Wang J, Hui J, Gao R, Lin G, Li B, Rao J, Xia S, Ji J. The value of computed tomography perfusion deficit volumes in acute isolated brainstem infarction. Front Neurol 2023; 14:1233784. [PMID: 37928165 PMCID: PMC10620965 DOI: 10.3389/fneur.2023.1233784] [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: 06/02/2023] [Accepted: 08/28/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose Diagnosis of acute isolated brainstem infarction is challenging owing to non-specific, variable symptoms, and the effectiveness of non-contrast computed tomography (NCCT) is poor owing to limited spatial resolution and artifacts. Computed tomography perfusion (CTP) imaging parameters are significantly associated with functional outcomes in posterior circulation acute ischemic stroke; however, the role of CTP in isolated brainstem infarction remains unclear. We aimed to determine the value of CTP imaging parameters in predicting functional outcomes for affected patients. Methods In total, 116 consecutive patients with isolated pontine/midbrain hypoperfusion who underwent CTP and follow-up by magnetic resonance imaging (MRI) between January 2018 and March 2022, were retrospectively analyzed. Perfusion deficit volumes on all maps, and the final infarction volume (FIV) on MRI were quantified. "Good" functional outcome was defined as a 90-day modified Rankin Scale score of 0 and 1. Statistical analysis included uni- and multivariate regression analyses, binary logistic regressions, and receiver operating characteristics (ROC) analyses. Results In total, 113 patients had confirmed isolated pontine/midbrain infarction on follow-up MRI. Onset-to-scan time, visibility of ischemic lesions on NCCT, the baseline National Institutes of Health Stroke Scale (NIHSS) score, and perfusion deficit volumes on all CTP maps were significantly associated with FIV (p < 0.05). In a multivariate linear regression model, adjusted for age, sex, NIHSS score, onset-to-scan time, and visibility of NCCT, perfusion deficit volumes remained significantly associated with FIV. In binary logistic regression analyses, perfusion deficit volumes on all CTP maps remained independent predictors of a good functional outcome. In ROC analyses, the cerebral blood flow deficit volume showed a slightly higher discriminatory value with the largest area under the curve being 0.683 [(95% CI, 0.587-0.780), p = 0.001]. Conclusion Perfusion deficit volumes of CTP imaging could reflect the FIV and contain prognostic information on functional outcomes in patients with acute isolated brainstem infarction.
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Affiliation(s)
- Pengjun Chen
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Yiying Pan
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Jingke Wang
- Institution of Laboratory, Lishui People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Junguo Hui
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Ruijie Gao
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Guihan Lin
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Bingrong Li
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Jie Rao
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Shuiwei Xia
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
| | - Jiansong Ji
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, Pascarella R. Perfusion Status in Lacunar Stroke: A Pathophysiological Issue. Diagnostics (Basel) 2023; 13:2003. [PMID: 37370898 DOI: 10.3390/diagnostics13122003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The pathophysiology of lacunar infarction is an evolving and debated field, where relevant information comes from histopathology, old anatomical studies and animal models. Only in the last years, have neuroimaging techniques allowed a sufficient resolution to directly or indirectly assess the dynamic evolution of small vessel occlusion and to formulate hypotheses about the tissue status and the mechanisms of damage. The core-penumbra concept was extensively explored in large vessel occlusions (LVOs) both from the experimental and clinical point of view. Then, the perfusion thresholds on one side and the neuroimaging techniques studying the perfusion of brain tissue were focused and optimized for LVOs. The presence of a perfusion deficit in the territory of a single small perforating artery was negated for years until the recent proposal of the existence of a perfusion defect in a subgroup of lacunar infarcts by using magnetic resonance imaging (MRI). This last finding opens pathophysiological hypotheses and triggers a neurovascular multidisciplinary reasoning about how to image this perfusion deficit in the acute phase in particular. The aim of this review is to summarize the pathophysiological issues and the application of the core-penumbra hypothesis to lacunar stroke.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
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Zedde M, Napoli M, Grisendi I, Assenza F, Moratti C, Valzania F, Pascarella R. CT Perfusion in Lacunar Stroke: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13091564. [PMID: 37174955 PMCID: PMC10177869 DOI: 10.3390/diagnostics13091564] [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: 03/18/2023] [Revised: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The main theory underlying the use of perfusion imaging in acute ischemic stroke is the presence of a hypoperfused volume of the brain downstream of an occluded artery. Indeed, the main purpose of perfusion imaging is to select patients for endovascular treatment. Computed Tomography Perfusion (CTP) is the more used technique because of its wide availability but lacunar infarcts are theoretically outside the purpose of CTP, and limited data are available about CTP performance in acute stroke patients with lacunar stroke. METHODS We performed a systematic review searching in PubMed and EMBASE for CTP and lacunar stroke with a final selection of 14 papers, which were examined for data extraction and, in particular, CTP technical issues and sensitivity, specificity, PPV, and NPV values. RESULTS A global cohort of 583 patients with lacunar stroke was identified, with a mean age ranging from 59.8 to 72 years and a female percentage ranging from 32 to 53.1%.CTP was performed with different technologies (16 to 320 rows), different post-processing software, and different maps. Sensitivity ranges from 0 to 62.5%, and specificity from 20 to 100%. CONCLUSIONS CTP does not allow to reasonable exclude lacunar infarct if no perfusion deficit is found, but the pathophysiology of lacunar infarct is more complex than previously thought.
