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Potential role of bolus-tracking data of carotid CT angiography for atrial fibrillation prediction. Eur Radiol 2023; 33:981-987. [PMID: 35962815 DOI: 10.1007/s00330-022-09072-z] [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: 03/27/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Atrial fibrillation (AF), a significant cause of ischemic stroke, often goes undetected because of its asymptomatic nature. This study investigated whether the total bolus-tracking time (TTT) and average slope (AS) of a bolus-tracking graph could be used to predict AF. METHODS This single-center, retrospective study included patients who underwent carotid CTA and a 24-h Holter test. TTT and the average degree of enhancement during bolus-tracking, derived from carotid CTA, were defined as variables of interest. All patients underwent transthoracic echocardiography. Left ventricular diastolic dysfunction and elevated left atrial pressure (LAP) were identified according to the guidelines of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging. RESULTS The final cohort comprised 716 patients, 80 of whom presented with AF. The TTT of the AF group was significantly longer (23.8 ± 5.2 s) than that of the non-AF group (18.7 ± 2.8 s); p < 0.001. The AS of the bolus-tracking graph of the AF group was 0.80 ± 0.24, which was significantly lower than that of the non-AF group 1.38 ± 0.21 (p < 0.001). TTT was associated with a significantly higher risk of AF (odds ratio [OR]: 1.36; p < 0.001) and elevated LAP (OR: 1.46; p < 0.001). In contrast, the AS of the bolus-tracking graph was not significantly associated with either AF or an elevated LAP. CONCLUSION TTT derived from bolus-tracking carotid CTA is an effective adjuvant tool for detecting AF related to left ventricular diastolic dysfunction and elevated LAP, confirmed using echocardiography. KEY POINTS • Atrial fibrillation is not only a significant cause of ischemic stroke but is also often masked because of its atypical and asymptomatic features. • The total tracking time, derived from bolus tracking of carotid computed tomography angiography, may be an effective adjuvant tool for detecting undiagnosed atrial fibrillation and elevated left atrial pressure in patients.
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Fallah Arzpeyma S, Kazemnezhad-Leili E, Rashidi H, Ghorbani-Shirkouhi S, Saberi A. Factors Contributing to Attenuation of Cerebral Venous Sinus in Brain Noncontrast Computed Tomography Scan. Indian J Radiol Imaging 2022; 31:882-887. [PMID: 35136500 PMCID: PMC8817799 DOI: 10.1055/s-0041-1741048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/Aim
In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT.
Material and Methods
Total 1,680 patients were included in this study, and their demographic and laboratory data and brain NCCT were reviewed. In their brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. Data analysis was conducted using the Statistical Package for the Social Sciences version 21.0 software by Kolmogorov-Smirnov, Spearman's correlation coefficient, and multiple linear regression tests. The significance level was considered less than 0.05.
Results
Hematocrit (B = 0.251,
p
< 0.001), hemoglobin (B = 0.533,
p
< 0.001), and creatinine (B = − 0.270,
p
= 0.048) were determined as predictors of attenuation of superior sagittal sinus. For both sigmoid sinuses, hematocrit (
p
< 0.001) and hemoglobin (
p
< 0.001) were determined as positive predictors, and creatinine (
p
< 0.001) and BUN (
p
< 0.002) were determined as negative and positive predictors, respectively.
Conclusion
Hemoglobin, hematocrit, creatinine, and BUN are the main factors that should be considered in the assessment of CVS density on brain NCCT. As with increasing hematocrit and hemoglobin of the subject, the CVS density in NCCT increases, and with increasing creatinine and in some instance decreasing BUN of the subject, the CVS density in NCCT decreases.
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Affiliation(s)
- Sima Fallah Arzpeyma
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad-Leili
- Clinical Statistics, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hosna Rashidi
- Department of Radiology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Ghorbani-Shirkouhi
- Neuroscience Research Center, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alia Saberi
- Neuroscience Research Center, Department of Neurology, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Staessens S, François O, Brinjikji W, Doyle KM, Vanacker P, Andersson T, De Meyer SF. Studying Stroke Thrombus Composition After Thrombectomy: What Can We Learn? Stroke 2021; 52:3718-3727. [PMID: 34517770 PMCID: PMC8545837 DOI: 10.1161/strokeaha.121.034289] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The composition of ischemic stroke thrombi has gained an increasing amount of interest in recent years. The implementation of endovascular procedures in standard stroke care has granted researchers the unique opportunity to examine patient thrombus material. Increasing evidence indicates that stroke thrombi are complex and heterogenous, consisting of various biochemical (eg, fibrin, von Willebrand Factor, and neutrophil extracellular traps) and cellular (eg, red blood cells, platelets, leukocytes, and bacteria) components. This complex composition may explain therapeutic limitations and also offer novel insights in several aspects of stroke management. Better understanding of thrombus characteristics could, therefore, potentially lead to improvements in the management of patients with stroke. In this review, we provide a comprehensive overview of the lessons learned by examining stroke thrombus composition after endovascular thrombectomy and its potential relevance for thrombectomy success rates, thrombolysis, clinical outcomes, stroke etiology, and radiological imaging.
