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Foschi M, Galante A, Ornello R, Necozione S, Marini C, Muselli M, Achard PO, Fratocchi L, Vinci SL, Cavallaro M, Silvestrini M, Polonara G, Marcheselli S, Straffi L, Colasurdo M, Sorrentino L, Franconi E, Alecci M, Caulo M, Sacco S. Point-Of-Care low-field MRI in acute Stroke (POCS): protocol for a multicentric prospective open-label study evaluating diagnostic accuracy. BMJ Open 2024; 14:e075614. [PMID: 38296269 PMCID: PMC10831427 DOI: 10.1136/bmjopen-2023-075614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Fast and accurate diagnosis of acute stroke is crucial to timely initiate reperfusion therapies. Conventional high-field (HF) MRI yields the highest accuracy in discriminating early ischaemia from haemorrhages and mimics. Rapid access to HF-MRI is often limited by contraindications or unavailability. Low-field (LF) MRI (<0.5T) can detect several types of brain injury, including ischaemic and haemorrhagic stroke. Implementing LF-MRI in acute stroke care may offer several advantages, including extended applicability, increased safety, faster administration, reduced staffing and costs. This multicentric prospective open-label trial aims to evaluate the diagnostic accuracy of LF-MRI, as a tool to guide treatment decision in acute stroke. METHODS AND ANALYSIS Consecutive patients accessing the emergency department with suspected stroke dispatch will be recruited at three Italian study units: Azienda Sanitaria Locale (ASL) Abruzzo 1 and 2, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital. The estimated sample size is 300 patients. Anonymised clinical and LF-MRI data, along with conventional neuroimaging data, will be independently assessed by two external units: Marche Polytechnic University and 'G. Martino' Polyclinic University Hospital. Both units will independently adjudicate the best treatment option, while the latter will provide historical HF-MRI data to develop artificial intelligence algorithms for LF-MRI images interpretation (Free University of Bozen-Bolzano). Agreement with conventional neuroimaging will be evaluated at different time points: hyperacute, acute (24 hours), subacute (72 hours), at discharge and chronic (4 weeks). Further investigations will include feasibility study to develop a mobile stroke unit equipped with LF-MRI and cost-effectiveness analysis. This trial will provide necessary data to validate the use of LF-MRI in acute stroke care. ETHICS AND DISSEMINATION The study was approved by the Research Ethics Committee of the Abruzzo Region (CEtRA) on 11 May 2023 (approval code: richyvgrg). Results will be disseminated in peer-reviewed journals and presented in academic conferences. TRIAL REGISTRATION NUMBER NCT05816213; Pre-Results.
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Affiliation(s)
- Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Angelo Galante
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- National Institute for Nuclear Physics, Gran Sasso National Laboratory, L'Aquila, Italy
- SPIN-CNR, c/o Department of Physical and Chemical Science, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carmine Marini
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mario Muselli
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Olimpia Achard
- Department of Industrial and Information Engineering and Economics, University of L'Aquila, L'Aquila, Italy
| | - Luciano Fratocchi
- Department of Industrial and Information Engineering and Economics, University of L'Aquila, L'Aquila, Italy
| | - Sergio Lucio Vinci
- Department of Biomorf, University of Messina, UOC Neuroradiology, Messina, Italy
| | - Marco Cavallaro
- Department of Biomorf, University of Messina, UOC Neuroradiology, Messina, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Gabriele Polonara
- Department of Odontostomatological and Specialized Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Simona Marcheselli
- Emergency Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Laura Straffi
- Emergency Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marco Colasurdo
- Department of Neuroscience and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Luca Sorrentino
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy
| | - Enrico Franconi
- Faculty of Computer Science, Free University of Bozen-Bolzano, Bolzano, Italy
| | - Marcello Alecci
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- National Institute for Nuclear Physics, Gran Sasso National Laboratory, L'Aquila, Italy
- SPIN-CNR, c/o Department of Physical and Chemical Science, University of L'Aquila, L'Aquila, Italy