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Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Federica Assenza
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Claudio Moratti
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
| | - Rosario Pascarella
- Neuroradiology Unit, AUSL-IRCCS di Reggio Emilia, via Amendola 2, 42122 Reggio Emilia, Italy
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Edwards LS, Cappelen-Smith C, Cordato D, Bivard A, Churilov L, Lin L, Chen C, Garcia-Esperon C, Butcher K, Kleinig T, Choi PMC, Cheng X, Dong Q, Aviv RI, Parsons MW. Optimal CT perfusion thresholds for core and penumbra in acute posterior circulation infarction. Front Neurol 2023; 14:1092505. [PMID: 36846146 PMCID: PMC9947562 DOI: 10.3389/fneur.2023.1092505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Background At least 20% of strokes involve the posterior circulation (PC). Compared to the anterior circulation, posterior circulation infarction (POCI) are frequently misdiagnosed. CT perfusion (CTP) has advanced stroke care by improving diagnostic accuracy and expanding eligibility for acute therapies. Clinical decisions are predicated upon precise estimates of the ischaemic penumbra and infarct core. Current thresholds for defining core and penumbra are based upon studies of anterior circulation stroke. We aimed to define the optimal CTP thresholds for core and penumbra in POCI. Methods Data were analyzed from 331-patients diagnosed with acute POCI enrolled in the International-stroke-perfusion-registry (INSPIRE). Thirty-nine patients with baseline multimodal-CT with occlusion of a large PC-artery and follow up diffusion weighted MRI at 24-48 h were included. Patients were divided into two-groups based on artery-recanalization on follow-up imaging. Patients with no or complete recanalisation were used for penumbral and infarct-core analysis, respectively. A Receiver operating curve (ROC) analysis was used for voxel-based analysis. Optimality was defined as the CTP parameter and threshold which maximized the area-under-the-curve. Linear regression was used for volume based analysis determining the CTP threshold which resulted in the smallest mean volume difference between the acute perfusion lesion and follow up MRI. Subanalysis of PC-regions was performed. Results Mean transit time (MTT) and delay time (DT) were the best CTP parameters to characterize ischaemic penumbra (AUC = 0.73). Optimal thresholds for penumbra were a DT >1 s and MTT>145%. Delay time (DT) best estimated the infarct core (AUC = 0.74). The optimal core threshold was a DT >1.5 s. The voxel-based analyses indicated CTP was most accurate in the calcarine (Penumbra-AUC = 0.75, Core-AUC = 0.79) and cerebellar regions (Penumbra-AUC = 0.65, Core-AUC = 0.79). For the volume-based analyses, MTT >160% demonstrated best correlation and smallest mean-volume difference between the penumbral estimate and follow-up MRI (R 2 = 0.71). MTT >170% resulted in the smallest mean-volume difference between the core estimate and follow-up MRI, but with poor correlation (R 2 = 0.11). Conclusion CTP has promising diagnostic utility in POCI. Accuracy of CTP varies by brain region. Optimal thresholds to define penumbra were DT >1 s and MTT >145%. The optimal threshold for core was a DT >1.5 s. However, CTP core volume estimates should be interpreted with caution.