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Affiliation(s)
- Senna Staessens
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | | | | | - Karen M. Doyle
- CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Peter Vanacker
- Department of Neurology, AZ Groeninge, Kortrijk, Belgium
- Department of Neurology, University Hospitals Antwerp, Antwerp, Belgium
- Department of Translational Neuroscience, University of Antwerp, Antwerp, Belgium
| | - Tommy Andersson
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
- Department of Neuroradiology, Karolinska University Hospital and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Digge P, Patel V, Bharath KV, Prakashini KK, Patil KH. Objective Evaluation of Cerebral Venous Sinus Attenuation on Plain CT Brain and Detecting Anemia. Noticing the "Unnoticed". Neurol India 2021; 69:874-878. [PMID: 34507404 DOI: 10.4103/0028-3886.323896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Plain computed tomography (CT) of the brain is an important first-line investigation of choice in an acute neurologic setup. Unless clinically suspected concealed areas like the confluence of venous sinuses often go unnoticed. Diagnosing anemia, thrombosis, or polycythemia correlating the CT attenuation values might prove to be fruitful in early patient management where the mode of varied clinical presentations causes a clinical dilemma. Aims 1) To determine the objective correlation between CT attenuation of the cerebral venous sinus and hemoglobin (Hb) as well as hematocrit (HCT) value and 2) to detect anemia from measuring venous sinus attenuation. Methods and Materials An exploratory study design of 200 patients, who had plain CT of the head and Hb and HCT levels obtained within 24 h of the scan. Statistical Analysis Used Two-tailed unpaired t-test was used to test the difference between two independent samples. Correlation and regression analyses were used to assess the correlation between two quantitative variables. Results A significant correlation was observed between the Hb-Hounsfield unit (HU) and HCT-HU. The simple linear regression model revealed that HU (P value < 0.001) was significantly correlated with Hb and the regression model was, Hb = 2.1 + 0.2 × HU. Similarly, HU (P value < 0.001) was significantly correlated with HCT and regression model was HCT = 6.2 + 0.7 × HU. Conclusions Objective attenuation values of dural sinuses on plain CT can be positively correlated with Hb and HCT values. Considering the cutoff of 35.5 HU, we were able to show the specificity of 100% for the detection of anemia.
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Affiliation(s)
- Poornima Digge
- Departments of Radiodiagnosis and Central Research Services, PS Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Viral Patel
- Departments of Radiodiagnosis and Central Research Services, PS Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - K V Bharath
- Departments of Radiodiagnosis and Central Research Services, PS Medical College and Shree Krishna Hospital, Bhaikaka University, Karamsad, Gujarat, India
| | - Koteshwar K Prakashini
- Department of Anaesthesia and Critical Care, Kasturba Medical College (KMC), Manipal, Karnataka, India
| | - Karamchand H Patil
- Department of Radio-Diagnosis, Kasturba Medical College (KMC), Manipal, Karnataka, India
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Akhavan R, Abbasi B, Kheirollahi M, Ghamari Khameneh A, Hashemi J, Khoei S, Darban Hosseini Amirkhiz G. Factors affecting dural sinus density in non-contrast computed tomography of brain. Sci Rep 2019; 9:12016. [PMID: 31427710 PMCID: PMC6700311 DOI: 10.1038/s41598-019-48545-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/07/2019] [Indexed: 01/31/2023] Open
Abstract
The possibility of changing the intracranial vasculature computed tomography (CT) attenuation under the influence of variable factors is a long-held unestablished belief. The purpose of this study is to evaluate factors affecting dural sinus density in non-contrast computed tomography of the brain. Patients presented with acute neurologic symptoms to the emergency department were candidates to be enrolled in this study. A region of interest (ROI) measuring 1-2-mm2 recorder (base on sinus size) used to measure the attenuation of each sinus in Hounsfield Unit (HU) and then mean density calculated. CBC, BUN and Cr were extracted from patients' records. Chi-square test, correlation analyze, independent sample unpaired student t-test and one-way ANOVA test and Multivariate logistic regression were used. Positive significant correlation (0.48) was found between the hematocrit level (HCT) and average attenuation in the four sinus segments (P value < 0.0001) and between the HCT and basilar artery attenuation (P value < 0.0001). There was no significant correlation between the age and average attenuation. There was a significant and negative correlation between the BUN/Cr and average attenuation. Using a multivariate analysis on a large sample volume, we conclude that Hgb and HCT are the only factors that have a significant correlation with average sinus attenuation. This correlation is relatively stronger for Hgb in comparison to HCT.