| | - Massimo Caulo
- Department of Neuroscience and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Matsuo K, Nakaura T, Morita K, Uetani H, Nagayama Y, Kidoh M, Hokamura M, Yamashita Y, Shinoda K, Ueda M, Mukasa A, Hirai T. Feasibility study of super-resolution deep learning-based reconstruction using k-space data in brain diffusion-weighted images. Neuroradiology 2023; 65:1619-1629. [PMID: 37673835 DOI: 10.1007/s00234-023-03212-y] [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: 04/23/2023] [Accepted: 08/08/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the influence of super-resolution deep learning-based reconstruction (SR-DLR), which utilizes k-space data, on the quality of images and the quantitation of the apparent diffusion coefficient (ADC) for diffusion-weighted images (DWI) in brain magnetic resonance imaging (MRI). METHODS A retrospective analysis was performed on 34 patients who had undergone DWI using a 3 T MRI system with SR-DLR reconstruction based on k-space data in August 2022. DWI was reconstructed with SR-DLR (Matrix = 684 × 684) and without SR-DLR (Matrix = 228 × 228). Measurements were made of the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) in white matter (WM) and grey matter (GM), and the full width at half maximum (FWHM) of the septum pellucidum. Two radiologists assessed image noise, contrast, artifacts, blur, and the overall quality of three image types using a four-point scale. Quantitative and qualitative scores between images with and without SR-DLR were compared using the Wilcoxon signed-rank test. RESULTS Images with SR-DLR showed significantly higher SNRs and CNRs than those without SR-DLR (p < 0.001). No statistically significant variances were found in the apparent diffusion coefficients (ADCs) in WM and GM between images with and without SR-DLR (ADC in WM, p = 0.945; ADC in GM, p = 0.235). Moreover, the FWHM without SR-DLR was notably lower compared to that with SR-DLR (p < 0.001). CONCLUSION SR-DLR has the potential to augment the quality of DWI in DL MRI scans without significantly impacting ADC quantitation.
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Affiliation(s)
- Kensei Matsuo
- Department of Central Radiology, Kumamoto University Hospital, Honjo 1-1-1, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, 860-8556, Japan.
| | - Kosuke Morita
- Department of Central Radiology, Kumamoto University Hospital, Honjo 1-1-1, Kumamoto, 860-8556, Japan
| | - Hiroyuki Uetani
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, 860-8556, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, 860-8556, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, 860-8556, Japan
| | - Masamichi Hokamura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, 860-8556, Japan
| | - Yuichi Yamashita
- Canon Medical Systems Corporation, 70-1, Yanagi, Saiwai, Kawasaki, Kanagawa, 212-0015, Japan
| | - Kensuke Shinoda
- MRI Systems Division, Canon Medical Systems Corporation, 1385 Shimoishigami, Otawara, Tochigi, 324-8550, Japan
| | - Mitsuharu Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, 860-8556, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Chuo, Kumamoto, 860-8556, Japan
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Shoghli A, Chow D, Kuoy E, Yaghmai V. Current role of portable MRI in diagnosis of acute neurological conditions. Front Neurol 2023; 14:1255858. [PMID: 37840918 PMCID: PMC10576557 DOI: 10.3389/fneur.2023.1255858] [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: 07/10/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
Neuroimaging is an inevitable component of the assessment of neurological emergencies. Magnetic resonance imaging (MRI) is the preferred imaging modality for detecting neurological pathologies and provides higher sensitivity than other modalities. However, difficulties such as intra-hospital transport, long exam times, and availability in strict access-controlled suites limit its utility in emergency departments and intensive care units (ICUs). The evolution of novel imaging technologies over the past decades has led to the development of portable MRI (pMRI) machines that can be deployed at point-of-care. This article reviews pMRI technologies and their clinical implications in acute neurological conditions. Benefits of pMRI include timely and accurate detection of major acute neurological pathologies such as stroke and intracranial hemorrhage. Additionally, pMRI can be potentially used to monitor the progression of neurological complications by facilitating serial measurements at the bedside.
