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Ospel JM, Rinkel L, Ganesh A, Demchuk A, Heran M, Sauvageau E, Joshi M, Haussen D, Jayaraman M, Coutts S, Yu A, Puetz V, Iancu D, Bang OY, Tarpley J, Holmin S, Kelly M, Tymianski M, Hill M, Goyal M. How Do Quantitative Tissue Imaging Outcomes in Acute Ischemic Stroke Relate to Clinical Outcomes? J Stroke 2024; 26:252-259. [PMID: 38836272 PMCID: PMC11164591 DOI: 10.5853/jos.2023.02180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 12/24/2023] [Accepted: 01/15/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND PURPOSE Infarct volume and other imaging markers are increasingly used as surrogate measures for clinical outcome in acute ischemic stroke research, but how improvements in these imaging surrogates translate into better clinical outcomes is currently unclear. We investigated how changes in infarct volume at 24 hours alter the probability of achieving good clinical outcome (modified Rankin Scale [mRS] 0-2). METHODS Data are from endovascular thrombectomy patients from the randomized controlled ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial. Infarct volume at 24 hours was manually segmented on non-contrast computed tomography or diffusion-weighted magnetic resonance imaging. Probabilities of achieving good outcome based on infarct volume were obtained from a multivariable logistic regression model. The probability of good outcome was plotted against infarct volume using linear spline regression. RESULTS A total of 1,099 patients were included in the analysis (median final infarct volume 24.9 mL [interquartile range: 6.6-92.2]). The relationship between total infarct volume and good outcome probability was nearly linear for infarct volumes between 0 mL and 250 mL. In this range, a 10% increase in the probability of achieving mRS 0-2 required a decrease in infarct volume of approximately 34.0 mL (95% confidence interval: -32.5 to -35.6). At infarct volumes above 250 mL, the probability of achieving mRS 0-2 probability was near zero. The relationships of tissue-specific infarct volumes and parenchymal hemorrhage volume generally showed similar patterns, although variability was high. CONCLUSION There seems to be a near-linear association between total infarct volume and probability of achieving good outcome for infarcts up to 250 mL, whereas patients with infarct volumes greater than 250 mL are highly unlikely to have a favorable outcome.
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Affiliation(s)
- Johanna M. Ospel
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Leon Rinkel
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Andrew Demchuk
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Manraj Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, FL, USA
| | - Manish Joshi
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Diogo Haussen
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Mahesh Jayaraman
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Shelagh Coutts
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Amy Yu
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Volker Puetz
- University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Neurology and Dresden Neurovascular Center, Dresden, Germany
| | - Dana Iancu
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Jason Tarpley
- Providence Little Company of Mary Medical Center, Providence Saint John’s Health Center and The Pacific Neuroscience Institute, Torrance, CA, USA
| | - Staffan Holmin
- Department of Clinical Neuroscience, Karolinska Institutet and Departments of Neuroradiology and Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Kelly
- Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Michael Hill
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - the ESCAPE-NA1 Investigators
- Department of Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Department of Neurology, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, FL, USA
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Warren Alpert School of Medicine, Brown University, Providence, RI, USA
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- University Hospital Carl Gustav Carus at the Technische Universität Dresden, Department of Neurology and Dresden Neurovascular Center, Dresden, Germany
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
- Providence Little Company of Mary Medical Center, Providence Saint John’s Health Center and The Pacific Neuroscience Institute, Torrance, CA, USA
- Department of Clinical Neuroscience, Karolinska Institutet and Departments of Neuroradiology and Neurology, Karolinska University Hospital, Stockholm, Sweden
- Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
- NoNO Inc., Toronto, ON, Canada
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Ospel JM, Rex N, Rinkel L, Kashani N, Buck B, Rempel J, Sahlas D, Kelly ME, Budzik R, Tymianski M, Hill MD, Goyal M. Prevalence of "Ghost Infarct Core" after Endovascular Thrombectomy. AJNR Am J Neuroradiol 2024; 45:291-295. [PMID: 38272571 DOI: 10.3174/ajnr.a8113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND PURPOSE Baseline CTP sometimes overestimates the size of the infarct core ("ghost core" phenomenon). We investigated how often CTP overestimates infarct core compared with 24-hour imaging, and aimed to characterize the patient subgroup in whom a ghost core is most likely to occur. MATERIALS AND METHODS Data are from the randomized controlled ESCAPE-NA1 trial, in which patients with acute ischemic stroke undergoing endovascular treatment were randomized to intravenous nerinetide or placebo. Patients with available baseline CTP and 24-hour follow-up imaging were included in the analysis. Ghost infarct core was defined as CTP core volume minus 24-hour infarct volume > 10 mL). Clinical characteristics of patients with versus without ghost core were compared. Associations of ghost core and clinical characteristics were assessed by using multivariable logistic regression. RESULTS A total of 421 of 1105 patients (38.1%) were included in the analysis. Forty-seven (11.2%) had a ghost core > 10 mL, with a median ghost infarct volume of 13.4 mL (interquartile range 7.6-26.8). Young patient age, complete recanalization, short last known well to CT times, and possibly male sex were associated with ghost infarct core. CONCLUSIONS CTP ghost core occurred in ∼1 of 10 patients, indicating that CTP frequently overestimates the infarct core size at baseline, particularly in young patients with complete recanalization and short ischemia duration.
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Affiliation(s)
- Johanna M Ospel
- From the Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Nathaniel Rex
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Diagnostic Imaging (N.R.), Brown University, Providence, Rhode Island
| | - Leon Rinkel
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Neurology (L.R.), Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nima Kashani
- Department of Neurosurgery (N.K., M.E.K.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brian Buck
- University of Alberta Hospital (B.B., J.R.), Edmonton, Alberta, Canada
| | - Jeremy Rempel
- University of Alberta Hospital (B.B., J.R.), Edmonton, Alberta, Canada
| | | | - Michael E Kelly
- Department of Neurosurgery (N.K., M.E.K.), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ron Budzik
- Ohio Health (R.B.), Riverside Methodist Hospital, Columbus, Ohio
| | | | - Michael D Hill
- From the Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- From the Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., N.R., L.R., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
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