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Affiliation(s)
- Reza Akhavan
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bita Abbasi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Moein Kheirollahi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afshar Ghamari Khameneh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Jahanbakhsh Hashemi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samin Khoei
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Quantitative Evaluation of Noncontrast Computed Tomography of the Head for Assessment of Anemia. J Comput Assist Tomogr 2015; 39:842-8. [DOI: 10.1097/rct.0000000000000306] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patzig M, Laub C, Janssen H, Ertl L, Fesl G. Pseudo-subarachnoid haemorrhage due to chronic hypoxaemia: case report and review of the literature. BMC Neurol 2014; 14:219. [PMID: 25403823 PMCID: PMC4243382 DOI: 10.1186/s12883-014-0219-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 11/04/2014] [Indexed: 02/03/2023] Open
Abstract
Background The specificity of computed tomography (CT) for subarachnoid haemorrhage (SAH) is very high. However, physicians should be aware of rare false positive findings, also referred to as “pseudo-SAH”. We present an unusual case in which such a finding was caused by chronic hypoxaemia. Case presentation A 37-year-old male patient presented with headaches. His CT-scan showed multiple confluent subarachnoid hyperattenuations, which mimicked SAH. However, the headache was chronic and had no features typical for SAH. The patient suffered from severe chronic hypoxaemia due to congenital heart failure. On CT-angiography diffuse intracranial vessel proliferation was found and laboratory results revealed a highly raised level of haematocrit, which had both probably developed as compensatory mechanisms. A combination of these findings explained the subarachnoid hyperdensities. Magnetic resonance imaging (MRI) showed no signs of SAH and visualized hypoxaemia in cerebral veins. A diagnosis of pseudo-SAH was made. The patient’s symptoms were likely due to a secondary headache attributed to hypoxia and/or hypercapnia. Therapy was symptomatic. Conclusions Severe chronic hypoxaemia should be recognised as a rare cause of pseudo-SAH. Clinical evaluation and MRI help differentiate SAH from pseudo-SAH.
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Niesten JM, van der Schaaf IC, van Dam L, Vink A, Vos JA, Schonewille WJ, de Bruin PC, Mali WPTM, Velthuis BK. Histopathologic composition of cerebral thrombi of acute stroke patients is correlated with stroke subtype and thrombus attenuation. PLoS One 2014; 9:e88882. [PMID: 24523944 PMCID: PMC3921255 DOI: 10.1371/journal.pone.0088882] [Citation(s) in RCA: 163] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/13/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction We related composition of cerebral thrombi to stroke subtype and attenuation on non-contrast CT (NCCT) to gain more insight in etiopathogenesis and to validate thrombus attenuation as a new imaging biomarker for acute stroke. Methods We histopathologically investigated 22 thrombi retrieved after mechanical thrombectomy in acute stroke patients. First, thrombi were classified as fresh, lytic or organized. Second, percentages of red blood cells (RBCs), platelets and fibrin and number of red, white (respectively RBCs or platelets outnumbering other components with ≥15%) or mixed thrombi were compared between large artery atherosclerosis (LAA), cardioembolism, dissection and unknown subtype. Third, correlation between attenuation and RBCs, platelets and fibrin was calculated using Pearson's correlation coefficients (r). Results Thrombi were fresh in 73% (n = 16), lytic in 18% (n = 4) and organized in 9% (n = 2). The stroke cause was LAA in eight (36%), cardioembolism in six (27%), dissection in three (14%), and unknown in five (23%) patients. LAA thrombi showed the highest percentage RBCs (median 50 (range 35–90)), followed by dissection (35 (20–40), p = 0.05), cardioembolism (35 (5–45), p = 0.013) and unknown subtype (25 (2–40), p = 0.006). No differences in platelets (p = 0.16) and fibrin (p = 0.52) between subtypes were found. LAA thrombi were classified as red or mixed (both n = 4), cardioembolisms as mixed (n = 5) or white (n = 1) and dissection as mixed (n = 3). There was a moderate positive correlation between attenuation and RBCs (r = 0.401, p = 0.049), and weak negative correlations with platelets (r = −0.368, p = 0.09) and fibrin (r = −0.073, p = 0.75). Conclusions The majority of cerebral thrombi is fresh. There are no differences in age of thrombi between subtypes. LAA thrombi have highest percentages RBCs, cardioembolism and unknown subtype lowest. No relationship exists between subtype and platelets or fibrin percentages. We found a correlation between the RBC-component and thrombus attenuation, which improves validation of thrombus attenuation on NCCT as an imaging biomarker for stroke management.
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Affiliation(s)
- Joris M. Niesten
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
| | | | - Lievay van Dam
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Albert Vos
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Peter C. de Bruin
- Department of Pathology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Willem P. T. M. Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Birgitta K. Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
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