Computed Tomography Perfusion and Diffusion-Weighted Imaging in Patients With Acute Stroke

Background and purpose Validation of automatically derived acute ischemic volumes (AAIV) from e-ASPECTS on non-contrast computed tomography (NCCT). Materials and methods Data from three studies were reanalyzed with e-ASPECTS Version 7. AAIV was calculated in milliliters (ml) in all scored ASPECTS regions of the hemisphere detected by e-ASPECTS. The National Institute of Health Stroke Scale (NIHSS) determined stroke severity at baseline and clinical outcome was measured with the modified Rankin Scale (mRS) between 45 and 120 days. Spearman ranked correlation coefficients (R) of AAIV and e-ASPECTS scores with NIHSS and mRS as well as Pearson correlation of AAIV with diffusion-weighted imaging and CT perfusion-estimated ischemic “core” volumes were calculated. Multivariate regression analysis (odds ratio, OR with 95% confidence intervals, CI) and Bland–Altman plots were performed. Results We included 388 patients. Mean AAIV was 11.6 ± 18.9 ml and e-ASPECTS was 9 (8–10: median and interquartile range). AAIV, respectively e-ASPECTS correlated with NIHSS at baseline (R = 0.35, p < 0.001; R = −0.36, p < 0.001) and follow-up mRS (R = 0.29, p < 0.001; R = −0.3, p < 0.001). In subsets of patients, AAIV correlated strongly with diffusion-weighted imaging ( n = 37, R = 0.68, p < 0.001) and computed tomography perfusion-derived ischemic “core” ( n = 41, R = 0.76, p < 0.001) lesion volume and Bland–Altman plots showed a bias close to zero (−2.65 ml for diffusion-weighted imaging and 0.45 ml forcomputed tomography perfusion “core”). Within the whole cohort, the AAIV (OR 0.98 per ml, 95% CI 0.96–0.99) and e-ASPECTS scores (OR 1.3, 95%CI 1.07–1.57) were independent predictors of good outcome Conclusion AAIV on NCCT correlated moderately with clinical severity but strongly with diffusion-weighted imaging lesion and computed tomography perfusion ischemic “core” volumes and predicted clinical outcome.

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Diagnosis of complications associated with acute cholecystitis using computed tomography and diffusion-weighted imaging with background body signal suppression/T2 image fusion

Experimental and Therapeutic Medicine ◽

10.3892/etm.2017.4567 ◽

2017 ◽

Vol 14 (1) ◽

pp. 743-747 ◽

Cited By ~ 2

Author(s):

Minoru Tomizawa ◽

Fuminobu Shinozaki ◽

Satomi Tanaka ◽

Takafumi Sunaoshi ◽

Daisuke Kano ◽

...

Keyword(s):

Computed Tomography ◽

Image Fusion ◽

Acute Cholecystitis ◽

Diffusion Weighted Imaging ◽

Diffusion Weighted ◽

Signal Suppression ◽

And Diffusion

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Effect of workflow metrics on clinical outcomes of low diffusion-weighted imaging Alberta Stroke Program Early Computed Tomography Score (DWI-ASPECTS) patients subjected to mechanical thrombectomy

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015519 ◽

2019 ◽

Vol 12 (8) ◽

pp. 742-746

Author(s):

Pietro Panni ◽

Caterina Michelozzi ◽

Sébastien Richard ◽

Gaultier Marnat ◽

Raphaël Blanc ◽

...

Keyword(s):

Computed Tomography ◽

Clinical Outcomes ◽

Diffusion Weighted Imaging ◽

Primary Outcome ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Good Outcome ◽