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Affiliation(s)
| | | | | | - Vahid Yaghmai
- Department of Radiological Sciences, School of Medicine, University of California, Irvine, Irvine, CA, United States
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Alouda N, Alshammari NH, Alomar KS, Shami I, Alobaid AO. A misdiagnosed aneurysm of the petrous internal carotid artery: A case report. Int J Surg Case Rep 2023; 110:108671. [PMID: 37634430 PMCID: PMC10509807 DOI: 10.1016/j.ijscr.2023.108671] [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: 08/01/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION An aneurysm is characterized by the weakening of the arterial wall, which leads to a bulge that can be filled with blood. Aneurysms of the petrous portion of the internal carotid artery are rare and predominantly detected incidentally. This is a report of multiple misdiagnoses of an aneurysm of the petrous segment of the internal carotid artery (ICA) that highlights its imaging-based diagnosis and risk of mortality. PRESENTATION OF CASE A 60-year-old woman with chronic kidney disease and a history of stroke presented with left ear discharge, decreased hearing, and non-pulsatile tinnitus that had persisted for four months. Clinical examination showed wet tympanic membrane perforation, and imaging revealed an ill-defined infiltrative mass involving the left petrous apex initially misdiagnosed as glomus jugulare. Diagnostic computed tomography (CT) angiography revealed a left aneurysm in the petrous part of the ICA, which was successfully treated with interventional radiology. Follow-up was planned for infectious diseases and internal medicine, but she was lost to follow-up by the otolaryngology department. DISCUSSION Aneurysms in the petrous portion of the ICA are rare and usually asymptomatic. However, their clinical manifestations vary, and they have various differential diagnoses. CT and magnetic resonance imaging are essential for diagnosis, and CT angiography is the gold standard. CONCLUSION Diagnosing petrous ICA aneurysms requires a high level of suspicion and CT angiography. Their clinical presentations vary from asymptomatic to severe. Case-specific management and endovascular treatment yield positive neurological outcomes.
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Affiliation(s)
- Nada Alouda
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Nouf H Alshammari
- Department of Otolaryngology-Head & Neck Surgery, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khalid Suwayyid Alomar
- Department of Otolaryngology-Head & Neck Surgery, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia; King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Shami
- Department of Otolaryngology-Head & Neck Surgery, Main Hospital, King Fahad Medical City, P.O. Box. 59046, Riyadh 11525, Saudi Arabia
| | - Abdullah Omar Alobaid
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Lampros M, Vlachos N, Tsitsopoulos PP, Zikou AK, Argyropoulou MI, Voulgaris S, Alexiou GA. The Role of Novel Imaging and Biofluid Biomarkers in Traumatic Axonal Injury: An Updated Review. Biomedicines 2023; 11:2312. [PMID: 37626808 PMCID: PMC10452517 DOI: 10.3390/biomedicines11082312] [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: 06/01/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of disability worldwide. Traumatic axonal injury (TAI) is a subtype of TBI resulting from high-impact forces that cause shearing and/or stretching of the axonal fibers in white matter tracts. It is present in almost half of cases of severe TBI and frequently associated with poor functional outcomes. Axonal injury results from axonotomy due to mechanical forces and the activation of a biochemical cascade that induces the activation of proteases. It occurs at a cellular level; hence, conventional imaging modalities often fail to display TAI lesions. However, the advent of novel imaging modalities, such as functional magnetic resonance imaging and fiber tractography, has significantly improved the detection and characteristics of TAI. Furthermore, the significance of several fluid and structural biomarkers has also been researched, while the contribution of omics in the detection of novel biomarkers is currently under investigation. In the present review, we discuss the role of imaging modalities and potential biomarkers in diagnosing, classifying, and predicting the outcome in patients with TAI.
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Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
| | - Nikolaos Vlachos
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
| | - Parmenion P. Tsitsopoulos
- Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, 54942 Thessaloniki, Greece;
| | - Anastasia K. Zikou
- Department of Radiology, University of Ioannina, 45110 Ioannina, Greece; (A.K.Z.); (M.I.A.)
| | - Maria I. Argyropoulou
- Department of Radiology, University of Ioannina, 45110 Ioannina, Greece; (A.K.Z.); (M.I.A.)
| | - Spyridon Voulgaris
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
| | - George A. Alexiou
- Department of Neurosurgery, School of Medicine, University of Ioannina, St. Niarhou Avenue, 45500 Ioannina, Greece; (M.L.); (N.V.); (S.V.)
