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Clottes P, Bochaton T, Mechtouff L, Derex L, Cho TH, Fontaine J, Rascle L, Berthezène Y, Amaz C, Thibault H, Bergerot C, Nighoghossian N, Ong E. Safety and efficacy of reperfusion therapies in acute ischemic stroke related to left ventricular thrombus: A retrospective cohort study. Rev Neurol (Paris) 2024:S0035-3787(24)00417-X. [PMID: 38431497 DOI: 10.1016/j.neurol.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Left ventricular thrombus (LVT) is a source of cardiogenic embolic stroke. Conflicting data exist in the literature regarding the utilization of intravenous thrombolysis (IVT) at the acute phase of stroke in presence of LVT. We sought to assess the efficacy and safety of reperfusion therapies (IVT and/or thrombectomy) in patients with LVT. METHODS We retrospectively analyzed patients with acute ischemic stroke and proven LVT and divided them in two groups: an intervention group with patients treated by reperfusion therapies and a control group with untreated patients. RESULTS Between 2009 and 2021, 3890 patients were treated by reperfusion therapies in the Lyon stroke center, 33 of whom (0.9%) had LVT. We identified 27 control patients. There were more embolic recurrences at six months in the intervention group than in the control group (nine recurrences versus three, P=0.03, OR=13.56, 95% CI [1.5;195]). Only two early embolic recurrences (< 24h) occurred, both in the IVT group. There was a 4.8-fold decrease in the median NIHSS score between baseline and 24h follow-up in the intervention group (P<0.0001), and the two groups exhibited similar six-month mortality. At stroke onset, cardiopathy was known in 70% of patients, while LVT was known in 30%. CONCLUSION Acute reperfusion therapies seem to be effective in the context of stroke in patients with LVT. However, further studies are needed to support the hypothesis that stroke recurrence might be related to the use of IVT.
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Affiliation(s)
- P Clottes
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France.
| | - T Bochaton
- Service d'urgences cardiologiques et de soins intensifs de cardiologie, hôpital Louis-Pradel, 59, boulevard Pinel, 69500 Bron, France
| | - L Mechtouff
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
| | - L Derex
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
| | - T-H Cho
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
| | - J Fontaine
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
| | - L Rascle
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
| | - Y Berthezène
- Service d'imagerie médicale, 59, boulevard Pinel, 69500 Bron, France
| | - C Amaz
- Centre d'investigations cliniques, hôpital Louis-Pradel, 59, boulevard Pinel, 69500 Bron, France
| | - H Thibault
- Service des explorations fonctionnelles cardiovasculaires, hôpital Louis-Pradel, 59, boulevard Pinel, 69500 Bron, France
| | - C Bergerot
- Service des explorations fonctionnelles cardiovasculaires, hôpital Louis-Pradel, 59, boulevard Pinel, 69500 Bron, France
| | - N Nighoghossian
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
| | - E Ong
- Service de neurologie vasculaire, hôpital Pierre-Wertheimer, 59, boulevard Pinel, 69500 Bron, France
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Fournel J, Hermier M, Martin A, Gamondès D, Tommasino E, Broussolle T, Morgado A, Baassiri W, Cotton F, Berthezène Y, Bani-Sadr A. It Looks Like a Spinal Cord Tumor but It Is Not. Cancers (Basel) 2024; 16:1004. [PMID: 38473365 DOI: 10.3390/cancers16051004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Differentiating neoplastic from non-neoplastic spinal cord pathologies may be challenging due to overlapping clinical and radiological features. Spinal cord tumors, which comprise only 2-4% of central nervous system tumors, are rarer than non-tumoral myelopathies of inflammatory, vascular, or infectious origins. The risk of neurological deterioration and the high rate of false negatives or misdiagnoses associated with spinal cord biopsies require a cautious approach. Facing a spinal cord lesion, prioritizing more common non-surgical myelopathies in differential diagnoses is essential. A comprehensive radiological diagnostic approach is mandatory to identify spinal cord tumor mimics. The diagnostic process involves a multi-step approach: detecting lesions primarily using MRI techniques, precise localization of lesions, assessing lesion signal intensity characteristics, and searching for potentially associated anomalies at spinal cord and cerebral MRI. This review aims to delineate the radiological diagnostic approach for spinal cord lesions that may mimic tumors and briefly highlight the primary pathologies behind these lesions.
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Affiliation(s)
- Julien Fournel
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Anna Martin
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Delphine Gamondès
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Emanuele Tommasino
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Théo Broussolle
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Alexis Morgado
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Wassim Baassiri
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Francois Cotton
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
- Department of Radiology, South Lyon Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
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Mechtouff L, Balanca B, Jung J, Bourgeois-Vionnet J, Dumot C, Guery D, Picart T, Bapteste L, Demarquay G, Bani-Sadr A, Rascle L, Berthezène Y, Jacquesson T, Amaz C, Macabrey J, Ramos I, Viprey M, Rode G, Cortet M. Interrater reliability in neurology objective structured clinical examination across specialties. Med Teach 2024; 46:239-244. [PMID: 37605843 DOI: 10.1080/0142159x.2023.2244146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE To assess interrater reliability and examiners' characteristics, especially specialty, associated with scoring of neurology objective structured clinical examination (OSCE). MATERIAL AND METHODS During a neurology mock OSCE, five randomly chosen students volunteers were filmed while performing 1 of the 5 stations. Video recordings were scored by physicians from the Lyon and Clermont-Ferrand university teaching hospitals to assess students performance using both a checklist scoring and a global rating scale. Interrater reliability between examiners were assessed using intraclass coefficient correlation. Multivariable linear regression models including video recording as random effect dependent variable were performed to detect factors associated with scoring. RESULTS Thirty examiners including 15 (50%) neurologists participated. The intraclass correlation coefficient of checklist scores and global ratings between examiners were 0.71 (CI95% [0.45-0.95]) and 0.54 (CI95% [0.28-0.91]), respectively. In multivariable analyses, no factor was associated with checklist scores, while male gender of examiner was associated with lower global rating (β coefficient = -0.37; CI 95% [-0.62-0.11]). CONCLUSIONS Our study demonstrated through a video-based scoring method that agreement among examiners was good using checklist scoring while moderate using global rating scale in neurology OSCE. Examiner's specialty did not affect scoring whereas gender was associated with global rating scale.
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Affiliation(s)
| | - Baptiste Balanca
- Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Lyon, France
| | - Julien Jung
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | | | - Chloé Dumot
- Department of Vascular and Tumoral Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Déborah Guery
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | - Thiébaud Picart
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bapteste
- Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Lyon, France
| | - Geneviève Demarquay
- Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, Lyon, France
| | | | - Lucie Rascle
- Stroke Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | | | - Camille Amaz
- Clinical Investigation Center, Hospices Civils de Lyon, Lyon, France
| | - Juliette Macabrey
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Inès Ramos
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Marie Viprey
- RESearch on HealthcAre Performance RESHAPE, INSERM U1290, Université Claude Bernard, Lyon, France
| | - Gilles Rode
- Physical Medicine and Rehabilitation Department, Henry Gabrielle Hospital, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Marion Cortet
- Gynecology and Obstetrics Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
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Bani-Sadr A, Escande R, Mechtouff L, Pavie D, Hermier M, Derex L, Choc TH, Eker OF, Nighoghossian N, Berthezène Y. Vascular hyperintensities on baseline FLAIR images are associated with functional outcome in stroke patients with successful recanalization after mechanical thrombectomy. Diagn Interv Imaging 2023; 104:337-342. [PMID: 37355301 DOI: 10.1016/j.diii.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The purpose of this study was to assess the prognostic value of vascular hyperintensities on FLAIR images (VHF) at admission MRI in patients with acute ischemic stroke (AIS) achieving successful recanalization after mechanical thrombectomy. MATERIALS AND METHODS Patients with AIS treated by mechanical thrombectomy following admission MRI from the single-center HIBISCUS-STROKE cohort were assessed for eligibility. VHF were categorized using a four-scale classification and were considered poor when grade < 3 (i.e., absence of distal VHF). Recanalization was considered successful when modified thrombolysis in cerebral infarction score was ≥ 2B Functional outcome was considered poor if modified Rankin scale (mRS) at three months was > 2. Univariable and multiple variable logistic regressions were performed to identify factors associated with poor functional outcome despite successful recanalization. RESULTS A total of 108 patients were included. There were 65 men and 43 women with a median age of 70.5 years (interquartile range: 55.0, 81.0; age range: 22.0-93.0 years). Among them, 39 subjects (36.1%) had poor functional outcome at three months. Univariable logistic regressions indicated that poorly extended VHF (VHF grade < 3) were associated with a poor functional outcome (P = 0.008) as well as age, hypertension and diabetes, baseline National Institute of Health Stroke Scale (NIHSS) score, pre-stroke mRS, lack of intravenous thrombolysis, cerebral microangiopathy and the presence of microbleeds. Multivariable analysis confirmed that poor VHF status was independently associated with a poor functional outcome (odds ratio [OR], 4.26; 95% confidence interval [CI]: 1.55-12.99; P = 0.007) in combination with hypertension (OR, 1.25; 95% CI: 0.87-1.85; P = 0.02), baseline NIHSS score (OR, 1.09; 95% CI: 1.04-1.20; P = 0.03), pre-stroke mRS (OR, 2.05; 95% CI: 1.07-4.61; P = 0.05) and lack of intravenous thrombolysis (OR, 0.23; 95% CI: 0.08-0.61; P = 0.004). CONCLUSION Poorly extended VHF (grade <3) at admission MRI are associated with a poor functional outcome at three months despite successful recanalization by mechanical thrombectomy.
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Affiliation(s)
- Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France.
| | - Raphaël Escande
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laura Mechtouff
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Dylan Pavie
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France
| | - Laurent Derex
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; Research on Healthcare Performance (RESHAPE), INSERM U 1290, Claude Bernard Lyon I University, 69373, Lyon Cedex 08, France
| | - Tae-Hee Choc
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Omer F Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
| | - Norbert Nighoghossian
- Stroke Department, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CarMeN Laboratory, INSERM U1060, Claude Bernard Lyon I University, 69500, Bron, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 69500, Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 69100, Villeurbanne, France
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5
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Bani-Sadr A, Eker OF, Cho TH, Ameli R, Berhouma M, Cappucci M, Derex L, Mechtouff L, Meyronet D, Nighoghossian N, Berthezène Y, Hermier M. Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas. AJNR Am J Neuroradiol 2023:ajnr.A7914. [PMID: 37385679 PMCID: PMC10337618 DOI: 10.3174/ajnr.a7914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/29/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas. MATERIALS AND METHODS Patients 1-55 years of age with acute (≤7 days) spontaneous intracerebral hemorrhage were included. Two neuroradiologists reviewed CT and MR imaging data and assessed the characteristics of hematomas, including their shape (spherical/ovoid or not), their regular or irregular margins, and associated abnormalities including extralesional hemorrhage and peripheral rim enhancement. Imaging findings were correlated with etiology. The study population was randomly split to provide a training sample (50%) and a validation sample (50%). From the training sample, univariate and multivariate logistic regression was performed to identify factors predictive of cavernomas, and a decision tree was built. Its performance was assessed using the validation sample. RESULTS Four hundred seventy-eight patients were included, of whom 85 had hemorrhagic cavernomas. In multivariate analysis, cavernoma-related hematomas were associated with spherical/ovoid shape (P < .001), regular margins (P = .009), absence of extralesional hemorrhage (P = .01), and absence of peripheral rim enhancement (P = .002). These criteria were included in the decision tree model. The validation sample (n = 239) had the following performance: diagnostic accuracy of 96.1% (95% CI, 92.2%-98.4%), sensitivity of 97.95% (95% CI, 95.8%-98.9%), specificity of 89.5% (95% CI, 75.2%-97.0%), positive predictive value of 97.7% (95% CI, 94.3%-99.1%), and negative predictive value of 94.4% (95% CI, 81.0%-98.5%). CONCLUSIONS An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.
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Affiliation(s)
- A Bani-Sadr
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - O F Eker
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - T-H Cho
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - R Ameli
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
| | | | - M Cappucci
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
| | - L Derex
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- Research on Healthcare Performance (L.D.), Institut National de la Santé et de la Recherche Médicale U 1290, Claude Bernard Lyon I University, Domaine Rockefeller, Lyon, France
| | - L Mechtouff
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - D Meyronet
- Department of Neurosurgery B Institute of Pathology East, Neuropathology (D.M.), East Group Hospital, Hospices Civils de Lyon, Bron, France
| | - N Nighoghossian
- Stroke Department (T.-H.C., L.D., L.M., N.N.)
- CarMeN Laboratory (T.-H.C., L.M., N.N.), Institut National de la Santé et de la Recherche Médicale U1060, Claude Bernard Lyon I University, Bron, France
| | - Y Berthezène
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
- Creatis Laboratory (A.B.-S., O.F.E., Y.B.), National Center for Scientific Research Unité Mixte de Recherche 5220, Institut National de la Santé et de la Recherche Médicale U 5220, Claude Bernard Lyon I University, Villeurbanne, France
| | - M Hermier
- From the Department of Neuroradiology (A.B.-S., O.F.E., R.A., M.C., Y.B., M.H.)
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Lerouge F, Ong E, Rositi H, Mpambani F, Berner LP, Bolbos R, Olivier C, Peyrin F, Apputukan VK, Monnereau C, Andraud C, Chaput F, Berthezène Y, Braun B, Jucker M, Åslund AK, Nyström S, Hammarström P, R Nilsson KP, Lindgren M, Wiart M, Chauveau F, Parola S. In vivo targeting and multimodal imaging of cerebral amyloid-β aggregates using hybrid GdF 3 nanoparticles. Nanomedicine (Lond) 2023; 17:2173-2187. [PMID: 36927004 DOI: 10.2217/nnm-2022-0252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Aim: To propose a new multimodal imaging agent targeting amyloid-β (Aβ) plaques in Alzheimer's disease. Materials & methods: A new generation of hybrid contrast agents, based on gadolinium fluoride nanoparticles grafted with a pentameric luminescent-conjugated polythiophene, was designed, extensively characterized and evaluated in animal models of Alzheimer's disease through MRI, two-photon microscopy and synchrotron x-ray phase-contrast imaging. Results & conclusion: Two different grafting densities of luminescent-conjugated polythiophene were achieved while preserving colloidal stability and fluorescent properties, and without affecting biodistribution. In vivo brain uptake was dependent on the blood-brain barrier status. Nevertheless, multimodal imaging showed successful Aβ targeting in both transgenic mice and Aβ fibril-injected rats.