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Affiliation(s)
- Leon Stephen Edwards
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia,Sydney Brain Centre, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia,*Correspondence: Leon Stephen Edwards ✉
| | - Cecilia Cappelen-Smith
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia,Sydney Brain Centre, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia,Sydney Brain Centre, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Andrew Bivard
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia,Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Leonid Churilov
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia,Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Longting Lin
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Chushuang Chen
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia,Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Carlos Garcia-Esperon
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia,Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia,Stroke and Brain Injury Group, Hunter Medical Research Institute and the University of Newcastle, Newcastle, NSW, Australia
| | - Kenneth Butcher
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tim Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Phillip M. C. Choi
- Department of Neurosciences, Box Hill Hospital, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Richard I. Aviv
- Division of Neuroradiology, Department of Radiology, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
| | - Mark William Parsons
- Department of Neurology and Neurophysiology, Liverpool Hospital, Sydney, NSW, Australia,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia,Sydney Brain Centre, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Arora K, Gaekwad A, Evans J, O'Brien W, Ang T, Garcia-Esperon C, Blair C, Edwards LS, Chew BLA, Delcourt C, Spratt NJ, Parsons MW, Butcher KS. Diagnostic Utility of Computed Tomography Perfusion in the Telestroke Setting. Stroke 2022; 53:2917-2925. [PMID: 35652343 DOI: 10.1161/strokeaha.122.038798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Definitive diagnosis of acute ischemic stroke is challenging, particularly in telestroke settings. Although the prognostic utility of CT perfusion (CTP) has been questioned, its diagnostic value remains under-appreciated, especially in cases without an easily visible intracranial occlusion. We assessed the diagnostic accuracy of routine CTP in the acute telestroke setting. METHODS Acute and follow-up data collected prospectively from consecutive suspected patients with stroke assessed by a state-wide telestroke service between March 2020 and August 2021 at 12 sites in Australia were analyzed. All patients in the final analysis had been assessed with multimodal CT, including CTP, which was post-processed with automated volumetric software. Diagnostic sensitivity and specificity were calculated for multimodal CT and each individual component (noncontrast CT [NCCT], CT angiogram [CTA], and CTP). Final diagnosis determined by consensus review of follow-up imaging and clinical data was used as the reference standard. RESULTS During the study period, complete multimodal CT examination was obtained in 831 patients, 457 of whom were diagnosed with stroke. Diagnostic sensitivity for ischemic stroke increased by 19.5 percentage points when CTP was included with NCCT and CTA compared with NCCT and CTA alone (73.1% positive with NCCT+CTA+CTP [95% CI, 68.8-77.1] versus 53.6% positive with NCCT+CTA alone [95% CI, 48.9-58.3], P<0.001). No difference was observed between specificities of NCCT+CTA and NCCT+CTA+CTP (98.7% [95% CI, 98.5-100] versus 98.7% [95% CI, 96.9-99.6], P=0.13). Multimodal CT, including CTP, demonstrated the highest negative predictive value (75.0% [95% CI, 72.1-77.7]). Patients with stroke not evident on CTP had small volume infarcts on follow-up (1.2 mL, interquartile range 0.5-2.7mL). CONCLUSIONS Acquisition of CTP as part of a telestroke imaging protocol permits definitive diagnosis of cerebral ischemia in 1 in 5 patients with normal NCCT and CTA.
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Affiliation(s)
- Kshitij Arora
- Prince of Wales Clinical School, University of New South Wales, Clinical Neurosciences, Randwick, Australia (K.A., A.G., K.S.B.)
| | - Aaron Gaekwad
- Prince of Wales Clinical School, University of New South Wales, Clinical Neurosciences, Randwick, Australia (K.A., A.G., K.S.B.)
| | - James Evans
- Gosford Hospital, Department of Neurosciences, Australia (J.E., W.O.B., L.S.E.)
| | - William O'Brien
- Gosford Hospital, Department of Neurosciences, Australia (J.E., W.O.B., L.S.E.)
| | - Timothy Ang
- Departments of Neurology and Radiology, Royal Prince Alfred Hospital, Camperdown, Australia (T.A.)
| | - Carlos Garcia-Esperon
- John Hunter Hospital, Department of Neurology, and Hunter Medical Research Institute, New Lambton Heights, Australia (C.G.-E., B.L.A.C., N.J.S.).,The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, Australia (C.G.-E., B.L.A.C., N.J.S.)
| | - Christopher Blair
- Sydney Brain Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia (C.B., L.S.E.)
| | - Leon S Edwards
- Gosford Hospital, Department of Neurosciences, Australia (J.E., W.O.B., L.S.E.).,Sydney Brain Centre, Ingham Institute for Applied Medical Research, Liverpool, Australia (C.B., L.S.E.).,South Western Sydney Clinical School, University of New South Wales, Department of Neurology and Neurophysiology, Liverpool, Australia (L.S.E., M.W.P.)
| | - Beng L A Chew
- John Hunter Hospital, Department of Neurology, and Hunter Medical Research Institute, New Lambton Heights, Australia (C.G.-E., B.L.A.C., N.J.S.).,The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, Australia (C.G.-E., B.L.A.C., N.J.S.)
| | - Candice Delcourt
- The George Institute for Global Health, University of New South Wales, Neurological and Mental Health Division, Newtown, Australia (C.D.).,Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia (C.D.)
| | - Neil J Spratt
- John Hunter Hospital, Department of Neurology, and Hunter Medical Research Institute, New Lambton Heights, Australia (C.G.-E., B.L.A.C., N.J.S.).,The University of Newcastle, School of Biomedical Sciences and Pharmacy, Callaghan, Australia (C.G.-E., B.L.A.C., N.J.S.)
| | - Mark W Parsons
- South Western Sydney Clinical School, University of New South Wales, Department of Neurology and Neurophysiology, Liverpool, Australia (L.S.E., M.W.P.)
| | - Ken S Butcher
- Prince of Wales Clinical School, University of New South Wales, Clinical Neurosciences, Randwick, Australia (K.A., A.G., K.S.B.)