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Jiang B, Mackay MT, Stence N, Domi T, Dlamini N, Lo W, Wintermark M. Neuroimaging in Pediatric Stroke. Semin Pediatr Neurol 2022; 43:100989. [PMID: 36344022 DOI: 10.1016/j.spen.2022.100989] [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: 05/04/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
Abstract
Pediatric stroke is unfortunately not a rare condition. It is associated with severe disability and mortality because of the complexity of potential clinical manifestations, and the resulting delay in seeking care and in diagnosis. Neuroimaging plays an important role in the multidisciplinary response for pediatric stroke patients. The rapid development of adult endovascular thrombectomy has created a new momentum in health professionals caring for pediatric stroke patients. Neuroimaging is critical to make decisions of identifying appropriate candidates for thrombectomy. This review article will review current neuroimaging techniques, imaging work-up strategies and special considerations in pediatric stroke. For resources limited areas, recommendation of substitute imaging approaches will be provided. Finally, promising new techniques and hypothesis-driven research protocols will be discussed.
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Affiliation(s)
- Bin Jiang
- Department of Radiology, Neuroradiology Section, Stanford University, Stanford, CA.
| | - Mark T Mackay
- Murdoch Children's Research Institute, Royal Children's Hospital and Department of Paediatrics, University of Melbourne, Victoria, Australia.
| | - Nicholas Stence
- Department of Radiology, pediatric Neuroradiology Section, University of Colorado School of Medicine, Aurora, CO
| | - Trish Domi
- Department of Neurology, Hospital for Sick Children, Toronto, Canada.
| | - Nomazulu Dlamini
- Department of Neurology, Hospital for Sick Children, Toronto, Canada.
| | - Warren Lo
- Department of Pediatrics and Neurology, The Ohio State University & Nationwide Children's Hospital, Columbus, OH.
| | - Max Wintermark
- Department of Neuroradiology, University of Texas MD Anderson Center, Houston, TX.
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Tasci B, Tasci I. Deep feature extraction based brain image classification model using preprocessed images: PDRNet. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kakkar P, Kakkar T, Patankar T, Saha S. Current approaches and advances in the imaging of stroke. Dis Model Mech 2021; 14:273651. [PMID: 34874055 PMCID: PMC8669490 DOI: 10.1242/dmm.048785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A stroke occurs when the blood flow to the brain is suddenly interrupted, depriving brain cells of oxygen and glucose and leading to further cell death. Neuroimaging techniques, such as computed tomography and magnetic resonance imaging, have greatly improved our ability to visualise brain structures and are routinely used to diagnose the affected vascular region of a stroke patient's brain and to inform decisions about clinical care. Currently, these multimodal imaging techniques are the backbone of the clinical management of stroke patients and have immensely improved our ability to visualise brain structures. Here, we review recent developments in the field of neuroimaging and discuss how different imaging techniques are used in the diagnosis, prognosis and treatment of stroke. Summary: Stroke imaging has undergone seismic shifts in the past decade. Although magnetic resonance imaging (MRI) is superior to computed tomography in providing vital information, further research on MRI is still required to bring its full potential into clinical practice.
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Affiliation(s)
- Pragati Kakkar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | - Tarun Kakkar
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
| | | | - Sikha Saha
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK
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Abstract
AbstractBrain tumor occurs owing to uncontrolled and rapid growth of cells. If not treated at an initial phase, it may lead to death. Despite many significant efforts and promising outcomes in this domain, accurate segmentation and classification remain a challenging task. A major challenge for brain tumor detection arises from the variations in tumor location, shape, and size. The objective of this survey is to deliver a comprehensive literature on brain tumor detection through magnetic resonance imaging to help the researchers. This survey covered the anatomy of brain tumors, publicly available datasets, enhancement techniques, segmentation, feature extraction, classification, and deep learning, transfer learning and quantum machine learning for brain tumors analysis. Finally, this survey provides all important literature for the detection of brain tumors with their advantages, limitations, developments, and future trends.