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Affiliation(s)
- Frédéric Lerouge
- University of Lyon, École Normale Supérieure de Lyon, Laboratoire de Chimie, University of Lyon 1, CNRS UMR, 5182, Lyon, France
| | - Elodie Ong
- University of Lyon, Lyon Neuroscience Research Center, CNRS UMR, 5292, INSERM U1028, University of Lyon 1, Lyon, France
| | - Hugo Rositi
- University of Clermont Auvergne, Clermont Auvergne INP, Institut Pascal, CNRS UMR, 6602, Clermont-Ferrand, France
| | - Francis Mpambani
- University of Lyon, École Normale Supérieure de Lyon, Laboratoire de Chimie, University of Lyon 1, CNRS UMR, 5182, Lyon, France
| | - Lise-Prune Berner
- University of Lyon, CREATIS, INSA-Lyon, University of Lyon 1, CNRS UMR, 5220, INSERM U1206, Villeurbanne, France
| | | | - Cécile Olivier
- University of Lyon, CREATIS, INSA-Lyon, University of Lyon 1, CNRS UMR, 5220, INSERM U1206, Villeurbanne, France
| | - Françoise Peyrin
- University of Lyon, CREATIS, INSA-Lyon, University of Lyon 1, CNRS UMR, 5220, INSERM U1206, Villeurbanne, France
| | - Vinu K Apputukan
- University of Lyon, École Normale Supérieure de Lyon, Laboratoire de Chimie, University of Lyon 1, CNRS UMR, 5182, Lyon, France
| | - Cyrille Monnereau
- University of Lyon, École Normale Supérieure de Lyon, Laboratoire de Chimie, University of Lyon 1, CNRS UMR, 5182, Lyon, France
| | - Chantal Andraud
- University of Lyon, École Normale Supérieure de Lyon, Laboratoire de Chimie, University of Lyon 1, CNRS UMR, 5182, Lyon, France
| | - Frederic Chaput
- University of Lyon, École Normale Supérieure de Lyon, Laboratoire de Chimie, University of Lyon 1, CNRS UMR, 5182, Lyon, France
| | - Yves Berthezène
- University of Lyon, CREATIS, INSA-Lyon, University of Lyon 1, CNRS UMR, 5220, INSERM U1206, Villeurbanne, France
| | - Bettina Braun
- Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Mathias Jucker
- Department of Cellular Neurology, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Andreas Ko Åslund
- Department of Physics, Chemistry, & Biology, Linköping University, Linköping, Sweden
| | - Sofie Nyström
- Department of Physics, Chemistry, & Biology, Linköping University, Linköping, Sweden
| | - Per Hammarström
- Department of Physics, Chemistry, & Biology, Linköping University, Linköping, Sweden
| | - K Peter R Nilsson
- Department of Physics, Chemistry, & Biology, Linköping University, Linköping, Sweden
| | - Mikael Lindgren
- Department of Physics, Norwegian University of Science & Technology, Trondheim, Norway
| | - Marlène Wiart
- University of Lyon, CarMeN laboratory, INSERM U1060, INRA, U1397, University of Lyon 1, INSA-Lyon, Oullins, France.,CNRS, Villeurbanne, France
| | - Fabien Chauveau
- University of Lyon, Lyon Neuroscience Research Center, CNRS UMR, 5292, INSERM U1028, University of Lyon 1, Lyon, France
| | - Stephane Parola
- University of Lyon, École Normale Supérieure de Lyon, Laboratoire de Chimie, University of Lyon 1, CNRS UMR, 5182, Lyon, France
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Peter-Derex L, Philippeau F, Garnier P, André-Obadia N, Boulogne S, Catenoix H, Convers P, Mazzola L, Gouttard M, Esteban M, Fontaine J, Mechtouff L, Ong E, Cho TH, Nighoghossian N, Perreton N, Termoz A, Haesebaert J, Schott AM, Rabilloud M, Pivot C, Dhelens C, Filip A, Berthezène Y, Rheims S, Boutitie F, Derex L. Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol 2022; 21:781-791. [PMID: 35963261 DOI: 10.1016/s1474-4422(22)00235-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The incidence of early seizures (occurring within 7 days of stroke onset) after intracerebral haemorrhage reaches 30% when subclinical seizures are diagnosed by continuous EEG. Early seizures might be associated with haematoma expansion and worse neurological outcomes. Current guidelines do not recommend prophylactic antiseizure treatment in this setting. We aimed to assess whether prophylactic levetiracetam would reduce the risk of acute seizures in patients with intracerebral haemorrhage. METHODS The double-blind, randomised, placebo-controlled, phase 3 PEACH trial was conducted at three stroke units in France. Patients (aged 18 years or older) who presented with a non-traumatic intracerebral haemorrhage within 24 h after onset were randomly assigned (1:1) to levetiracetam (intravenous 500 mg every 12 h) or matching placebo. Randomisation was done with a web-based system and stratified by centre and National Institutes of Health Stroke Scale (NIHSS) score at baseline. Treatment was continued for 6 weeks. Continuous EEG was started within 24 h after inclusion and recorded over 48 h. The primary endpoint was the occurrence of at least one clinical seizure within 72 h of inclusion or at least one electrographic seizure recorded on continuous EEG, analysed in the modified intention-to-treat population, which comprised all patients who were randomly assigned to treatment and who had a continuous EEG performed. This trial was registered at ClinicalTrials.gov, NCT02631759, and is now closed. Recruitment was prematurely stopped after 48% of the recruitment target was reached due to a low recruitment rate and cessation of funding. FINDINGS Between June 1, 2017, and April 14, 2020, 50 patients with mild-to-moderate severity intracerebral haemorrhage were included: 24 were assigned to levetiracetam and 26 to placebo. During the first 72 h, a clinical or electrographic seizure was observed in three (16%) of 19 patients in the levetiracetam group versus ten (43%) of 23 patients in the placebo group (odds ratio 0·16, 95% CI 0·03-0·94, p=0·043). All seizures in the first 72 h were electrographic seizures only. No difference in depression or anxiety reporting was observed between the groups at 1 month or 3 months. Depression was recorded in three (13%) patients who received levetiracetam versus four (15%) patients who received placebo, and anxiety was reported for two (8%) patients versus one (4%) patient. The most common treatment-emergent adverse events in the levetiracetam group versus the placebo group were headache (nine [39%] vs six [24%]), pain (three [13%] vs ten [40%]), and falls (seven [30%] vs four [16%]). The most frequent serious adverse events were neurological deterioration due to the intracerebral haemorrhage (one [4%] vs four [16%]) and severe pneumonia (two [9%] vs two [8%]). No treatment-related death was reported in either group. INTERPRETATION Levetiracetam might be effective in preventing acute seizures in intracerebral haemorrhage. Larger studies are needed to determine whether seizure prophylaxis improves functional outcome in patients with intracerebral haemorrhage. FUNDING French Ministry of Health.
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Affiliation(s)
- Laure Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France.
| | - Frédéric Philippeau
- Stroke Unit, Department of Neurology, Fleyriat Hospital, Bourg en Bresse, France
| | - Pierre Garnier
- Stroke Centre, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Nathalie André-Obadia
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Sébastien Boulogne
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Hélène Catenoix
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Philippe Convers
- Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France; Clinical Neurophysiology Unit, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Laure Mazzola
- Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France; Clinical Neurophysiology Unit, Department of Neurology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Michel Gouttard
- Stroke Unit, Department of Neurology, Fleyriat Hospital, Bourg en Bresse, France
| | - Maud Esteban
- Stroke Centre, Lyon University Hospital, Lyon, France
| | | | | | - Elodie Ong
- Stroke Centre, Lyon University Hospital, Lyon, France
| | - Tae-Hee Cho
- Stroke Centre, Lyon University Hospital, Lyon, France
| | | | - Nathalie Perreton
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne Termoz
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Julie Haesebaert
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Anne-Marie Schott
- Public Health Unit, Clinical Research and Epidemiology Department, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
| | - Muriel Rabilloud
- Department of Biostatistics, Lyon University Hospital, Lyon, France; Biometry and Evolutionary Biology Laboratory, CNRS UMR 5558, Biostatistics Health Team, Villeurbanne, France
| | - Christine Pivot
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Carole Dhelens
- Pharmacy, FRIPHARM, Edouard Herriot Hospital, Lyon University Hospital, Lyon, France
| | - Andrea Filip
- Department of Neuroradiology, Neurological Hospital, Lyon University Hospital, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Neurological Hospital, Lyon University Hospital, Lyon, France
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Lyon University Hospital, Lyon, France; Lyon Neuroscience Research Centre, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Florent Boutitie
- Department of Biostatistics, Lyon University Hospital, Lyon, France; Biometry and Evolutionary Biology Laboratory, CNRS UMR 5558, Biostatistics Health Team, Villeurbanne, France
| | - Laurent Derex
- Stroke Centre, Lyon University Hospital, Lyon, France; University Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France
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Rascle L, Bani Sadr A, Amaz C, Mewton N, Buisson M, Hermier M, Ong E, Fontaine J, Derex L, Berthezène Y, Eker OF, Cho TH, Nighoghossian N, Mechtouff L. Does the Brush-Sign Reflect Collateral Status and DWI-ASPECTS in Large Vessel Occlusion? Front Neurol 2022; 13:828256. [PMID: 35309551 PMCID: PMC8924293 DOI: 10.3389/fneur.2022.828256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The relevance of the brush-sign remained poorly documented in large vessel occlusion (LVO). We aimed to assess the relationship between the brush-sign and collateral status and its potential impact on baseline diffusion-weighted imaging–Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) in acute ischemic stroke (AIS) patients eligible to mechanical thrombectomy (MT). Methods Consecutive patients admitted in the Lyon Stroke Center with anterior circulation AIS due to intracranial internal carotid artery (ICA) and/or M1 or M2 segment of the middle cerebral artery (MCA) occlusion eligible for MT were included. The brush-sign was assessed on T2-gradient-echo MRI. Collateral status was assessed on digital subtraction angiography according to the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score. Results In this study, 504 patients were included, among which 171 (33.9%) patients had a brush-sign. Patients with a brush-sign more frequently had a poor collateral status [72 (42.1%) vs. 103 (30.9%); p = 0.017]. In univariable analysis, a DWI-ASPECTS < 7 was associated with a brush sign. Following multivariable analysis, the brush-sign no longer affected DWI-ASPECTS < 7 while the latter remained associated with younger age [odds ratio (OR) 0.97, 95% CI.96–0.99], male sex (OR 1.79, 95% CI 1.08–2.99), a higher National Institutes of Health Stroke Scale (NIHSS) score (OR 1.16, 95% CI 1.1–1.21), a poor collateral status (OR 9.35, 95% CI 5.59-16.02), MCA segment (OR 2.54, 95% CI 1.25–5.38), and intracranial ICA (OR 3.01, 95% CI 1.16–8) occlusion. Conclusions and Relevance The brush-sign may be a marker of poor collateral status but did not independently predict a lower DWI-ASPECTS. Clinical Trial Registration ClinicalTrials.gov, identifier: NCT04620642.
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Affiliation(s)
- Lucie Rascle
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | | | - Camille Amaz
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Nathan Mewton
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, Hospices Civils de Lyon, INSERM, Lyon, France
| | - Marc Hermier
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Elodie Ong
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Stroke, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM, University Lyon 1, Lyon, France
- *Correspondence: Laura Mechtouff
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9
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Bani-Sadr A, Cho TH, Cappucci M, Hermier M, Ameli R, Filip A, De Bourguignon C, Riva R, Derex L, Mechtouff L, Eker O, Nighoghossian N, Berthezène Y. Évaluation des logiciels de perfusion irm dans la prédiction du volume final de l'infarctus après thrombectomie mécanique. J Neuroradiol 2022. [DOI: 10.1016/j.neurad.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Hubert V, Hristovska I, Karpati S, Benkeder S, Dey A, Dumot C, Amaz C, Chounlamountri N, Watrin C, Comte J, Chauveau F, Brun E, Marche P, Lerouge F, Parola S, Berthezène Y, Vorup‐Jensen T, Pascual O, Wiart M. Multimodal Imaging with NanoGd Reveals Spatiotemporal Features of Neuroinflammation after Experimental Stroke. Adv Sci (Weinh) 2021; 8:e2101433. [PMID: 34197055 PMCID: PMC8425862 DOI: 10.1002/advs.202101433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/12/2021] [Indexed: 05/09/2023]
Abstract
The purpose of this study is to propose and validate a preclinical in vivo magnetic resonance imaging (MRI) tool to monitor neuroinflammation following ischemic stroke, based on injection of a novel multimodal nanoprobe, NanoGd, specifically designed for internalization by phagocytic cells. First, it is verified that NanoGd is efficiently internalized by microglia in vitro. In vivo MRI coupled with intravenous injection of NanoGd in a permanent middle cerebral artery occlusion mouse model results in hypointense signals in the ischemic lesion. In these mice, longitudinal two-photon intravital microscopy shows NanoGd internalization by activated CX3CR1-GFP/+ cells. Ex vivo analysis, including phase contrast imaging with synchrotron X-ray, histochemistry, and transmission electron microscopy corroborate NanoGd accumulation within the ischemic lesion and uptake by immune phagocytic cells. Taken together, these results confirm the potential of NanoGd-enhanced MRI as an imaging biomarker of neuroinflammation at the subacute stage of ischemic stroke. As far as it is known, this work is the first to decipher the working mechanism of MR signals induced by a nanoparticle passively targeted at phagocytic cells by performing intravital microscopy back-to-back with MRI. Furthermore, using a gadolinium-based rather than an iron-based contrast agent raises future perspectives for the development of molecular imaging with emerging computed tomography technologies.