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Lakatos L, Bolognese M, Müller M, Österreich M, von Hessling A. Automated Supra- and Infratentorial Brain Infarct Volume Estimation on Diffusion Weighted Imaging Using the RAPID Software. Front Neurol 2022; 13:907151. [PMID: 35873774 PMCID: PMC9304979 DOI: 10.3389/fneur.2022.907151] [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: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThe present computerized techniques have limits to estimate the ischemic lesion volume especially in vertebrobasilar ischemia (VBI) automatically. We investigated the ability of the RAPID AI (RAPID) software on diffusion-weighted imaging (DWI) to estimate the infarct size in VBI in comparison to supratentorial ischemia (STI).MethodsAmong 123 stroke patients (39 women, 84 men, mean age 66 ± 11 years) having undergone DWI, 41 had had a VBI and 82 a STI. The infarct volume calculation by RAPID was compared to volume calculations by 2 neurologists using the ABC/2 method. For inter-reader and between-method analysis intraclass correlation coefficient (ICC), area under the curve (AUC) estimations, and Bland–Altman plots were used.ResultsICC between the two neurologists and each neurologist and RAPID were >0.946 (largest 95% CI boundaries 0.917–0.988) in the STI group, and > 0.757 (95% CI boundaries between 0.544 and 0.982) in the VBI group. In the STI group, AUC values ranged between 0.982 and 0.999 (95% CI 0.971–1) between the 2 neurologists and between 0.875 and 1 (95% CI 0.787–1) between the neurologists and RAPID; in the VBI group, they ranged between 0.925 and 0.965 (95% CI 0.801–1) between the neurologists, and between 0.788 and 0.931 (95% CI 0.663–1) between RAPID and the neurologists. Compared to the visual DWI interpretation by the neurologists, RAPID did not recognize a substantial number of infarct volumes of ≤ 2 ml.ConclusionThe ability of the RAPID software to depict strokes in the vertebrobasilar artery system seems close to its ability in the supratentorial brain tissue. However, small lesion volumes ≤ 2 ml remain still undetected in both brain areas.
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Affiliation(s)
- Lehel Lakatos
- Department of Neurology and Neurorehabilitation, Lucerne Kantonsspital, Lucerne, Switzerland
| | - Manuel Bolognese
- Department of Neurology and Neurorehabilitation, Lucerne Kantonsspital, Lucerne, Switzerland
| | - Martin Müller
- Department of Neurology and Neurorehabilitation, Lucerne Kantonsspital, Lucerne, Switzerland
- *Correspondence: Martin Müller
| | - Mareike Österreich
- Department of Neurology and Neurorehabilitation, Lucerne Kantonsspital, Lucerne, Switzerland
| | - Alexander von Hessling
- Department of Radiology (Section Neuroradiology), Lucerne Kantonsspital, Lucerne, Switzerland
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The Potential Impact of Neuroimaging and Translational Research on the Clinical Management of Lacunar Stroke. Int J Mol Sci 2022; 23:ijms23031497. [PMID: 35163423 PMCID: PMC8835925 DOI: 10.3390/ijms23031497] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
Lacunar infarcts represent one of the most frequent subtypes of ischemic strokes and may represent the first recognizable manifestation of a progressive disease of the small perforating arteries, capillaries, and venules of the brain, defined as cerebral small vessel disease. The pathophysiological mechanisms leading to a perforating artery occlusion are multiple and still not completely defined, due to spatial resolution issues in neuroimaging, sparsity of pathological studies, and lack of valid experimental models. Recent advances in the endovascular treatment of large vessel occlusion may have diverted attention from the management of patients with small vessel occlusions, often excluded from clinical trials of acute therapy and secondary prevention. However, patients with a lacunar stroke benefit from early diagnosis, reperfusion therapy, and secondary prevention measures. In addition, there are new developments in the knowledge of this entity that suggest potential benefits of thrombolysis in an extended time window in selected patients, as well as novel therapeutic approaches targeting different pathophysiological mechanisms involved in small vessel disease. This review offers a comprehensive update in lacunar stroke pathophysiology and clinical perspective for managing lacunar strokes, in light of the latest insights from imaging and translational studies.
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