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Multi-view iterative random walker for automated salvageable tissue delineation in ischemic stroke from multi-sequence MRI. J Neurosci Methods 2021; 360:109260. [PMID: 34146591 DOI: 10.1016/j.jneumeth.2021.109260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/19/2021] [Accepted: 06/13/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Non-invasive and robust identification of salvageable tissue (penumbra) is crucial for interventional stroke therapy. Besides identifying stroke injury as a whole, the ability to automatically differentiate core and penumbra tissues, using both diffusion and perfusion magnetic resonance imaging (MRI) sequences is essential for ischemic stroke treatment. METHOD A fully automated and novel one-shot multi-view iterative random walker (MIRW) method with an automated injury seed point detection is developed for lesion delineation. MIRW utilizes the heirarchical decomposition of multi-sequence MRI physical properties of the underlying tissue within the lesion to maximize the inter-class variations of the volumetric histogram to estimate the probable seed points. These estimates are further utilized to conglomerate the lesion estimations iteratively from axial, coronal and sagittal MRI volumes for a computationally efficient segmentation and quantification of salvageable and necrotic tissues from multi-sequence MRI. RESULTS Comprehensive experimental analysis of MIRW is performed on three challenging adult(sub-)acute ischemic stroke datasets using performance measures like precision, sensitivity, specificity and Dice similarity score (DSC), which are computed with respect to the manual ground-truth. COMPARISON WITH EXISTING METHODS MIRW method resulted in a high DSC of 83.5% in a very less computational time of 98.23 s/volume, which is a significant improvement on the ISLES benchmark dataset for penumbra detection, compared to the state-of-the-art techniques. CONCLUSION Quantitative measures demonstrate the promising potential of MIRW for computational analysis of adult stroke and quantifying penumbra in stroke patients which is essential for selecting the good candidates for recanalization.
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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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Abdel-Tawab M, Hasan AA, Ahmed MA, Seif HMA, Yousif HA. Prognostic factors of delayed cerebral ischemia after subarachnoid hemorrhage including CT perfusion: a prospective cohort study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00180-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background
Delayed cerebral ischemia (DCI) is the worst sequel following subarachnoid hemorrhage (SAH), representing a challenge in prediction and prevention. The current study aims to identify the optimum predictors of DCI including CT perfusion (CTP) and to determine the best prognostic thresholds.
This prospective study included 49 SAH patients. All patients were treated with the standard therapy and underwent non-contrast CT, CTP, and CTA within 3 days after SAH. Hunt and Hess and Fisher scales were assessed besides quantitative CTP parameters. The primary endpoint was DCI within 21 days after SAH, defined as clinical deterioration or infarction.
Results
Out of 49 eligible patients with SAH, 9 patients developed DCI. Univariate analysis revealed that Hunt and Hess scale, Fisher scale, the presence of a cerebral aneurysm, and mean transit time (MTT) were predictive for DCI. Diagnostic threshold values by ROC curve analysis with optimal sensitivity and specificity were Hunt and Hess scale > 2, Fisher scale > 2, and MTT of 4.65 s.
Conclusion
MTT is a sensitive and specific predictor of DCI. However, Hunt and Hess scale has the optimal sensitivity and specificity to distinguish between patients who developed DCI and clinically stable patients.
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Nanomedicine for Ischemic Stroke. Int J Mol Sci 2020; 21:ijms21207600. [PMID: 33066616 PMCID: PMC7590220 DOI: 10.3390/ijms21207600] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
Stroke is a severe brain disease leading to disability and death. Ischemic stroke dominates in stroke cases, and there are no effective therapies in clinic, partly due to the challenges in delivering therapeutics to ischemic sites in the brain. This review is focused on the current knowledge of pathogenesis in ischemic stroke, and its potential therapies and diagnosis. Furthermore, we present recent advances in developments of nanoparticle-based therapeutics for improved treatment of ischemic stroke using polymeric NPs, liposomes and cell-derived nanovesicles. We also address several critical questions in ischemic stroke, such as understanding how nanoparticles cross the blood brain barrier and developing in vivo imaging technologies to address this critical question. Finally, we discuss new opportunities in developing novel therapeutics by targeting activated brain endothelium and inflammatory neutrophils to improve the current therapies for ischemic stroke.