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Affiliation(s)
- Violaine Hubert
- Univ‐LyonIRIS TeamCarMeN LaboratoryInserm U1060INRA U1397INSA LyonUniversité Claude Bernard Lyon 1Groupement Hospitalier Est59 bd. PinelBron69500France
| | - Ines Hristovska
- SYNATAC TeamInstitut NeuroMyoGèneUniversité Claude Bernard Lyon 1CNRS UMR 5310, INSERM U1217Faculté de Médecine et de Pharmacie8 avenue RockefellerLyon69008France
| | - Szilvia Karpati
- Université de LyonÉcole Normale Supérieure de LyonCNRS UMR 5182Université Claude Bernard Lyon 1Laboratoire de ChimieLyonF69342France
| | - Sarah Benkeder
- SYNATAC TeamInstitut NeuroMyoGèneUniversité Claude Bernard Lyon 1CNRS UMR 5310, INSERM U1217Faculté de Médecine et de Pharmacie8 avenue RockefellerLyon69008France
| | - Arindam Dey
- Institut pour l'Avancée des BiosciencesCentre de Recherche UGA / Inserm U 1209 / CNRS UMR 5309Site Santé ‐ Allée des AlpesLa Tronche38700France
| | - Chloé Dumot
- Univ‐LyonIRIS TeamCarMeN LaboratoryInserm U1060INRA U1397INSA LyonUniversité Claude Bernard Lyon 1Groupement Hospitalier Est59 bd. PinelBron69500France
| | - Camille Amaz
- Clinical Investigation CenterHospices Civils de LyonLouis Pradel Hospital28 avenue Doyen LépineBron69500France
| | - Naura Chounlamountri
- SYNATAC TeamInstitut NeuroMyoGèneUniversité Claude Bernard Lyon 1CNRS UMR 5310, INSERM U1217Faculté de Médecine et de Pharmacie8 avenue RockefellerLyon69008France
| | - Chantal Watrin
- SYNATAC TeamInstitut NeuroMyoGèneUniversité Claude Bernard Lyon 1CNRS UMR 5310, INSERM U1217Faculté de Médecine et de Pharmacie8 avenue RockefellerLyon69008France
| | - Jean‐Christophe Comte
- FORGETTING TeamLyon Neuroscience Research Center (CRNL)CNRS UMR5292INSERM U1028Université Claude Bernard Lyon 1Centre Hospitalier Le Vinatier ‐ Bâtiment 462 ‐ Neurocampus Michel Jouvet95 boulevard PinelBron69675France
| | - Fabien Chauveau
- Université de LyonLyon Neuroscience Research Center (CRNL)CNRS UMR5292INSERM U1028Université Claude Bernard Lyon 1Groupement Hospitalier Est ‐ CERMEP59 bd PinelBron Cedex69677France
| | - Emmanuel Brun
- Synchrotron Radiation for Biomedical Research (STROBE)UA7 INSERMUniversité Grenoble AlpesMedical Beamline at the European Synchrotron Radiation Facility71 Avenue des MartyrsGrenoble Cedex 938043France
| | - Patrice Marche
- Institut pour l'Avancée des BiosciencesCentre de Recherche UGA / Inserm U 1209 / CNRS UMR 5309Site Santé ‐ Allée des AlpesLa Tronche38700France
| | - Fréderic Lerouge
- Université de LyonÉcole Normale Supérieure de LyonCNRS UMR 5182Université Claude Bernard Lyon 1Laboratoire de ChimieLyonF69342France
| | - Stéphane Parola
- Université de LyonÉcole Normale Supérieure de LyonCNRS UMR 5182Université Claude Bernard Lyon 1Laboratoire de ChimieLyonF69342France
| | - Yves Berthezène
- Univ‐LyonCreatis LaboratoryCNRS UMR5220Inserm U1044INSA LyonVilleurbanne Cedex69621France
| | - Thomas Vorup‐Jensen
- Department of BiomedicineBiophysical Immunology LaboratoryAarhus UniversityAarhus CDK‐8000Denmark
| | - Olivier Pascual
- SYNATAC TeamInstitut NeuroMyoGèneUniversité Claude Bernard Lyon 1CNRS UMR 5310, INSERM U1217Faculté de Médecine et de Pharmacie8 avenue RockefellerLyon69008France
| | - Marlène Wiart
- Univ‐LyonIRIS TeamCarMeN LaboratoryInserm U1060INRA U1397INSA LyonUniversité Claude Bernard Lyon 1Groupement Hospitalier Est59 bd. PinelBron69500France
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Debs N, Cho TH, Rousseau D, Berthezène Y, Buisson M, Eker O, Mechtouff L, Nighoghossian N, Ovize M, Frindel C. Impact of the reperfusion status for predicting the final stroke infarct using deep learning. Neuroimage Clin 2020; 29:102548. [PMID: 33450521 PMCID: PMC7810765 DOI: 10.1016/j.nicl.2020.102548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Predictive maps of the final infarct may help therapeutic decisions in acute ischemic stroke patients. Our objectives were to assess whether integrating the reperfusion status into deep learning models would improve their performance, and to compare them to current clinical prediction methods. METHODS We trained and tested convolutional neural networks (CNNs) to predict the final infarct in acute ischemic stroke patients treated by thrombectomy in our center. When training the CNNs, non-reperfused patients from a non-thrombectomized cohort were added to the training set to increase the size of this group. Baseline diffusion and perfusion-weighted magnetic resonance imaging (MRI) were used as inputs, and the lesion segmented on day-6 MRI served as the ground truth for the final infarct. The cohort was dichotomized into two subsets, reperfused and non-reperfused patients, from which reperfusion status specific CNNs were developed and compared to one another, and to the clinically-used perfusion-diffusion mismatch model. Evaluation metrics included the Dice similarity coefficient (DSC), precision, recall, volumetric similarity, Hausdorff distance and area-under-the-curve (AUC). RESULTS We analyzed 109 patients, including 35 without reperfusion. The highest DSC were achieved in both reperfused and non-reperfused patients (DSC = 0.44 ± 0.25 and 0.47 ± 0.17, respectively) when using the corresponding reperfusion status-specific CNN. CNN-based models achieved higher DSC and AUC values compared to those of perfusion-diffusion mismatch models (reperfused patients: AUC = 0.87 ± 0.13 vs 0.79 ± 0.17, P < 0.001; non-reperfused patients: AUC = 0.81 ± 0.13 vs 0.73 ± 0.14, P < 0.01, in CNN vs perfusion-diffusion mismatch models, respectively). CONCLUSION The performance of deep learning models improved when the reperfusion status was incorporated in their training. CNN-based models outperformed the clinically-used perfusion-diffusion mismatch model. Comparing the predicted infarct in case of successful vs failed reperfusion may help in estimating the treatment effect and guiding therapeutic decisions in selected patients.
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Affiliation(s)
- Noëlie Debs
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France.
| | - Tae-Hee Cho
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France.
| | - David Rousseau
- LARIS, UMR IRHS INRA, Université d'Angers, Angers, France.
| | - Yves Berthezène
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France.
| | - Marielle Buisson
- Department of Cardiology, Clinical Investigation Center, CarMeN INSERM U1060, INRA U1397, INSA Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France.
| | - Omer Eker
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France.
| | - Laura Mechtouff
- Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France; Department of Cardiology, Clinical Investigation Center, CarMeN INSERM U1060, INRA U1397, INSA Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France.
| | - Norbert Nighoghossian
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France; Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France.
| | - Michel Ovize
- Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France.
| | - Carole Frindel
- CREATIS, CNRS, UMR-5220, INSERM U1206, Université Lyon 1, INSA Lyon, Villeurbanne, France.
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12
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Plumereau C, Cho TH, Buisson M, Amaz C, Cappucci M, Derex L, Ong E, Fontaine J, Rascle L, Riva R, Schiavo D, Benhamed A, Douplat M, Bony T, Tazarourte K, Tuttle C, Eker OF, Berthezène Y, Ovize M, Nighoghossian N, Mechtouff L. Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network. J Neurol 2020; 268:2314-2319. [PMID: 32902732 PMCID: PMC7479751 DOI: 10.1007/s00415-020-10199-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 01/13/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. Methods We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. Results A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187–339] vs 210 [163–260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133–2238] vs 1023 [960–1410]; p < 0.01). Conclusions Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.
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Affiliation(s)
- Cécile Plumereau
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Marielle Buisson
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Camille Amaz
- Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Matteo Cappucci
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Elodie Ong
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Julia Fontaine
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Lucie Rascle
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France
| | - Roberto Riva
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - David Schiavo
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Axel Benhamed
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Marion Douplat
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Thomas Bony
- Emergency Department, Hospices Civils de Lyon, Lyon, France
| | - Karim Tazarourte
- Emergency Department, Hospices Civils de Lyon, Lyon, France.,EA 7425 HESPER, Health Services and Performance Research, Claude Bernard Lyon 1 University, Lyon, France
| | - Célia Tuttle
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Omer Faruk Eker
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Neuroradiology Department, Hospices Civils de Lyon, Lyon, France.,CREATIS, CNRS UMR 5220, INSERM U1044, University Lyon 1, Lyon, France
| | - Michel Ovize
- CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.,Clinical Investigation Center, INSERM 1407, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France.,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France
| | - Laura Mechtouff
- Department of Neurology, Stroke Center, Hospices Civils de Lyon, Lyon, France. .,CarMeN Laboratory, INSERM U1060, University Lyon 1, Lyon, France.
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Cuccione E, Chhour P, Si-Mohamed S, Dumot C, Kim J, Hubert V, Da Silva CC, Vandamme M, Chereul E, Balegamire J, Chevalier Y, Berthezène Y, Boussel L, Douek P, Cormode DP, Wiart M. Multicolor spectral photon counting CT monitors and quantifies therapeutic cells and their encapsulating scaffold in a model of brain damage. Nanotheranostics 2020; 4:129-141. [PMID: 32483519 PMCID: PMC7256015 DOI: 10.7150/ntno.45354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/04/2020] [Indexed: 12/13/2022] Open
Abstract
Rationale & aim: Various types of cell therapies are currently under investigation for the treatment of ischemic stroke patients. To bridge the gap between cell administration and therapeutic outcome, there is a need for non-invasive monitoring of these innovative therapeutic approaches. Spectral photon counting computed tomography (SPCCT) is a new imaging modality that may be suitable for cell tracking. SPCCT is the next generation of clinical CT that allows the selective visualization and quantification of multiple contrast agents. The aims of this study are: (i) to demonstrate the feasibility of using SPCCT to longitudinally monitor and quantify therapeutic cells, i.e. bone marrow-derived M2-polarized macrophages transplanted in rats with brain damage; and (ii) to evaluate the potential of this approach to discriminate M2-polarized macrophages from their encapsulating scaffold. Methods: Twenty one rats received an intralesional transplantation of bone marrow-derived M2-polarized macrophages. In the first set of experiments, cells were labeled with gold nanoparticles and tracked for up to two weeks post-injection in a monocolor study via gold K-edge imaging. In the second set of experiments, the same protocol was repeated for a bicolor study, in which the labeled cells are embedded in iodine nanoparticle-labeled scaffold. The amount of gold in the brain was longitudinally quantified using gold K-edge images reconstructed from SPCCT acquisition. Animals were sacrificed at different time points post-injection, and ICP-OES was used to validate the accuracy of gold quantification from SPCCT imaging. Results: The feasibility of therapeutic cell tracking was successfully demonstrated in brain-damaged rats with SPCCT imaging. The imaging modality enabled cell monitoring for up to 2 weeks post-injection, in a specific and quantitative manner. Differentiation of labeled cells and their embedding scaffold was also feasible with SPCCT imaging, with a detection limit as low as 5,000 cells in a voxel of 250 × 250 × 250 µm in dimension in vivo. Conclusion: Multicolor SPCCT is an innovative translational imaging tool that allows monitoring and quantification of therapeutic cells and their encapsulating scaffold transplanted in the damaged rat brain.
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Affiliation(s)
- Elisa Cuccione
- CarMeN Laboratory, Institut National de la Santé et de la Recherche Médicale U1060, INRA U1397, Université Lyon 1, INSA Lyon, F-69600 Oullins, France
- VOXCAN, 1 avenue Bourgelat, 69280 Marcy l'Etoile, France
| | - Peter Chhour
- Department of Radiology, University of Pennsylvania, Pennsylvania, United States
| | - Salim Si-Mohamed
- CREATIS, CNRS UMR 5220 - INSERM U1206 - University of Lyon 1 - INSA Lyon, Lyon, France
- Hospices Civils de Lyon, Radiology Department, Lyon, France
| | - Chloé Dumot
- CarMeN Laboratory, Institut National de la Santé et de la Recherche Médicale U1060, INRA U1397, Université Lyon 1, INSA Lyon, F-69600 Oullins, France
| | - Johoon Kim
- Department of Radiology, University of Pennsylvania, Pennsylvania, United States
| | - Violaine Hubert
- CarMeN Laboratory, Institut National de la Santé et de la Recherche Médicale U1060, INRA U1397, Université Lyon 1, INSA Lyon, F-69600 Oullins, France
| | - Claire Crola Da Silva
- CarMeN Laboratory, Institut National de la Santé et de la Recherche Médicale U1060, INRA U1397, Université Lyon 1, INSA Lyon, F-69600 Oullins, France
| | - Marc Vandamme
- VOXCAN, 1 avenue Bourgelat, 69280 Marcy l'Etoile, France
| | | | - Joëlle Balegamire
- LAGEPP, University of Lyon 1, CNRS UMR 5007, 43 bd 11 Novembre, 69622 Villeurbanne, France
| | - Yves Chevalier
- LAGEPP, University of Lyon 1, CNRS UMR 5007, 43 bd 11 Novembre, 69622 Villeurbanne, France
| | - Yves Berthezène
- CREATIS, CNRS UMR 5220 - INSERM U1206 - University of Lyon 1 - INSA Lyon, Lyon, France
- Hospices Civils de Lyon, Radiology Department, Lyon, France
| | - Loïc Boussel
- CREATIS, CNRS UMR 5220 - INSERM U1206 - University of Lyon 1 - INSA Lyon, Lyon, France
- Hospices Civils de Lyon, Radiology Department, Lyon, France
| | - Philippe Douek
- CREATIS, CNRS UMR 5220 - INSERM U1206 - University of Lyon 1 - INSA Lyon, Lyon, France
- Hospices Civils de Lyon, Radiology Department, Lyon, France
| | - David P. Cormode
- Department of Radiology, University of Pennsylvania, Pennsylvania, United States
| | - Marlène Wiart
- CarMeN Laboratory, Institut National de la Santé et de la Recherche Médicale U1060, INRA U1397, Université Lyon 1, INSA Lyon, F-69600 Oullins, France
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14
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Izquierdo C, Barritault M, Poncet D, Cartalat S, Joubert B, Bruna J, Jouanneau E, Guyotat J, Vasiljevic A, Fenouil T, Berthezène Y, Honnorat J, Meyronet D, Ducray F. Radiological Characteristics and Natural History of Adult IDH-Wildtype Astrocytomas with TERT Promoter Mutations. Neurosurgery 2020; 85:E448-E456. [PMID: 30407589 DOI: 10.1093/neuros/nyy513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/30/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Adult IDH-wildtype astrocytomas with TERT promoter mutations (TERTp) are associated with a poor prognosis. OBJECTIVE To analyze the radiological presentation and natural history of adult IDH-wildtype astrocytomas with TERTp. METHODS We retrospectively reviewed the characteristics of 40 IDH-wildtype TERTp-mutant astrocytomas (grade II n = 19, grade III n = 21) and compared them to those of 114 IDH-mutant lower grade gliomas (LGG), of 92 IDH-wildtype TERTp-mutant glioblastomas, and of 15 IDH-wildtype TERTp-wildtype astrocytomas. RESULTS Most cases of IDH-wildtype TERTp-mutant astrocytomas occurred in patients aged >50 yr (88%) and presented as infiltrative lesions without contrast enhancement (73%) that were localized in the temporal and/or insular lobes (37.5%) or corresponded to a gliomatosis cerebri (43%). Thalamic involvement (33%) and extension to the brainstem (27%) were frequently observed, as was gyriform infiltration (33%). This radiological presentation was different from that of IDH-mutant LGG, IDH-wildtype TERTp-mutant glioblastomas, and IDH-wildtype TERTp-wildtype astrocytomas. Tumor evolution before treatment initiation was assessable in 17 cases. Ten cases demonstrated a rapid growth characterized by the apparition of a ring-like contrast enhancement and/or a median velocity of diametric expansion (VDE) ≥8 mm/yr but 7 cases displayed a slow growth (VDE <8 mm/yr) that could last several years before anaplastic transformation. Median overall survival of IDH-wildtype TERTp-mutant astrocytomas was 27 mo. CONCLUSION IDH-wildtype TERTp-mutant astrocytomas typically present as nonenhancing temporo-insular infiltrative lesions or as gliomatosis cerebri in patients aged >50 yr. In the absence of treatment, although rapid tumor growth is frequent, an initial falsely reassuring, slow growth can be observed.
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Affiliation(s)
- Cristina Izquierdo
- Hospices Civils de Lyon, Groupe Hos-pitalier Est, Service de Neuro-Oncologie, Lyon, France.,Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, l'Hospitalet de Llo-bregat, Barcelona, Spain
| | - Marc Barritault
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service d'anatomopathologie, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
| | - Delphine Poncet
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service d'anatomopathologie, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Stéphanie Cartalat
- Hospices Civils de Lyon, Groupe Hos-pitalier Est, Service de Neuro-Oncologie, Lyon, France
| | - Bastien Joubert
- Hospices Civils de Lyon, Groupe Hos-pitalier Est, Service de Neuro-Oncologie, Lyon, France
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, l'Hospitalet de Llo-bregat, Barcelona, Spain
| | - Emmanuel Jouanneau
- Université Claude Bernard Lyon 1, Lyon, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Neurochirurgie B, Lyon, France.,Signaling, Metabolism and Tumor Progression, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
| | - Jacques Guyotat
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Neurochirurgie D, Lyon, France
| | - Alexandre Vasiljevic
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service d'anatomopathologie, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Tanguy Fenouil
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service d'anatomopathologie, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France
| | - Yves Berthezène
- Université Claude Bernard Lyon 1, Lyon, France.,Hospices Civils de Lyon, Groupe Hos-pitalier Est, Service de Neuroradiologie, Lyon, France
| | - Jérôme Honnorat
- Hospices Civils de Lyon, Groupe Hos-pitalier Est, Service de Neuro-Oncologie, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Institut NeuroMyoGene, INSERM 1217/CNRS 5310, Université de Lyon, Lyon, France
| | - David Meyronet
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service d'anatomopathologie, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
| | - François Ducray
- Hospices Civils de Lyon, Groupe Hos-pitalier Est, Service de Neuro-Oncologie, Lyon, France.,Université Claude Bernard Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
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15
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Mechtouff L, Nighoghossian N, Amaz C, Buisson M, Berthezène Y, Derex L, Ong E, Eker OF, Cho TH. White matter burden does not influence the outcome of mechanical thrombectomy. J Neurol 2019; 267:618-624. [DOI: 10.1007/s00415-019-09624-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/01/2019] [Accepted: 11/03/2019] [Indexed: 01/07/2023]
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16
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Tozlu C, Ozenne B, Cho TH, Nighoghossian N, Mikkelsen IK, Derex L, Hermier M, Pedraza S, Fiehler J, Østergaard L, Berthezène Y, Baron JC, Maucort-Boulch D. Comparison of classification methods for tissue outcome after ischaemic stroke. Eur J Neurosci 2019; 50:3590-3598. [PMID: 31278787 DOI: 10.1111/ejn.14507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
Abstract
In acute ischaemic stroke, identifying brain tissue at high risk of infarction is important for clinical decision-making. This tissue may be identified with suitable classification methods from magnetic resonance imaging data. The aim of the present study was to assess and compare the performance of five popular classification methods (adaptive boosting, logistic regression, artificial neural networks, random forest and support vector machine) in identifying tissue at high risk of infarction on human voxel-based brain imaging data. The classification methods were used with eight MRI parameters, including diffusion-weighted imaging and perfusion-weighted imaging obtained in 55 patients. The five criteria used to assess the performance of the methods were the area under the receiver operating curve (AUCroc ), the area under the precision-recall curve (AUCpr ), sensitivity, specificity and the Dice coefficient. The methods performed equally in terms of sensitivity and specificity, while the results of AUCroc and the Dice coefficient were significantly better for adaptive boosting, logistic regression, artificial neural networks and random forest. However, there was no statistically significant difference between the performances of these five classification methods regarding AUCpr , which was the main comparison metric. Machine learning methods can provide valuable prognostic information using multimodal imaging data in acute ischaemic stroke, which in turn can assist in developing personalized treatment decision for clinicians after a thorough validation of methods with an independent data set.
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Affiliation(s)
- Ceren Tozlu
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et de Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Brice Ozenne
- Neurobiology Research Unit, Rigshospitalet, Copenhagen O, Denmark.,Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Tae-Hee Cho
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | | | - Laurent Derex
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Marc Hermier
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yves Berthezène
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS, UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France.,Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jean-Claude Baron
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Lyon, France.,Université Lyon 1, Villeurbanne, France.,Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et de Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
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17
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Bani Sadr A, Eker OF, Berner L, Ameli R, Hermier M, Barritault M, Meyronet D, Guyotat J, Jouanneau E, Honnorat J, Ducray F, Berthezène Y. P13.02 Conventional MRI radiomics in the diagnosis of early- and pseudo-progression. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
After radiochemotherapy, 20% to 30% of patients with early worsening MRI experience pseudoprogression (Psp) which is not distinguishable from early progression (EP). We aimed to assess the diagnostic performance and survival predictive ability of radiomics in patients with suspected EP or Psp.
MATERIAL AND METHODS
Radiomics features (RF) of 76 patients (53 EP and 23 Psp) retrospectively identified were extracted from conventional MRI based on four volumes-of-interest. Subjects were randomly assigned into training and validation groups. Classification model (EP versus Psp) consisted of a random forest algorithm after univariate filtering. Overall (OS) and progression-free survivals (PFS) were predicted using a semi-supervised principal component analysis and, forecasts were evaluated using C index and integrated Brier scores (IBS).
RESULTS
Using 11 RFs, radiomics classified patients with 75.0% and 76.0% accuracy, 81.6% and 94.1% sensitivity, 50.0% and 37.5% specificity, respectively in training and validation phases. Addition of MGMT promoter status improved accuracy to 83% and 79.2% and, specificity to 63.6% and 75%.
OS model included 14 RFs and stratified low- and high-risk patients both in the training (hazard ratio (HR), 3.63, p=0.002) and the validation (HR, 3.76, p=0.001) phases. Similarly, PFS model stratified patients during training (HR, 2.58, p=0.005) and validation (HR, 3.58, p=0.004) phases using 5 RF. OS and PFS forecasts had C index of 0.65 and 0.69 and IBS of 0.122 and 0.147, respectively.
CONCLUSION
Conventional MRI radiomics has promising diagnostic value, especially when combined with MGMT promoter status, but specificity remains moderate. In addition, our results suggest a potential for predicting OS and PFS.
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Affiliation(s)
| | - O F Eker
- Hospices Civils de Lyon, Bron, France
| | - L Berner
- Hospices Civils de Lyon, Bron, France
| | - R Ameli
- Hospices Civils de Lyon, Bron, France
| | - M Hermier
- Hospices Civils de Lyon, Bron, France
| | | | | | - J Guyotat
- Hospices Civils de Lyon, Bron, France
| | | | | | - F Ducray
- Hospices Civils de Lyon, Bron, France
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18
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Ozenne B, Cho TH, Mikkelsen IK, Hermier M, Thomalla G, Pedraza S, Roy P, Berthezène Y, Nighoghossian N, Østergaard L, Baron JC, Maucort-Boulch D. Individualized quantification of the benefit from reperfusion therapy using stroke predictive models. Eur J Neurosci 2019; 50:3251-3260. [PMID: 31283062 DOI: 10.1111/ejn.14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/28/2019] [Accepted: 06/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Recent imaging developments have shown the potential of voxel-based models in assessing infarct growth after stroke. Many models have been proposed but their relevance in predicting the benefit of a reperfusion therapy remains unclear. We searched for a predictive model whose volumetric predictions would identify stroke patients who are to benefit from tissue plasminogen activator (t-PA)-induced reperfusion. MATERIAL AND METHODS Forty-five cases were used to study retrospectively stroke progression from admission to end of follow-up. Predictive approaches based on various statistical models, predictive variables and spatial filtering methods were compared. The optimal approach was chosen according to the area under the precision-recall curve (AUPRC). The final lesion volume was then predicted assuming that the patient would or would not reperfuse. Patients, with an acute lesion of ≤50 ml and a predicted reduction in the presence of reperfusion >6 ml and >25% of the acute lesion, were classified as responders. RESULTS The optimal model was a logistic regression using the voxel distance to the acute lesion, the volume of the acute lesion and Gaussian-filtered MRI contrast parameters as predictive variables. The predictions gave a median AUPRC of 0.655, a median AUC of 0.976 and a median volumetric error of 8.29 ml. Nineteen patients matched the responder profile. A non-significant trend of improved reduction in NIHSS score (-42.8%, p = .09) and in lesion volume (-78.1%, p = 0.21) following reperfusion was observed for responder patients. CONCLUSION Despite limited volumetric accuracy, predictive stroke models can be used to quantify the benefit of reperfusion therapies.
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Affiliation(s)
- Brice Ozenne
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, The Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark.,Department of Biostatistics, University of Copenhagen, Copenhagen K, Denmark
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | | | - Marc Hermier
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Pascal Roy
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.,Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France.,Université Lyon I, Lyon, France
| | - Yves Berthezène
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Leif Østergaard
- Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark
| | - Jean-Claude Baron
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Department of Neurology, INSERM U894, Hôpital Sainte-Anne, Paris Descartes University, Paris, France
| | - Delphine Maucort-Boulch
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France.,Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France.,Université Lyon I, Lyon, France
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19
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Eker OF, Ameli R, Makris N, Jurkovic T, Montigon O, Barbier EL, Cho TH, Nighoghossian N, Berthezène Y. MRI Assessment of Oxygen Metabolism and Hemodynamic Status in Symptomatic Intracranial Atherosclerotic Stenosis: A Pilot Study. J Neuroimaging 2019; 29:467-475. [DOI: 10.1111/jon.12615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/14/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022] Open
Affiliation(s)
- Omer F. Eker
- Department of NeuroradiologyHospices Civils de Lyon Bron France
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
| | - Roxana Ameli
- Department of NeuroradiologyHospices Civils de Lyon Bron France
| | - Nikolaos Makris
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
| | - Thomas Jurkovic
- Department of NeuroradiologyHospices Civils de Lyon Bron France
| | - Olivier Montigon
- INSERM U1216Grenoble Institut des Neurosciences La Tronche France
| | - Emmanuel L. Barbier
- INSERM U1216Grenoble Institut des Neurosciences La Tronche France
- Université Grenoble Alpes Saint‐Martin‐d'Hères France
| | - Tae Hee Cho
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
| | | | - Yves Berthezène
- Department of NeuroradiologyHospices Civils de Lyon Bron France
- CREATIS CNRS UMR 5220, INSERM U1044 Villeurbanne cedex France
- Department of Vascular Neurology, Hospices Civils de LyonHôpital Pierre Wertheimer Bron France
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20
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Seners P, Delepierre J, Turc G, Henon H, Piotin M, Arquizan C, Cho TH, Lapergue B, Cottier JP, Richard S, Legrand L, Bricout N, Mazighi M, Dargazanli C, Nighoghossian N, Consoli A, Debiais S, Bracard S, Naggara O, Leclerc X, Obadia M, Costalat V, Berthezène Y, Tisserand M, Narata AP, Gory B, Mas JL, Oppenheim C, Baron JC. Thrombus Length Predicts Lack of Post-Thrombolysis Early Recanalization in Minor Stroke With Large Vessel Occlusion. Stroke 2019; 50:761-764. [DOI: 10.1161/strokeaha.118.023455] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pierre Seners
- From the Department of Neurology, INSERM U894 (P.S., J.D., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, Paris, France
| | - Julie Delepierre
- From the Department of Neurology, INSERM U894 (P.S., J.D., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, Paris, France
| | - Guillaume Turc
- From the Department of Neurology, INSERM U894 (P.S., J.D., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, Paris, France
| | - Hilde Henon
- Stroke Unit (H.H.), Roger Salengro Hospital, Lille, France
| | - Michel Piotin
- Department of Neuroradiology Paris Descartes University (M.P., M.M.), Fondation Rothschild, Paris, France
| | - Caroline Arquizan
- Department of Neurology (C.A.), CHRU Gui de Chauliac, Montpellier, France
| | - Tae-Hee Cho
- Stroke Unit (T.-H.C., N.N.), Hospices Civils de Lyon, France
| | | | | | | | - Laurence Legrand
- Department of Neuroradiology, INSERM U894 (L.L., O.N., C.O.), Sainte-Anne Hospital, Paris, France
| | - Nicolas Bricout
- Department of Neuroradiology (N.B., X.L.), Roger Salengro Hospital, Lille, France
| | - Mikaël Mazighi
- Department of Neuroradiology Paris Descartes University (M.P., M.M.), Fondation Rothschild, Paris, France
- Department of Neurology, Lariboisière Hospital, Paris, France (M.M.)
| | - Cyril Dargazanli
- Department of Neuroradiology (C.D., V.C.), CHRU Gui de Chauliac, Montpellier, France
| | | | - Arturo Consoli
- Department of Neuroradiology (A.C., M.T.), Foch Hospital, Suresnes, France
| | - Séverine Debiais
- Department of Neurology (S.D.), Bretonneau Hospital, Tours, France
| | - Serge Bracard
- Department of Neuroradiology (S.B., B.G.), Nancy University Hospital, France
| | - Olivier Naggara
- Department of Neuroradiology, INSERM U894 (L.L., O.N., C.O.), Sainte-Anne Hospital, Paris, France
| | - Xavier Leclerc
- Department of Neuroradiology (N.B., X.L.), Roger Salengro Hospital, Lille, France
| | - Michael Obadia
- Department of Neurology (M.O.), Fondation Rothschild, Paris, France
| | - Vincent Costalat
- Department of Neuroradiology (C.D., V.C.), CHRU Gui de Chauliac, Montpellier, France
| | - Yves Berthezène
- Department of Neuroradiology (Y.B.), Hospices Civils de Lyon, France
| | - Marie Tisserand
- Department of Neuroradiology (A.C., M.T.), Foch Hospital, Suresnes, France
| | - Ana-Paula Narata
- Department of Neuroradiology (J.-P.C., A.-P.N.), Bretonneau Hospital, Tours, France
| | - Benjamin Gory
- Department of Neuroradiology (S.B., B.G.), Nancy University Hospital, France
| | - Jean-Louis Mas
- From the Department of Neurology, INSERM U894 (P.S., J.D., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, INSERM U894 (L.L., O.N., C.O.), Sainte-Anne Hospital, Paris, France
| | - Jean-Claude Baron
- From the Department of Neurology, INSERM U894 (P.S., J.D., G.T., J.-L.M., J.-C.B.), Sainte-Anne Hospital, Paris, France
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21
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Makris N, Chamard L, Mikkelsen IK, Hermier M, Derex L, Pedraza S, Thomalla G, Østergaard L, Baron JC, Nighoghossian N, Berthezène Y, Cho TH. Acute reperfusion without recanalization: Serial assessment of collaterals within 6 h of using perfusion-weighted magnetic resonance imaging. J Cereb Blood Flow Metab 2019; 39:251-259. [PMID: 29291673 PMCID: PMC6365601 DOI: 10.1177/0271678x17744716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute reperfusion despite persistent arterial occlusion may occur in up to 30% of ischemic stroke patients. Recruitment of leptomeningeal collaterals may explain this phenomenon. Using dynamic susceptibility-contrast perfusion imaging (DSC-PI), we assessed acute changes in collateral flow among patients without recanalization. From a multicenter prospective database (I-KNOW), 46 patients with magnetic resonance angiography visible occlusion in whom both reperfusion and recanalization were assessed within 6 h of onset were identified. Maps of collateral flow at arterial, capillary and late venous phases were generated from DSC-PI through inter-frame registration, baseline signal subtraction and temporal summation, and graded blind to all other relevant clinical and radiological data using the Higashida scale. Flow direction and the acute evolution of collaterals were evaluated against the reperfusion status. Among patients without recanalization ( n = 33), flow direction remained retrograde. Collateral grades significantly improved between admission and acute follow-up in patients who reperfused (OR: 4.57; 95% CI: 1.1-22.7; p = 0.048), but not in those without reperfusion (OR: 1.34; 95% CI: 0.4-4.5; p = 0.623). Our study confirmed that acute reperfusion without recanalization is associated with a significant improvement of retrograde collateral flow. DSC-PI can detect acute changes in collateral flow, and may help evaluate novel treatments targeting leptomeningeal collaterals.