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Bhat SS, Fernandes TT, Poojar P, Silva Ferreira M, Rao PC, Hanumantharaju MC, Ogbole G, Nunes RG, Geethanath S. Low‐Field MRI of Stroke: Challenges and Opportunities. J Magn Reson Imaging 2020; 54:372-390. [DOI: 10.1002/jmri.27324] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Seema S. Bhat
- Medical Imaging Research Centre Dayananda Sagar College of Engineering Bangalore India
| | - Tiago T. Fernandes
- Institute for Systems and Robotics and Department of Bioengineering, Instituto Superior Técnico Universidade de Lisboa Lisbon Portugal
| | - Pavan Poojar
- Medical Imaging Research Centre Dayananda Sagar College of Engineering Bangalore India
- Columbia University Magnetic Resonance Research Center New York New York USA
| | - Marta Silva Ferreira
- Institute for Systems and Robotics and Department of Bioengineering, Instituto Superior Técnico Universidade de Lisboa Lisbon Portugal
| | - Padma Chennagiri Rao
- Medical Imaging Research Centre Dayananda Sagar College of Engineering Bangalore India
| | | | - Godwin Ogbole
- Department of Radiology, College of Medicine University of Ibadan Ibadan Nigeria
| | - Rita G. Nunes
- Institute for Systems and Robotics and Department of Bioengineering, Instituto Superior Técnico Universidade de Lisboa Lisbon Portugal
| | - Sairam Geethanath
- Medical Imaging Research Centre Dayananda Sagar College of Engineering Bangalore India
- Columbia University Magnetic Resonance Research Center New York New York USA
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15
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The diagnostic value of diffusion-weighted imaging in differentiating benign from malignant hepatic lesions. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-0020-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Background
Diffusion-weighted imaging (DWI) is a novel imaging technique with growing application in onco-imaging. This modality evaluates the diffusion of water molecules in various tissues, which is restricted in hyper cellular regions such as malignant tissue. Apparent diffusion co-efficient (ADC) is a method which can quantify the degree of restriction in tissues and can have diagnostic roles in characterization of hepatic lesions. In this study, 93 patients with proven hepatic lesions were included. These patients had undergone initial evaluation via ultrasonography and dynamic CT scan, and had a definite diagnosis confirmed by biopsy. These patients underwent DW imaging and ADC values of their lesions were calculated. Patients were divided into two groups, benign and malignant groups, based on their biopsy results; and ADC values of hepatic lesions were compared in the two groups.
Results
The two groups were gender matched. There was a significant difference in the age distribution between the two groups. Mean ADC values for benign and malignant hepatic lesions were 1.58 ± 0.35 (10-3 mm2/s) and 0.87 ± 0.16 (10-3 mm2/s), respectively. There was a statistically significant differences between benign and malignant hepatic lesions (p value < 10-3). DW imaging had a sensitivity of 97.6% and specificity of 98.7% in detecting malignant hepatic lesions from benign ones (p = 0.0001, AUC = 0.99).
Conclusion
DW MRI imaging can differentiate malignant and benign liver lesions with high sensitivity and specificity using ADC values generated; furthermore, each subgroup of hepatic lesions could be determined based on ADC values.
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Zhang XH, Liang HM. Systematic review with network meta-analysis: Diagnostic values of ultrasonography, computed tomography, and magnetic resonance imaging in patients with ischemic stroke. Medicine (Baltimore) 2019; 98:e16360. [PMID: 31348236 PMCID: PMC6709059 DOI: 10.1097/md.0000000000016360] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Ischemic stroke is a foremost cause for disability and death worldwide. This study is conducted in order to compare the diagnostic values between transcranial Doppler ultrasound (ultrasonography), computed tomography (CT), and magnetic resonance imaging (MRI) in patients suffering from ischemic stroke by performing a network meta-analysis. METHODS We made use of Cochrane Library, PubMed, and Embase in order to obtain literature and papers. The combination analysis of both direct and indirect evidence in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy was conducted so as to assess the odds ratios (ORs) and surface under the cumulative ranking curve (SUCRA) values of the seven different imaging methods. These imaging techniques include ultrasonography, computed tomography (traditional CT, computed tomography angiography [CTA], computed tomography perfusion [CTP]), and MRI (traditional MRI, diffusion-weighted imaging [DWI], magnetic resonance angiography), in order to properly diagnose ischemic stroke patients. RESULTS Thirteen eligible diagnostic trials were enrolled into this network meta-analysis. The results of the traditional meta-analysis showed that among CT methods, CTP showed higher sensitivity, NPV, and accuracy; among MRI methods, DWI had relatively higher sensitivity, NPV, and accuracy. The results of network meta-analysis showed that DWI had relatively higher sensitivity, NPV, and accuracy when compared with traditional CT, CTA, magnetic resonance angiography and traditional MRI. CTP showed higher SUCRA among CT methods while DWI showed higher SUCRA among MRI methods. A cluster analysis revealed that DWI had the highest diagnostic value in terms of sensitivity, PPV, NPV, and accuracy amongst the aforementioned seven imaging techniques. CONCLUSION This network meta-analysis provides supporting evidence to the idea that DWI has a higher diagnostic value regarding ischemic stroke among MRI methods, and CTP has a poor diagnostic value among CT methods, which provide therapeutic considerations for Ischemic stroke intervention.