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Affiliation(s)
- Nikolaos Makris
- 1 Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Leila Chamard
- 1 Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Irene K Mikkelsen
- 2 Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Marc Hermier
- 1 Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- 1 Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- 3 Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Götz Thomalla
- 4 Department of Neurology, Head and Neuro Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Leif Østergaard
- 2 Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
| | - Jean-Claude Baron
- 5 University of Cambridge, Department of Clinical Neurosciences, Cambridge, UK; INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France
| | - Norbert Nighoghossian
- 1 Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- 1 Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- 1 Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
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22
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Izquierdo C, Barritault M, Poncet D, Cartalat S, Joubert B, Bruna J, Jouanneau E, Guyotat J, Vasiljevic A, Fenouil T, Berthezène Y, Honnorat J, Meyronet D, Ducray F. NIMG-43. RADIOLOGICAL CHARACTERISTICS AND NATURAL HISTORY OF ADULT IDH WILD-TYPE ASTROCYTOMAS WITH TERT PROMOTER MUTATIONS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cristina Izquierdo
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuro-Oncologie, Lyon, France
| | - Marc Barritault
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service danatomopathologie, Lyon, France
| | - Delphine Poncet
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service danatomopathologie, Lyon, France
| | - Stéphanie Cartalat
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuro-Oncologie, Lyon, France
| | - Bastien Joubert
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuro-Oncologie, Lyon, France
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO LHospitalet-IDIBELL, lHospitalet de Llobregat, Barcelona, Spain
| | - Emmanuel Jouanneau
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Neurochirurgie B, Lyon
| | - Jacques Guyotat
- Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Neurochirurgie D, Bron, Lyon, France
| | - Alexandre Vasiljevic
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service danatomopathologie, Bron, Lyon, France
| | - Tanguy Fenouil
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service danatomopathologie, Bron, Lyon, France
| | - Yves Berthezène
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuroradiology, Bron, Lyon, France
| | - Jerôme Honnorat
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuro-Oncologie, Bron, Lyon, France
| | - David Meyronet
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service danatomopathologie, Bron, Lyon, France
| | - François Ducray
- Hospices Civils de Lyon, Groupe Hospitalier Est, Service de Neuro-Oncologie, Lyon, France
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23
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Izquierdo C, Barritault M, Poncet D, Cartalat S, Joubert B, Bruna J, Jouanneau E, Guyotat J, Vasiljevic A, Fenouil T, Berthezène Y, Honnorat J, Meyronet D, Ducray F. OS3.3 Radiological characteristics and natural history of adult IDH wild type astrocytomas with TERT promoter mutations. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - D Poncet
- Hôpital Pierre Wertheimer, Lyon, France
| | | | - B Joubert
- Hôpital Pierre Wertheimer, Lyon, France
| | - J Bruna
- Hospital Universitari de Bellvitge-ICO L’Hospitalet-IDIBELL, Hospitalet Llobregat, Spain
| | | | - J Guyotat
- Hôpital Pierre Wertheimer, Lyon, France
| | | | - T Fenouil
- Hôpital Pierre Wertheimer, Lyon, France
| | | | | | | | - F Ducray
- Hôpital Pierre Wertheimer, Lyon, France
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24
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Viannay L, Haesebaert J, Florin F, Riva R, Mechtouff L, Gory B, Ong E, Labeyrie PE, Derex L, Hermier M, Chamard L, Berner LP, Ameli R, Berthezène Y, Turjman F, Nighoghossian N, Cho TH. Impact of the Thrombectomy Trials on the Management and Outcome of Large Vessel Stroke: Data From the Lyon Stroke Center. Front Neurol 2018; 9:722. [PMID: 30210442 PMCID: PMC6121096 DOI: 10.3389/fneur.2018.00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/08/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Randomized trials (RT) have recently validated the superiority of thrombectomy over standard medical care, including intravenous thrombolysis (IVT). However, data on their impact on routine clinical care remains scarce. Methods: Using a prospective observational registry, we assessed: (1) the clinical and radiological characteristics of all consecutive patients treated with thrombectomy; (2) the outcome of all patients with M1 occlusion (treated with thrombectomy or IVT alone). Two periods were compared: before (2013–2014) and after (2015–2016) the publication of RT. Results: Endovascular procedures significantly increased between the two periods (N = 82 vs. 314, p < 0.0001). In 2015–2016, patients were older (median [IQR]: 69 [57-80]; vs. 66 [53-74]; p = 0.008), had shorter door-to-clot times (69 [47-95]; vs. 110 [83-155]; p < 0.0001) resulting in a trend toward shorter delay from symptom onset to reperfusion (232 [185-300]; vs. 250 [200-339]; p = 0.1), with higher rates of reperfusion (71 vs. 48%; p = 0.0001). Conversely, no significant differences in baseline NIHSS scores, ASPECTS, delay to IVT or intracranial hemorrhage were found. In 2015–2016, patients with M1 occlusion were treated with thrombectomy more often than in 2013–2014 (87 vs. 32%, respectively; p < 0.0001), with a significant improvement in clinical outcome (shift analysis, lower modified Rankin scale scores: OR = 1.68; 95% CI: 1.10–2.57; p = 0.017). Conclusion: Following the publication of RT, thrombectomy was rapidly implemented with significant improvements in intrahospital delay and reperfusion rates. Treatment with thrombectomy increased with better clinical outcomes in patients with M1 occlusion.
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Affiliation(s)
- Louis Viannay
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Health Information Department, HESPER EA7425, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Fannie Florin
- Department of Stroke Medicine, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Roberto Riva
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Laura Mechtouff
- Department of Stroke Medicine, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Benjamin Gory
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Elodie Ong
- Department of Stroke Medicine, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Paul-Emile Labeyrie
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Health Information Department, HESPER EA7425, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
- Department of Stroke Medicine, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Marc Hermier
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Leila Chamard
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Lise-Prune Berner
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Roxana Ameli
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
- CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Francis Turjman
- Department of Neuroradiology, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
- CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
- CREATIS, CNRS UMR 5220-INSERM U1206, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
- *Correspondence: Tae-Hee Cho
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25
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Tschirret O, Moreno Legast G, Mansuy A, Mewton N, Buisson M, Hannoun S, Chamard L, Sappey-Marinier D, El Khoury C, Bischoff M, de Parisot A, Derex L, Nighoghossian N, Berthezène Y, Mechtouff L. Impact of Brain Atrophy on Early Neurological Deterioration and Outcome in Severe Ischemic Stroke Treated by Intravenous Thrombolysis. Eur Neurol 2018; 79:240-246. [DOI: 10.1159/000487668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/13/2018] [Indexed: 11/19/2022]
Abstract
Background: Brain atrophy has shown a protective effect on the risk of early neurological deterioration (END) related to malignant edema in patients with hemispheric infarction but could be deleterious on the outcome. Aims: We aimed to assess whether brain atrophy has an impact on the risk of END and on the outcome in severe ischemic strokes after intravenous (IV) thrombolysis. Methods: From a prospective thrombolysis registry, 137 patients who had a National Institutes of Health Stroke Scale (NIHSS) ≥15, MRI at admission, and IV thrombolysis were included. Relative cerebral volume was calculated. END was defined as a ≥2-points deterioration 72-h NIHSS and a good outcome as a modified Rankin Scale (mRS) ≤2 at 3 months. A multiple logistic regression analysis with a stepwise backward procedure was performed. Results: END and a good outcome were observed, respectively, in 20 (14.6%) and 48 (37.5%) patients. In univariate analysis, predictors of END included age (p = 0.049), diabetes (p = 0.041), and parenchymal hemorrhage (p = 0.039). In multivariate analysis, age (p = 0.018) was significantly associated with END. Brain atrophy was not associated with END even in subgroup analysis according to the baseline infarct size. In univariate analysis, age (p = 0.003), prestroke mRS (p = 0.002), hypertension (p = 0.006), baseline NIHSS (p = 0.002), END (p = 0.002), proximal occlusion (p = 0.006), and recanalization at 24 h (p < 0.001) were associated with a good outcome. Only baseline NIHSS (p = 0.006) was associated with a good outcome after adjustment. Conclusions: We did not find any impact of brain atrophy on the risk of END and the outcome at 3 months in severe ischemic strokes after IV thrombolysis.
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26
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Brisset JC, Gazeau F, Corot C, Nighoghossian N, Berthezène Y, Canet-Soulas E, Wiart M. INFLAM – INFLAMmation in Brain and Vessels with Iron Nanoparticles and Cell Trafficking: A Multiscale Approach of Tissue Microenvironment, Iron Nanostructure and Iron Biotransformation. Ing Rech Biomed 2018. [DOI: 10.1016/j.irbm.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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Ritzenthaler T, Cho TH, Mechtouff L, Ong E, Turjman F, Robinson P, Berthezène Y, Nighoghossian N. Cerebral Near-Infrared Spectroscopy. Stroke 2017; 48:3390-3392. [DOI: 10.1161/strokeaha.117.019176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/21/2017] [Accepted: 08/31/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Regional brain oxygen saturation (rSO
2
) changes, assessed by cerebral near-infrared spectroscopy, are likely influenced by cerebral hemodynamic fluctuations induced by thrombectomy of acute proximal occlusion. We studied the correlations between rSO
2
and baseline magnetic resonance imaging perfusion parameters and the relationship between rSO
2
changes, recanalization, and clinical outcome.
Methods—
Seventeen acute ischemic stroke patients, treated with mechanical thrombectomy, were monitored using bilateral near-infrared spectroscopy before, during, and continuously for 24 hours after the procedure. All patients had baseline brain magnetic resonance imaging with perfusion weighted imaging.
Results—
rSO
2
was only correlated with baseline Tmax (ρ=−0.42;
P
<0.05) and mean transit time (ρ=−0.45;
P
<0.05) within forehead explored areas. Before thrombectomy, an interhemispheric rSO
2
difference was noted, and this diminished over time when recanalization had occurred (median [interquartile range], −8 [−12 to −5] to 3 [−3 to 7];
P
=0.01). rSO
2
changes were not correlated with clinical outcome.
Conclusions—
rSO
2
was merely correlated with baseline Tmax and mean transit time magnetic resonance imaging perfusion parameters. Multiple sites recording beyond frontal pole explored areas may provide more relevant correlation with hemodynamic parameters.
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Affiliation(s)
- Thomas Ritzenthaler
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
| | - Tae-Hee Cho
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
| | - Laura Mechtouff
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
| | - Elodie Ong
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
| | - Francis Turjman
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
| | - Philip Robinson
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
| | - Yves Berthezène
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
| | - Norbert Nighoghossian
- From the Service de neurologie vasculaire, Hôpital neurologique (T.R., T.H.C., L.M., E.O., N.N.), Service de neuroradiologie interventionnelle, Hôpital neurologique (F.T.), Service de neuroradiologie, Hôpital neurologique (Y.B.), and Direction de la Recherche Clinique et de l’Innovation (P.R.), Hospices Civils de Lyon, France; and CREATIS, CNRS UMR 5220, INSERM U1044, Université Lyon 1, France (T.R., T.H.C., E.O., Y.B., N.N.)
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28
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Cuccione E, Versace A, Cho TH, Carone D, Berner LP, Ong E, Rousseau D, Cai R, Monza L, Ferrarese C, Sganzerla EP, Berthezène Y, Nighoghossian N, Wiart M, Beretta S, Chauveau F. Multi-site laser Doppler flowmetry for assessing collateral flow in experimental ischemic stroke: Validation of outcome prediction with acute MRI. J Cereb Blood Flow Metab 2017; 37:2159-2170. [PMID: 27466372 PMCID: PMC5464709 DOI: 10.1177/0271678x16661567] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
High variability in infarct size is common in experimental stroke models and affects statistical power and validity of neuroprotection trials. The aim of this study was to explore cerebral collateral flow as a stratification factor for the prediction of ischemic outcome. Transient intraluminal occlusion of the middle cerebral artery was induced for 90 min in 18 Wistar rats. Cerebral collateral flow was assessed intra-procedurally using multi-site laser Doppler flowmetry monitoring in both the lateral middle cerebral artery territory and the borderzone territory between middle cerebral artery and anterior cerebral artery. Multi-modal magnetic resonance imaging was used to assess acute ischemic lesion (diffusion-weighted imaging, DWI), acute perfusion deficit (time-to-peak, TTP), and final ischemic lesion at 24 h. Infarct volumes and typology at 24 h (large hemispheric versus basal ganglia infarcts) were predicted by both intra-ischemic collateral perfusion and acute DWI lesion volume. Collateral flow assessed by multi-site laser Doppler flowmetry correlated with the corresponding acute perfusion deficit using TTP maps. Multi-site laser Doppler flowmetry monitoring was able to predict ischemic outcome and perfusion deficit in good agreement with acute MRI. Our results support the additional value of cerebral collateral flow monitoring for outcome prediction in experimental ischemic stroke, especially when acute MRI facilities are not available.
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Affiliation(s)
- Elisa Cuccione
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy.,2 PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Alessandro Versace
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy
| | - Tae-Hee Cho
- 3 Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, Lyon, France.,4 Hospices Civils de Lyon, France
| | - Davide Carone
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy
| | - Lise-Prune Berner
- 3 Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, Lyon, France.,4 Hospices Civils de Lyon, France
| | - Elodie Ong
- 3 Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, Lyon, France.,4 Hospices Civils de Lyon, France
| | - David Rousseau
- 3 Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, Lyon, France
| | - Ruiyao Cai
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy
| | - Laura Monza
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy
| | - Carlo Ferrarese
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy.,5 Milan Center for Neuroscience (NeuroMi), Milan, Italy
| | - Erik P Sganzerla
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy.,5 Milan Center for Neuroscience (NeuroMi), Milan, Italy
| | - Yves Berthezène
- 3 Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, Lyon, France.,4 Hospices Civils de Lyon, France
| | - Norbert Nighoghossian
- 3 Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, Lyon, France.,4 Hospices Civils de Lyon, France
| | - Marlène Wiart
- 3 Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, Lyon, France
| | - Simone Beretta
- 1 Department of Medicine and Surgery, Laboratory of Experimental Stroke Research, University of Milano-Bicocca, Monza, Italy.,5 Milan Center for Neuroscience (NeuroMi), Milan, Italy
| | - Fabien Chauveau
- 6 Université de Lyon, Lyon Neuroscience Research Center, BioRaN team; CNRS UMR5292; Inserm U1028; Université Lyon 1, Lyon, France
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Gory B, Chamard L, Turjman F, Lukaszewicz AC, Nighoghossian N, Berthezène Y. Early lesion reversal on DWI and FLAIR after thrombectomy reperfusion in acute ischemic stroke. Rev Neurol (Paris) 2017; 173:422-424. [PMID: 28483387 DOI: 10.1016/j.neurol.2017.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/17/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022]
Affiliation(s)
- B Gory
- Department of Interventional Neuroradiology, hôpital neurologique Pierre-Wertheimer, hospices civils-de-Lyon, université Claude-Bernard-Lyon 1, Lyon, France; Normandie Univ, UNICAEN, INSERM, INSERM UMR-S U1237, Physiopathology and Imaging for Neurological Disorders (PhIND), Cyceron, 14000 Caen, France.
| | - L Chamard
- Department of diagnostic Neuroradiology, hôpital neurologique Pierre-Wertheimer, hospices civils-de-Lyon, université Claude-Bernard-Lyon 1, Lyon, France
| | - F Turjman
- Department of Interventional Neuroradiology, hôpital neurologique Pierre-Wertheimer, hospices civils-de-Lyon, université Claude-Bernard-Lyon 1, Lyon, France
| | - A-C Lukaszewicz
- Anesthesiology and Critical Care, hôpital neurologique Pierre-Wertheimer, hospices civils-de-Lyon, université Claude-Bernard-Lyon 1, Lyon, France
| | - N Nighoghossian
- Department of Neurology, Stroke Unit, hôpital neurologique Pierre-Wertheimer, hospices civils-de-Lyon, université Claude-Bernard Lyon 1, Lyon, France
| | - Y Berthezène
- Department of diagnostic Neuroradiology, hôpital neurologique Pierre-Wertheimer, hospices civils-de-Lyon, université Claude-Bernard-Lyon 1, Lyon, France
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Ong E, Mewton N, Bouvier J, Chauveau F, Ritzenthaler T, Mechtouff L, Derex L, Buisson M, Berthezène Y, Ovize M, Nighoghossian N, Cho TH. Effect of Cyclosporine on Lesion Growth and Infarct Size within the White and Gray Matter. Front Neurol 2017; 8:151. [PMID: 28496428 PMCID: PMC5406390 DOI: 10.3389/fneur.2017.00151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 04/03/2017] [Indexed: 12/21/2022] Open
Abstract
Background In a recent trial, cyclosporine A (CsA) failed to reduce infarct size in acute stroke patients treated with intravenous thrombolysis. White matter (WM) and gray matter (GM) may have distinct vulnerability to ischemia and response to therapy. Using final infarct size and lesion growth as endpoints, our objectives were to (1) investigate any tissue-specific effect of CsA and (2) compare WM and GM response to thrombolysis. Materials and methods We analyzed 84 patients from the randomized and placebo-controlled CsA-Stroke trial, who underwent MRI both on admission and at 1 month. Lesion growth was defined voxel-wise as infarcted tissue at 1 month with no visible lesion on baseline diffusion-weighted imaging. After automatic segmentation of GM/WM, final infarct size and lesion growth were compared within the GM and WM. Results Occlusion level was distal (>M1) in 51% of cases. No significant difference in GM/WM proportions was observed within final infarcts between treatment groups (P = 0.21). Infarct size within the GM or WM was similar between the CsA and control groups [GM: 9.2 (2.4; 22.8) with CsA vs 8.9 (3.7; 28.4) mL with placebo, P = 0.74; WM: 9.9 (4.7; 25.4) with CsA vs 14.1 (5.6; 34.1) mL with placebo, P = 0.26]. There was no significant effect of CsA on lesion growth in either the GM or WM. Pooling all patients, a trend for increased relative lesion growth in WM compared to GM was observed [49.0% (14.7; 185.7) vs 43.1% (15.4; 117.1), respectively; P = 0.12]. Conclusion No differential effect of CsA was observed between WM and GM. Pooling all patients, a trend toward greater lesion growth in WM was observed.
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Affiliation(s)
- Elodie Ong
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Nathan Mewton
- Department of Cardiology, Clinical Investigation Center, Université Lyon 1, Lyon, France.,CarMeN, CNRS-UMR1060, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Julien Bouvier
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Fabien Chauveau
- Lyon Neuroscience Research Center, Université Lyon 1, Lyon, France.,CNRS-UMR5292, Lyon, France.,INSERM-U1028, Lyon, France
| | - Thomas Ritzenthaler
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Laura Mechtouff
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Marielle Buisson
- Department of Cardiology, Clinical Investigation Center, Université Lyon 1, Lyon, France.,CarMeN, CNRS-UMR1060, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Michel Ovize
- Department of Cardiology, Clinical Investigation Center, Université Lyon 1, Lyon, France.,CarMeN, CNRS-UMR1060, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon 1, Lyon, France.,Department of Neuroradiology, Université Lyon 1, Lyon, France.,CREATIS, CNRS-UMR5220 INSERM-U1044, Lyon, France.,INSA-Lyon, Lyon, France.,Hospices Civils de Lyon, Lyon, France
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Berner LP, Cho TH, Haesebaert J, Bouvier J, Wiart M, Hjort N, Klærke Mikkelsen I, Derex L, Thomalla G, Pedraza S, Østergaard L, Baron JC, Nighoghossian N, Berthezène Y. MRI Assessment of Ischemic Lesion Evolution within White and Gray Matter. Cerebrovasc Dis 2016; 41:291-7. [PMID: 26867026 DOI: 10.1159/000444131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In acute ischemic stroke (AIS), gray matter (GM) and white matter (WM) have different vulnerabilities to ischemia. Thus, we compared the evolution of ischemic lesions within WM and GM using MRI. METHODS From a European multicenter prospective database (I-KNOW), available T1-weighted images were identified for 50 patients presenting with an anterior AIS and a perfusion weighted imaging (PWI)/diffusion weighted imaging (DWI) mismatch ratio of 1.2 or more. Six lesion compartments were outlined: initial DWI (b = 1,000 s/mm2) lesion, initial PWI-DWI mismatch (Tmax >4 s and DWI-negative), final infarct mapped on 1-month fluid-attenuated inversion recovery (FLAIR) imaging, lesion growth between acute DWI and 1-month FLAIR, DWI lesion reversal at 1 month and salvaged mismatch. The WM and GM were segmented on T1-weighted images, and all images were co-registered within subjects to the baseline MRI. WM and GM proportions were calculated for each compartment. RESULTS Fifty patients were eligible for the study. Median delay between symptom onset and baseline MRI was 140 min. The percentage of WM was significantly greater in the following compartments: initial mismatch (52.5 vs. 47.5%, p = 0.003), final infarct (56.7 vs. 43.3%, p < 0.001) and lesion growth (58.9 vs. 41.2%, p < 0.001). No significant difference was found between GM and WM percentages within the initial DWI lesion, DWI reversal and salvaged mismatch compartments. CONCLUSIONS Ischemic lesions may extend preferentially within the WM. Specific therapeutic strategies targeting WM ischemic processes may deserve further investigation.
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Ronsin S, Deiana G, Geraldo AF, Durand-Dubief F, Thomas-Maisonneuve L, Formaglio M, Desestret V, Meyronet D, Nighoghossian N, Berthezène Y, Honnorat J, Ducray F. Pseudotumoral presentation of cerebral amyloid angiopathy-related inflammation. Neurology 2016; 86:912-9. [PMID: 26850981 DOI: 10.1212/wnl.0000000000002444] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/09/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify the clinical and radiologic features that should raise suspicion for the pseudotumoral presentation of cerebral amyloid angiopathy-related inflammation (CAA-I). METHODS We retrospectively reviewed the characteristics of 5 newly diagnosed and 23 previously reported patients in whom the CAA-I imaging findings were initially interpreted as CNS neoplasms. RESULTS Most cases (85%) occurred in patients >60 years old. The clinical characteristics at presentation included subacute cognitive decline (50%), confusion (32%), focal deficits (32%), seizures (25%), and headaches (21%). Brain MRI demonstrated infiltrative white matter lesions that exhibited a loco-regional mass effect without parenchymal enhancement (93%). In general, these findings were interpreted as low-grade glioma or lymphoma. Eighteen patients (64%) underwent a biopsy, which was nondiagnostic in 4 patients (14%), and 6 patients (21%) underwent a surgical resection. The primary reason for the misinterpretation of the imaging findings was the absence of T2*-weighted gradient recalled echo (T2*-GRE) sequences on initial imaging (89%). When subsequently performed (39%), the T2*-GRE sequences demonstrated multiple characteristic cortical and subcortical microhemorrhages in all cases. Perfusion MRI and magnetic resonance spectroscopy (MRS), which were performed on a subset of patients, indicated markedly reduced relative cerebral blood flow and a normal metabolic ratio. CONCLUSION The identification of one or several nonenhancing space-occupying lesions, especially in elderly patients presenting with cognitive impairment, should raise suspicion for the pseudotumoral presentation of CAA-I and lead to T2*-GRE sequences. Perfusion MRI and MRS appear to be useful techniques for the differential diagnosis of this entity.
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Affiliation(s)
- Solène Ronsin
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Gianluca Deiana
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Ana Filipa Geraldo
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Françoise Durand-Dubief
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Laure Thomas-Maisonneuve
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Maïté Formaglio
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Virginie Desestret
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - David Meyronet
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Norbert Nighoghossian
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Yves Berthezène
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
| | - Jérôme Honnorat
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France.
| | - François Ducray
- From the Neuro-oncology Department (S.R., L.T.-M., J.H., F.D.), Neuro-radiology Department (G.D., A.F.G., Y.B.), Neurology Department A (F.D.-D.), Neurology Department D (M.F., V.D.), Neuropathology Department (D.M.), and Stroke Unit (N.N.), Hôpital Neurologique, Hospices Civils de Lyon; Université de Lyon-Université Claude Bernard Lyon 1 (S.R., G.D., A.F.G., F.D.-D., L.T.-M., M.F., V.D., D.M., N.N., Y.B., J.H., F.D.), France; Neurology Department and Stroke Unit (G.D.), Ospedale San Francesco, Nuoro, Italy; and Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292 (J.H., F.D.), France
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Ozenne B, Cho TH, Mikkelsen IK, Hermier M, Ribe L, Thomalla G, Pedraza S, Baron JC, Roy P, Berthezène Y, Nighoghossian N, Østergaard L, Maucort-Boulch D. Evaluation of Early Reperfusion Criteria in Acute Ischemic Stroke. J Neuroimaging 2015; 25:952-8. [PMID: 25940773 DOI: 10.1111/jon.12255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Though still debated, early reperfusion is increasingly used as a biomarker for clinical outcome. However, the lack of a standard definition hinders the assessment of reperfusion therapies and study comparisons. The objective was to determine the optimal early reperfusion criteria that predicts clinical outcome in ischemic stroke. METHODS Early reperfusion was assessed voxel-wise in 57 patients within 6 hours of symptom onset. The performance of the time to peak (TTP), the mean transit time (MTT), and the time to maximum of residue function (Tmax ) at various delays thresholds in predicting the neurological response (based on the National Institutes of Health Stroke Scale) and the functional outcome (modified Rankin scale ≤1) at 1 month were compared. A receiver operating characteristics (ROC) analysis determined the optimal extent of reperfusion. A novel unsupervised classification of reperfusion using group-based trajectory modeling (GBTM) was evaluated. RESULTS MTT had a lower performance than TTP and Tmax in predicting the neurological response (P = .008 vs. TTP and P = .006 vs. Tmax ) or the functional outcome (P = .0006 vs. TTP; P = .002 vs. Tmax ). No delay threshold had a significantly higher predictive value than another. The optimal percentage of reperfusion was dependent on the outcome scale (P < .001). The GBTM-based classification of reperfusion was closely associated with the clinical outcome and had a similar accuracy compared to ROC-based classification. CONCLUSIONS TTP and Tmax should be preferred to MTT in defining early reperfusion. GBTM provided a clinically relevant reperfusion classification that does not require prespecified delay thresholds or clinical outcomes.
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Affiliation(s)
- Brice Ozenne
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Irene Klaerke Mikkelsen
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark.,Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Hermier
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
| | - Lars Ribe
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Jean-Claude Baron
- INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France
| | - Pascal Roy
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
| | - Yves Berthezène
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine and Department of Neuroradiology, Université Lyon 1; CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Leif Østergaard
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Delphine Maucort-Boulch
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France, Equipe Biostatistique Santé CNRS UMR 5558, Villeurbanne, France; Université Lyon I, Lyon, France
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Nighoghossian N, Berthezène Y, Mechtouff L, Derex L, Cho TH, Ritzenthaler T, Rheims S, Chauveau F, Béjot Y, Jacquin A, Giroud M, Ricolfi F, Philippeau F, Lamy C, Turc G, Bodiguel E, Domigo V, Guiraud V, Mas JL, Oppenheim C, Amarenco P, Cakmak S, Sevin-Allouet M, Guillon B, Desal H, Hosseini H, Sibon I, Mahagne MH, Ong E, Mewton N, Ovize M. Cyclosporine in acute ischemic stroke. Neurology 2015; 84:2216-23. [PMID: 25948727 DOI: 10.1212/wnl.0000000000001639] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/19/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES We examined whether IV administration of cyclosporine in combination with thrombolysis might reduce cerebral infarct size. METHODS Patients aged 18 to 85 years, presenting with an anterior-circulation stroke and eligible for thrombolytic therapy, were enrolled in this multicenter, single-blinded, controlled trial. Fifteen minutes after randomization, patients received either an IV bolus injection of 2.0 mg/kg cyclosporine (Sandimmune, Novartis) or placebo. The primary endpoint was infarct volume on MRI at 30 days. Secondary endpoints included infarct volume according to the site (proximal/distal) of arterial occlusion and recanalization after thrombolysis. RESULTS From October 2009 to July 2013, 127 patients were enrolled. The primary endpoint was assessed in 110 of 127 patients. The reduction of infarct volume in the cyclosporine compared with the control group was overall not significant (21.8 mL [interquartile range, IQR 5.1, 69.2 mL] vs 28.8 mL [IQR 7.7, 95.0 mL], respectively; p = 0.18). However, in patients with proximal occlusion and effective recanalization, infarct volume was significantly reduced in the cyclosporine compared with the control group (14.9 mL [IQR 1.3, 23.2 mL] vs 48.3 mL [IQR 34.5, 118.2 mL], respectively; p = 0.009). CONCLUSIONS Cyclosporine was generally not effective in reducing infarct size. However, a smaller infarct size was observed in patients with proximal cerebral artery occlusion and efficient recanalization. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that in patients with an acute anterior-circulation stroke, thrombolysis plus IV cyclosporine does not significantly decrease 30-day MRI infarct volume compared with thrombolysis alone.