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Affiliation(s)
| | - Hui-Min Liang
- Department of Neurology, Huaihe Hospital of Henan University, Kaifeng, P. R. China
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17
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Holdsworth SJ, O'Halloran R, Setsompop K. The quest for high spatial resolution diffusion-weighted imaging of the human brain in vivo. NMR IN BIOMEDICINE 2019; 32:e4056. [PMID: 30730591 DOI: 10.1002/nbm.4056] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/11/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
Diffusion-weighted imaging, a contrast unique to MRI, is used for assessment of tissue microstructure in vivo. However, this exquisite sensitivity to finer scales far above imaging resolution comes at the cost of vulnerability to errors caused by sources of motion other than diffusion motion. Addressing the issue of motion has traditionally limited diffusion-weighted imaging to a few acquisition techniques and, as a consequence, to poorer spatial resolution than other MRI applications. Advances in MRI imaging methodology have allowed diffusion-weighted MRI to push to ever higher spatial resolution. In this review we focus on the pulse sequences and associated techniques under development that have pushed the limits of image quality and spatial resolution in diffusion-weighted MRI.
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Affiliation(s)
- Samantha J Holdsworth
- Department of Anatomy Medical Imaging & Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | | | - Kawin Setsompop
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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18
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WU L, ZHANG L. Effect of High-quality Nursing on Improvement of Anxiety and Depression of Patients with Acute Stroke in MRI Examination. IRANIAN JOURNAL OF PUBLIC HEALTH 2017; 46:1646-1651. [PMID: 29259939 PMCID: PMC5734964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to evaluate the effect of high-quality nursing on improvement of anxiety and depression of patients with acute stroke in magnetic resonance imaging (MRI) examination. METHODS A total of 120 patients diagnosed as acute stroke for the first time were enrolled in Liaocheng People's Hospital from 2016-2017 and randomly divided into control group (n=60) and observation group (n=60). All patients received cerebral MRI examination at 6h and 24h after admission and before discharge. The control group was treated with routine nursing, while the observation group was treated with high-quality nursing, and the specific nursing measures included the establishment of high-quality nursing group, full evaluation of the severity of disease, timely solving of difficulties in MRI examination, understanding of the patient's anxiety and depression, establishment of personal information files before discharge, etc. The completion rate and average duration of examination, the improvement of anxiety and depression and the nursing satisfaction were compared between the two groups. RESULTS In observation group, the completion rate of MRI examination was significantly increased (P=0.035), the average duration was shortened (P=0.011), the anxiety and depression scores (self-rating anxiety scale (SAS) and self-rating depression scale (SDS)) were improved obviously (P=0.006 and 0.009), and the nursing satisfaction score and rate was increased (P=0.000 and 0.027); the differences were statistically significant (P<0.05). CONCLUSION High-quality nursing can significantly improve the anxiety and depression of patients with acute stroke in MRI examination, which has a better application value in increasing the completion rate of examination, shortening the duration of examination and improving the nursing satisfaction.
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Affiliation(s)
- Lin WU
- Dept. of MRI, Liaocheng People’s Hospital, Liaocheng, Shandong, China,Corresponding Author:
| | - Li ZHANG
- Dept. of Cardiology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
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