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Affiliation(s)
- Norbert Nighoghossian
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Yves Berthezène
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Laura Mechtouff
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Laurent Derex
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Tae Hee Cho
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Thomas Ritzenthaler
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Sylvain Rheims
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Fabien Chauveau
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Yannick Béjot
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Agnès Jacquin
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Maurice Giroud
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Frédéric Ricolfi
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Frédéric Philippeau
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Catherine Lamy
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Guillaume Turc
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Eric Bodiguel
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Valérie Domigo
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Vincent Guiraud
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Jean-Louis Mas
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Catherine Oppenheim
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Pierre Amarenco
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Serkan Cakmak
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Mathieu Sevin-Allouet
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Benoit Guillon
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Hubert Desal
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Hassan Hosseini
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Igor Sibon
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Marie-Hélène Mahagne
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Elodie Ong
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Nathan Mewton
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France
| | - Michel Ovize
- From the Departments of Neurology (N.N., L.M., L.D., T.H.C., T.R., S.R., E.O.) and Neuroradiology (Y. Berthezène, F.C.), Hôpital Neurologique Pierre Wertheimer, Creatis CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon; Dijon Stroke Registry (Y. Béjot, A.J., M.G., F.R.) (EA 4184, Inserm, Invs), University Hospital of Dijon, Regional Council and University of Burgondy, CHU le Bocage, Dijon; Department of Neurology (F.P.), Centre Hospitalier de Fleyriat, Bourg en Bresse; Departments of Neurology (C.L., G.T., E.B., V.D., V.G., J.-L.M.) and Neuroradiology (C.O.), CH Sainte-Anne, University Paris-Descartes, INSERM U894, DHU NeuroVasc Sorbonne Paris Cité; Department of Neurology (P.A.), Hôpital Bichat-Claude Bernard, Paris; Department of Neurology (S.C.), Hôpital Nord-Ouest, Plateau d'Ouilly, Villefranche sur Saône; Department of Neurology (M.S.-A., B.G., H.D.), Hôpital Nord-Laënnec, Saint-Herblain; Department of Neurology (H.H.), Hôpital Henri Mondor, Créteil; Department of Neurology (I.S.), Groupe Hospitalier Pellegrin, Place Amélie Raba-Léon, Bordeaux; Unité Neurosciences (M.-H.M.), Hôpital Saint Roch, Nice; Hôpital Louis Pradel (N.M., M.O.), Service d'Explorations Fonctionelles Cardiovasculaires, Centre d'Investigation Clinique & UMR1060 (CarMeN), Université Claude Bernard Lyon 1, France.
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Cho TH, Nighoghossian N, Mikkelsen IK, Derex L, Hermier M, Pedraza S, Fiehler J, Østergaard L, Berthezène Y, Baron JC. Reperfusion within 6 hours outperforms recanalization in predicting penumbra salvage, lesion growth, final infarct, and clinical outcome. Stroke 2015; 46:1582-9. [PMID: 25908463 DOI: 10.1161/strokeaha.114.007964] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The relative merits of reperfusion versus recanalization to predict tissue and clinical outcomes in anterior circulation stroke have been previously assessed using data acquired >12 hours postonset. To avoid late-occurring confounders such as non-nutritional reperfusion, futile recanalization and no-reflow phenomenon, we performed ultraearly assessment of reperfusion and recanalization. METHODS From a multicenter prospective database, 46 patients with acute magnetic resonance angiography-visible occlusion and in whom both reperfusion and recanalization were assessed on follow-up magnetic resonance imaging ≤6 hours of symptom onset were identified. Multiple linear regressions modeled salvaged penumbra, diffusion-weighted imaging lesion growth, and final infarct at 1 month using baseline clinical and imaging parameters and acute reperfusion or recanalization. Best predictors were determined with the Akaike information criterion. Univariate and multivariate logistic regressions identified the clinical and imaging predictors of clinical outcome. RESULTS Admission magnetic resonance imaging showed M1 occlusion in 15 (33%) patients; median penumbra volume was 13.4 mL. Acute reperfusion was observed in 27 (59%) patients; 42% of nonrecanalized patients demonstrated reperfusion. The dichotomized classification of reperfusion and recanalization was discordant (P=0.0002). Reperfusion≤6 hours was a significant (P<0.05) predictor of increased penumbra salvage, reduced lesion growth, and final infarct size. Recanalization did not improve model accuracy. Reperfusion, but not recanalization, was significantly associated with good clinical outcome in logistic regressions. CONCLUSIONS Reperfusion≤6 hours was consistently superior to recanalization in predicting tissue and clinical outcome. Reperfusion without recanalization was frequent and probably related to retrograde reperfusion through leptomeningeal collaterals. Acute reperfusion was the strongest predictor of, and may therefore, represent a reliable surrogate for, clinical outcome.
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Affiliation(s)
- Tae-Hee Cho
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.).
| | - Norbert Nighoghossian
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Irene Klærke Mikkelsen
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Laurent Derex
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Marc Hermier
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Salvador Pedraza
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Jens Fiehler
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Leif Østergaard
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Yves Berthezène
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
| | - Jean-Claude Baron
- From the Department of Stroke Medicine (T.-H.C., N.N., L.D.) and Department of Neuroradiology (M.H., Y.B.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.Ø.); Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain (S.P.); Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (J.-C.B.); and INSERM U894, Hôpital Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, France (J.-C.B.)
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Frindel C, Rouanet A, Giacalone M, Cho TH, Østergaard L, Fiehler J, Pedraza S, Baron JC, Wiart M, Berthezène Y, Nighoghossian N, Rousseau D. Validity of shape as a predictive biomarker of final infarct volume in acute ischemic stroke. Stroke 2015; 46:976-81. [PMID: 25744520 DOI: 10.1161/strokeaha.114.008046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE This study examines whether lesion shape documented on magnetic resonance diffusion-weighted imaging during acute stroke improves the prediction of the final infarct volume compared with lesion volume only. METHODS Diffusion-weighted imaging data and clinical information were retrospectively reviewed in 110 consecutive patients who underwent (n=67) or not (n=43) thrombolytic therapy for acute ischemic stroke. Three-dimensional shape analysis was performed on admission diffusion-weighted imaging data and 5 shape descriptors were developed. Final infarct volume was measured on T2-fluid-attenuated inversion recovery imaging data performed 30 days after stroke. RESULTS Shape analysis of acute ischemic lesion and more specifically the ratio of the bounding box volume to the lesion volume before thrombolytic treatment improved the prediction of the final infarct for patients undergoing thrombolysis (R(2)=0.86 in model with volume; R(2)=0.98 in model with volume and shape). CONCLUSIONS Our findings suggest that lesion shape contains important predictive information and reflects important environmental factors that might determine the progression of ischemia from the core.
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Affiliation(s)
- Carole Frindel
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Anaïs Rouanet
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Mathilde Giacalone
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Tae-Hee Cho
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Leif Østergaard
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Jens Fiehler
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Salvador Pedraza
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Jean-Claude Baron
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Marlène Wiart
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Yves Berthezène
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - Norbert Nighoghossian
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.)
| | - David Rousseau
- From Université de Lyon, CREATIS, CNRS UMR5220, INSERM 1044, Université Lyon 1, INSA Lyon, Villeurbanne, France (C.F., A.R., M.G., T.-H.C., M.W., Y.B., N.N., D.R.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark (L.Ø.); Departments of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (J.F.); Department of Radiology, Girona Biomedical Research Institute, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain (S.P.); and INSERM U894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (J.-C.B.).
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Giraud M, Cho TH, Nighoghossian N, Maucort-Boulch D, Deiana G, Østergaard L, Baron JC, Fiehler J, Pedraza S, Derex L, Berthezène Y. Early Blood Brain Barrier Changes in Acute Ischemic Stroke: A Sequential MRI Study. J Neuroimaging 2015; 25:959-63. [PMID: 25702824 DOI: 10.1111/jon.12225] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/18/2014] [Accepted: 01/10/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE We sought to identify MRI factors associated with BBB changes at the acute stage of ischemic stroke. METHODS We analyzed BBB changes on admission and within 3 hours after the first scan. BBB changes was defined as the presence of leptomeningeal and parenchymal contrast enhancement on T1-weighted imaging. Tmax , CBV, and DWI lesion volume were assessed on baseline MRI. Clinical and MRI factors associated with BBB changes were assessed by univariate and multivariate logistic regressions analyses. RESULTS Forty-four patients were included. BBB changes on baseline MRI was observed in 2 of 44 patients (3%). BBB disruption on H3-MRI was present in 19 of 44 patients (43%). Hemodynamic status and baseline ischemic core size were not different between patients with or without BBB changes. BBB alteration on H3 MRI was strongly associated with FLAIR MRI sequence positivity, 16/19 patients (83%) P = .001. CONCLUSION BBB changes are exceptional during the first 3 hours after stroke onset. Delayed BBB alteration was associated with FLAIR positivity mainly reflecting vasogenic edema.
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Affiliation(s)
- Marc Giraud
- Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Department of Stroke Medicine, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Delphine Maucort-Boulch
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France, CNRS UMR 5558, Equipe Biostatistique Santé, Pierre-Bénite, France, Université Lyon I, Villeurbanne, France
| | - Gianluca Deiana
- Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Leif Østergaard
- Department of Neuroradiology, Center of Functionally Integrative Neuroscience, Århus University, Århus, Denmark
| | - Jean-Claude Baron
- Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK, Centre de Psychiatrie & Neurosciences, Inserm U894, Centre Hospitalier Sainte Anne, Sorbonne Paris Cité, Paris, France
| | - Jens Fiehler
- Departments of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Salvador Pedraza
- Department of Radiology (IDI), Girona Biomedical Research Institute (IDIBGI), Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - Laurent Derex
- Department of Stroke Medicine, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Department of Neuroradiology, Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
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Durand A, Chauveau F, Cho TH, Kallus C, Wagner M, Boutitie F, Maucort-Boulch D, Berthezène Y, Wiart M, Nighoghossian N. Effects of a TAFI-inhibitor combined with a suboptimal dose of rtPA in a murine thromboembolic model of stroke. Cerebrovasc Dis 2014; 38:268-75. [PMID: 25401979 DOI: 10.1159/000366266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Since thrombolysis is the only approved intervention for ischemic stroke, improving its efficacy and safety is a therapeutic aim of considerable interest. The activated form of thrombin activatable fibrinolysis inhibitor (TAFI) has antifibrinolytic effects, and inhibition of TAFI might thus favor recanalization. The present study compared efficacy between TAFI inhibition alone and TAFI inhibition in combination with rtPA at a suboptimal dose, in a murine model of thromboembolic stroke. METHODS Focal ischemia was induced in mice by thrombin injection in the middle cerebral artery. Animals were placed within the magnet immediately after surgery for baseline MRI (H0). MRI examination comprised diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and T2-weighted imaging (T2-WI). Animals were randomly assigned to 1 of 5 treatment groups: saline, rtPA 5 mg/kg (tPA(5): suboptimal or low dose), rtPA 10 mg/kg (tPA(10): standard dose), TAFI-I 100 mg/kg (TAFI-I), and rtPA 5 mg/kg + TAFI-I 100 mg/kg (tPA(5) + TAFI-I). Treatments were administered inside the magnet, via a catheter placed in the tail vein, using a power injector, as 10% bolus and 90% infusion over a period of 20 min. MRI examination was repeated at 3 h (H3) and 24 h (H24) after surgery. Therapeutic benefit was evaluated by: (1) improvement of reperfusion and (2) reduction in final lesion size. Microhemorrhages were assessed as black spots on T2-WI at H24. Animals were sacrificed after the last MR examination. The surgeon and all investigators were blinded to treatment allocation. RESULTS A total of 104 mice were operated on. Forty four of these were excluded from the study and 27 from the analysis, according to a priori defined criteria (no lesion or no mismatch), leading to the following distribution: saline (n = 6), tPA(5) (n = 8), tPA(10) (n = 7), TAFI-I (n = 7), and TAFI-I + tPA(5) (n = 5). Standard-dose rtPA treatment (tPA(10)) significantly improved lesion regression between H0 and H24 compared to saline (-57 ± 18% vs. -36 ± 21%, p = 0.03), which treatment with rtPA(5) or TAFI-I alone did not. On the other hand, combined treatment with tPA(5) + TAFI-I showed only a trend toward lesion regression (-49 ± 26%), similarly to treatment with tPA(10), but not significantly different from saline (p = 0.46). Nine animals showed microhemorrhage on T2-WI at H24. These animals were evenly distributed between groups. CONCLUSIONS The present study showed that the combination of TAFI-I with a suboptimal dose of rtPA is not as effective as the standard dose of rtPA, while TAFI inhibition alone is not effective at all. The thromboembolic model is of particular interest in assessing rtPA association to improve thrombolysis, especially when coupled with longitudinal MRI assessment.
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Affiliation(s)
- Anne Durand
- CREATIS, CNRS UMR5220, INSERM U1044, INSA de Lyon, Université de Lyon, Lyon 1, France
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Mesmann C, Sigovan M, Berner LP, Abergel A, Tronc F, Berthezène Y, Douek P, Boussel L. Evaluation of image quality of DWIBS versus DWI sequences in thoracic MRI at 3T. Magn Reson Imaging 2014; 32:1237-41. [PMID: 25159472 DOI: 10.1016/j.mri.2014.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 01/12/2014] [Accepted: 08/12/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare diffusion weighted imaging with background suppression (DWIBS) sequence with classic spectral diffusion sequence (DWI) with and without respiratory gating in mediastinal lymph node analysis at 3T. MATERIALS AND METHODS 26 patients scheduled for mediastinoscopic lymph node analysis, prospectively undergone a thoracic 3T MRI with DWIBS (FatSat=STIR; TR/TE=6674.1/44.7ms; IR=260 ms) and DWI sequences (FatSat=SPIR; TR/TE=1291/59.6 ms) (b=0-400-800 s/mm2) with and without (free breathing) respiratory gating. Images at b=800 were analyzed by two radiologists. They performed qualitative analysis of fat-sat homogeneity and motion artifacts, rated from 0 to 4, and quantitative evaluation by studying signal to background (STB) of lymph nodes. RESULTS Quality of fat suppression was significantly higher for DWIBS than for DWI both for free-breathing (score 3.48±0.65 vs. 1.76±0.96, p<0.0001) and respiratory-gated scans (3.17±0.77 vs. 1.72±0.73, p=0.0001). Similarly, artifacts were reduced with DWIBS (3.16±0.47 vs. 1.76±0.59, p<0.0001; 3.0±0.73 vs. 2.04±0.53, p=0.0001). Quantitative analysis showed higher STB with DWIBS (3.26±1.83 vs. 0.98±0.44, p<0.0001; 3.56±, 2.09 vs. 0.92±0.59, p<0.0001). Gating did not improve image quality and STB on DWIBS (p>0.05). CONCLUSION In thoracic MRI, ungated DWIBS sequence improves fat-sat homogeneity, reduces motion artifacts and increases STB of lymph nodes. Respiratory gating does not improve DWIBS image quality.
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Affiliation(s)
- Caroline Mesmann
- Department of Radiology, Centre hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Monica Sigovan
- Department of Radiology, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Lise-Prune Berner
- Department of Radiology, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Adva Abergel
- Department of Radiology, Centre hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Tronc
- Department of Thoracic Surgery, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Y Berthezène
- Department of Radiology, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France
| | - P Douek
- Department of Radiology, Hopital Cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France
| | - Loic Boussel
- Department of Radiology, Centre hospitalier de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université de Lyon, CREATIS; CNRS UMR5220; Inserm U1044; INSA-Lyon; Université Lyon 1, France
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Le Moigne F, Boussel L, Haquin A, Bancel B, Ducerf C, Berthezène Y, Rode A. Grading of small hepatocellular carcinomas (≤2 cm): correlation between histology, T2 and diffusion-weighted imaging. Br J Radiol 2014; 87:20130763. [PMID: 25007142 DOI: 10.1259/bjr.20130763] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the capacity of diffusion-weighted imaging (DWI) to determine the histological grade of small-sized hepatocellular carcinomas (HCCs) in liver cirrhosis in comparison with T2 weighted imaging. METHODS 51 cirrhotic patients with 63 histologically proven HCCs ≤2 cm underwent abdominal MRI, including DWI (b-values 50, 400 and 800 s mm(-2)) and T2 weighted sequences. HCCs were classified into well-differentiated HCCs (n = 37) and moderately differentiated HCCs (n = 26). Relative contrast ratios (RCRs) between the lesions and the surrounding liver were performed and compared between the two groups for T2 weighted images, each b-value and apparent diffusion coefficients (ADCs). A receiver operating characteristic (ROC) analysis was performed to compare RCRs in T2 and diffusion-weighted images. RESULTS We found significant differences in RCRs between well-differentiated vs moderately differentiated HCCs for b = 50, 400 and 800 s mm(-2) and T2 weighted images (1.35 ± 0.36 vs 1.86 ± 0.62; 1.35 ± 0.38 vs 1.82 ± 0.60; 1.27 ± 0.30 vs 1.74 ± 0.53; 1.14 ± 0.18 vs 1.43 ± 0.28, respectively; p < 0.001), whereas no significant differences were observed in ADC and ADC RCR (1.05 ± 0.19 vs 0.99 ± 0.15 and 1.1 ± 0.22 vs 1.09 ± 0.23; p = 0.16 and p = 0.82, respectively). No significant difference was found in the areas under the ROC curve for RCRs of T2 weighted images and every DWI b-value (p = 0.18). CONCLUSION The RCR measurement performed in DWI 50, 400 and 800 b-values and T2 demonstrated a significant difference between well-differentiated and moderately differentiated small-sized HCCs. Furthermore, no difference was shown by using either ADC or ADC RCR. ADVANCES IN KNOWLEDGE DWI with RCR measurement may be a valuable tool for non-invasively predicting the histological grade of small HCCs.
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Affiliation(s)
- F Le Moigne
- 1 Department of Radiology, Desgenettes Military Teaching Hospital, Lyon, France
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Berner L, Rositi H, Vadcard F, Bolbos R, Langlois JB, Parola S, Rousseau D, Nighoghossian N, Frindel C, Berthezène Y, Wiart M. Caractérisation en IRM d un nouveau produit de contraste bimodal pour l’imagerie cérébrale in vivo : premiers résultats expérimentaux chez la souris. J Neuroradiol 2014. [DOI: 10.1016/j.neurad.2014.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brusseau E, Detti V, Coulon A, Maissiat E, Boublay N, Berthezène Y, Fromageau J, Bush N, Bamber J. In Vivo response to compression of 35 breast lesions observed with a two-dimensional locally regularized strain estimation method. Ultrasound Med Biol 2014; 40:300-12. [PMID: 24315397 DOI: 10.1016/j.ultrasmedbio.2013.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 02/16/2013] [Accepted: 02/21/2013] [Indexed: 06/02/2023]
Abstract
The objective of this study was to assess the in vivo performance of our 2-D locally regularized strain estimation method with 35 breast lesions, mainly cysts, fibroadenomas and carcinomas. The specific 2-D deformation model used, as well as the method's adaptability, led to an algorithm that is able to track tissue motion from radiofrequency ultrasound images acquired in clinical conditions. Particular attention was paid to strain estimation reliability, implying analysis of the mean normalized correlation coefficient maps. For all lesions examined, the results indicated that strain image interpretation, as well as its comparison with B-mode data, should take into account the information provided by the mean normalized correlation coefficient map. Different trends were observed in the tissue response to compression. In particular, carcinomas appeared larger in strain images than in B-mode images, resulting in a mean strain/B-mode lesion area ratio of 2.59 ± 1.36. In comparison, the same ratio was assessed as 1.04 ± 0.26 for fibroadenomas. These results are in agreement with those of previous studies, and confirm the interest of a more thorough consideration of size difference as one parameter discriminating between malignant and benign lesions.
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Affiliation(s)
- Elisabeth Brusseau
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, France.
| | - Valérie Detti
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, France
| | - Agnès Coulon
- Hospices Civils de Lyon, Service de Radiologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Emmanuèle Maissiat
- Hospices Civils de Lyon, Service de Radiologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Nawele Boublay
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Lyon, France; Université Lyon 1, Equipe d'Accueil 4129, France; Centre Mémoire de Ressources et de Recherche (CMRR), Hôpital des Charpennes, Lyon, France
| | - Yves Berthezène
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, France; Hospices Civils de Lyon, Service de Radiologie, Hôpital de la Croix-Rousse, Lyon, France
| | - Jérémie Fromageau
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Nigel Bush
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Jeffrey Bamber
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey, UK
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Hermitte L, Cho TH, Ozenne B, Nighoghossian N, Mikkelsen IK, Ribe L, Baron JC, Østergaard L, Derex L, Hjort N, Fiehler J, Pedraza S, Hermier M, Maucort-Boulch D, Berthezène Y. Very low cerebral blood volume predicts parenchymal hematoma in acute ischemic stroke. Stroke 2013; 44:2318-20. [PMID: 23723309 DOI: 10.1161/strokeaha.113.001751] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to explore the impact of early reperfusion and recanalization. METHODS The volume of cerebral tissue with CBV≤2.5th percentile of the normal hemisphere was calculated within the acute diffusion-weighted imaging lesion. Hemorrhagic transformation was assessed on day 2 MRI according to the European Cooperative Acute Stroke Study II criteria. Recanalization and reperfusion were assessed on 3-hour follow-up MRI. RESULTS Of the 110 patients, hemorrhagic transformation occurred in 59 patients, including 7 PH. In univariate analysis, the acute National Institutes of Health Stroke Scale score (P=0.002), acute diffusion-weighted imaging lesion volume (P=0.02), and thrombolysis (P=0.03), but not very low CBV (P=0.52), were associated with hemorrhagic transformation. The volume of very low CBV was the only predictor of PH (P=0.007). Early reperfusion and recanalization had no influence on either hemorrhagic transformation or PH. CONCLUSION Very low CBV was the only independent predictor of PH in patients with acute stroke.
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Affiliation(s)
- Laure Hermitte
- Université de Lyon, Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France
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Marinescu M, Langer M, Durand A, Olivier C, Chabrol A, Rositi H, Chauveau F, Cho TH, Nighoghossian N, Berthezène Y, Peyrin F, Wiart M. Synchrotron Radiation X-Ray Phase Micro-computed Tomography as a New Method to Detect Iron Oxide Nanoparticles in the Brain. Mol Imaging Biol 2013; 15:552-9. [DOI: 10.1007/s11307-013-0639-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Riou A, Chauveau F, Cho TH, Marinescu M, Nataf S, Nighoghossian N, Berthezène Y, Wiart M. MRI assessment of the intra-carotid route for macrophage delivery after transient cerebral ischemia. NMR Biomed 2013; 26:115-123. [PMID: 22730167 DOI: 10.1002/nbm.2826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/21/2012] [Accepted: 05/05/2012] [Indexed: 06/01/2023]
Abstract
The broad aim underlying the present research was to investigate the distribution and homing of bone marrow-derived macrophages in a rodent model of transient middle cerebral artery occlusion using MRI and ultrasmall superparamagnetic iron oxide (USPIO) to magnetically label bone marrow-derived macrophages. The specific aim was to assess the intra-carotid infusion route for bone marrow-derived macrophage delivery at reperfusion. Fifteen Sprague-Dawley rats sustained 1 h of middle cerebral artery occlusion. USPIO-labeled bone marrow-derived macrophages were slowly injected for 5 min immediately after reperfusion in ischemic animals (n=7), 1 h after the end of surgery in sham animals (n=5) and very shortly after anesthesia in healthy animals (n=3). Multiparametric MRI was performed at day 0, just after cell administration, and repeated at day 1. Immunohistological analysis included Prussian blue for iron detection and rat endothelial cell antigen-1 for endothelium visualization. Intra-carotid cell delivery brought a large number of cells to the ipsilateral hemisphere of the brain, as seen on both MRI and immunohistology. However, it was associated with high mortality (50%). The study of sham animals demonstrated that intra-carotid cell delivery could induce ischemic lesions and may thus favor additional brain damage. The present study highlights severe drawbacks to the intra-carotid delivery of macrophages at the time of reperfusion in this rodent model of transient cerebral ischemia. Multiparametric MRI appears to be a method of choice to monitor longitudinally the effects of cell infusion, allowing the assessment of both cell fate with the help of magnetic labeling and of potential tissue damage.
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Affiliation(s)
- Adrien Riou
- Université de Lyon, Lyon 1, UMR CNRS 5220, INSERM U1044, INSA de Lyon, Creatis, Bron, France
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Durand A, Chauveau F, Cho TH, Bolbos R, Langlois JB, Hermitte L, Wiart M, Berthezène Y, Nighoghossian N. Spontaneous reperfusion after in situ thromboembolic stroke in mice. PLoS One 2012; 7:e50083. [PMID: 23166825 PMCID: PMC3500336 DOI: 10.1371/journal.pone.0050083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/15/2012] [Indexed: 11/19/2022] Open
Abstract
Injection of thrombin into the middle cerebral artery (MCA) of mice has been proposed as a new model of thromboembolic stroke. The present study used sequential multiparametric Magnetic Resonance Imaging (MRI), including Magnetic Resonance Angiography (MRA), Diffusion-Weighted Imaging (DWI) and Perfusion-Weighted Imaging (PWI), to document MCA occlusion, PWI-DWI mismatch, and lesion development. In the first experiment, complete MCA occlusion and reproducible hypoperfusion were obtained in 85% of animals during the first hour after stroke onset. In the second experiment, 80% of animals showed partial to complete reperfusion during a three-hour follow-up. Spontaneous reperfusion thus contributed to the variability in ischemic volume in this model. The study confirmed the value of the model for evaluating new thrombolytic treatments, but calls for extended MRI follow-up at the acute stage in therapeutic studies.
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Affiliation(s)
- Anne Durand
- Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Fabien Chauveau
- Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Tae-Hee Cho
- Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Radu Bolbos
- CERMEP-Imagerie du Vivant, Animage, Lyon, France
| | | | - Laure Hermitte
- Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Marlène Wiart
- Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Yves Berthezène
- Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
| | - Norbert Nighoghossian
- Université de Lyon, CREATIS, CNRS UMR5220, INSERM U1044, INSA-Lyon, Université Lyon 1, Hospices Civils de Lyon, Lyon, France
- * E-mail:
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Cho TH, Aguettaz P, Campuzano O, Charriaut-Marlangue C, Riou A, Berthezène Y, Nighoghossian N, Ovize M, Wiart M, Chauveau F. Pre- and post-treatment with cyclosporine A in a rat model of transient focal cerebral ischaemia with multimodal MRI screening. Int J Stroke 2012; 8:669-74. [PMID: 22882746 DOI: 10.1111/j.1747-4949.2012.00849.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Irreversible damage may occur at reperfusion after sustained cerebral ischaemia. AIMS We investigated the value of cyclosporine A for reducing the infarct size in a model of transient middle cerebral artery occlusion. METHODS Twenty-seven Sprague-Dawley rats sustained a middle cerebral artery occlusion of one-hour. Acute multimodal Magnetic Resonance Imaging (MRI) was used during occlusion to confirm the success of surgery and measure baseline lesion size. Animals were randomly treated by: (i) intracarotid cyclosporine A (10 mg/kg) 20 mins before middle cerebral artery occlusion (pretreatment group); (ii) intracarotid cyclosporine A (10 mg/kg) immediately after reperfusion (post-treatment group); and (iii) intracarotid saline immediately after reperfusion. RESULTS Histopathological measurements on day 1 showed a significant reduction of infarct size in the pretreatment group compared to the post-treatment (percentage values of ipsilateral hemispheres: 16 ± 5% vs. 29 ± 11%, P = 0·004) and saline groups (16 ± 5% vs. 42 ± 12%, P = 0·015). No significant difference was observed between the post-treatment and saline groups (P = 0·065). Behavioural examinations on day 1 showed no significant difference between groups. Immunohistochemistry showed a statistically significant reduction of microglial cell count in the pretreatment group compared to either saline or cyclosporine A post-treatment groups. CONCLUSIONS We conclude that intracarotid cyclosporine A is effective in reducing infarct size when given prior to ischaemia, but not when administered at reperfusion.
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Affiliation(s)
- Tae-Hee Cho
- Université de Lyon, CREATIS; CNRS UMR5220, INSERM U1044, INSA-Lyon; Université Lyon 1, Hospices Civils de Lyon, France
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Marinescu M, Chauveau F, Durand A, Riou A, Cho TH, Dencausse A, Ballet S, Nighoghossian N, Berthezène Y, Wiart M. Monitoring therapeutic effects in experimental stroke by serial USPIO-enhanced MRI. Eur Radiol 2012; 23:37-47. [DOI: 10.1007/s00330-012-2567-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/25/2012] [Accepted: 06/02/2012] [Indexed: 01/28/2023]
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Chauveau F, Cho TH, Riou A, Langlois JB, Berthezène Y, Nighoghossian N, Wiart M. Does acute behavioral testing reflect successful ischemia in rats with transient middle cerebral artery occlusion? Int J Stroke 2011; 7:465-72. [PMID: 22151768 DOI: 10.1111/j.1747-4949.2011.00710.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Models of intraluminal middle cerebral artery occlusion present an intrinsic variability in infarct size. Behavioral evaluation is frequently performed during arterial occlusion to confirm success of surgery. AIMS AND/OR HYPOTHESIS We compared the value of behavioral testing and multimodal magnetic resonance imaging performed during arterial occlusion for identifying successfully operated animals. METHODS Rats were tested with behavioral assessment (using three scoring scales and the adhesive removal test) and multimodal magnetic resonance imaging (including magnetic resonance angiography, diffusion-weighted and perfusion-weighted imaging), both performed during the two-hours of middle cerebral artery occlusion using the intraluminal suture model. Behavioral assessment was repeated 24 h after reperfusion, followed by sacrifice. RESULTS Acute apparent diffusion coefficient lesion volume was correlated with both 2,3,5-triphenyl tetrazolium chloride infarct size (r = 0·75, P = 0·02) and behavioral status (r = 0·66, P = 0·05) on day one. Conversely, no correlation was found between acute behavioral examination and day one outcomes (2,3,5-triphenyl tetrazolium chloride infarct volume, r = 0·40, P = 0·28; behavioral examination, r = 0·39, P = 0·30). Day zero apparent diffusion coefficient volumes (P = 0·04), but not behavioral assessment (P = 0·60), discriminated animals with day one corticostriatal infarcts from these with subcortical infarcts. CONCLUSIONS Acute behavioral testing performed during arterial occlusion fails to identify successfully operated animals. Acute diffusion magnetic resonance imaging may be more appropriate to assess and reduce infarct size variability in this model.
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Affiliation(s)
- Fabien Chauveau
- Université de Lyon, CREATIS, CNRS UMR5220, Inserm U1044, INSA-Lyon, Université Lyon 1, France
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Berthezène Y, Nighoghossian N, Meyer R, Damien J, Cinotti L, Adeleine P, Trouillas P, Froment J. Course of Vasomotor Reactivity Using Dynamic Susceptibility Contrast-Enhanced MRI in a Patient with High-Grade Internal Carotid Artery Stenosis: Pre-and Post-Surgical Findings. Cerebrovasc Dis 2010. [DOI: 10.1159/000108198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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