Diffusion Weighted ◽

Degree Of Disability ◽

And Diffusion

BackgroundAlthough accumulating evidence has demonstrated the benefit of mechanical thrombectomy (MT) in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), it is still unclear how workflow metrics impact the clinical outcomes of this subgroup of patients.MethodsPatients with acute stroke and diffusion-weighted imaging (DWI) ASPECTS ≤5 at baseline, who underwent MT within 6 hours of symptoms onset, were included from a prospectively maintained national multicentric registry between January 1, 2012 to August 31, 2017. The degree of disability was assessed by the modified Rankin Scale (mRS) at 90 days. The primary outcome was functional independence defined as mRS 0 to 2 at 90 days.ResultsThe study included 291 patients with baseline DWI-ASPECTS ≤5. Good outcome was achieved in 82 (28.2%) patients, and 104 (35.7%) patients died within 90 days. Successful reperfusion (modified Thrombolysis In Cerebral Infarction (mTICI) 2b-3) rate was 75.3%, and median onset to recanalization (OTR) time was 2 268min. Among time-related variables, OTR emerged as the strongest predictor of primary outcome (adjusted OR for every 60 min 0.59, 95% CI 0.44 to 0.77; p<0.001). mTICI 2c-3 independently predicted a good outcome (adjusted OR 1.91, 95% CI 1.004 to 3.6; p=0.049) along with age and baseline DWI-ASPECTS. Recanalization status failed to significantly impact outcome in the DWI-ASPECTS 0–3 subpopulation.ConclusionsNear complete reperfusion (mTICI 2c-3) and OTR are the strongest modifiable outcome predictors in patients with DWI-ASPECTS ≤5 treated with MT.

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Diffusion-weighted imaging volume and diffusion-weighted imaging volume growth in acute stroke

Neuroreport ◽

10.1097/wnr.0000000000001291 ◽

2019 ◽

Vol 30 (13) ◽

pp. 875-881 ◽

Cited By ~ 2

Author(s):

Shi-Bo Zhou ◽

Xiu-Ming Zhang ◽

Yang Gao ◽

Bo Yang ◽

Wen-Rong Shen

Keyword(s):

Acute Stroke ◽

Diffusion Weighted Imaging ◽

Volume Growth ◽

Diffusion Weighted ◽

And Diffusion

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Reliability of Smartphone for Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores in Acute Ischemic Stroke Patients: Diagnostic Test Accuracy Study

Journal of Medical Internet Research ◽

10.2196/15893 ◽

2020 ◽

Vol 22 (6) ◽

pp. e15893

Author(s):

Kenichiro Sakai ◽

Teppei Komatsu ◽

Yasuyuki Iguchi ◽

Hiroyuki Takao ◽

Toshihiro Ishibashi ◽

...

Keyword(s):

Computed Tomography ◽

Acute Stroke ◽

Diffusion Weighted Imaging ◽

Interrater Agreement ◽

Great Promise ◽

Smartphone App ◽

Test Accuracy ◽

Computed Tomography Images ◽

Diffusion Weighted ◽

Medical App

Background High-quality neuroimages can be viewed using a medical app installed on a smartphone. Although interdevice agreement between smartphone and desktop PC monitor was found to be favorable for evaluating computed tomography images, there are no interdevice agreement data for diffusion-weighted imaging (DWI). Objective The aim of our study was to compare DWI interpretation using the Join smartphone app with that using a desktop PC monitor, in terms of interdevice and interrater agreement and elapsed interpretation time. Methods The ischemic change in the DWI of consecutive patients with acute stroke in the middle cerebral artery territory was graded by 2 vascular neurologists using the Join smartphone app and a desktop PC monitor. The vascular neurologists were blinded to all patient information. Each image was categorized as either Diffusion-Weighted Imaging–Alberta Stroke Program Early Computed Tomography Scores (DWI-ASPECTS) ≥7 or DWI-ASPECTS <7 according to the Japanese Society for Neuroendovascular Therapy. We analyzed interdevice agreement and interrater agreement with respect to DWI-ASPECTS. Elapsed interpretation time was compared between DWI-ASPECTS evaluated by the Join smartphone app and a desktop PC monitor. Results We analyzed the images of 111 patients (66% male; median age=69 years; median National Institutes of Health Stroke Scale score on admission=4). Interdevice agreement regarding DWI-ASPECTS between the smartphone and the desktop PC monitor was favorable (vascular neurologist 1: κ=0.777, P<.001, vascular neurologist 2: κ=0.787, P<.001). Interrater agreement was also satisfactory for the smartphone (κ=0.710, P<.001) and the desktop PC monitor (κ=0.663, P<.001). Median elapsed interpretation time was similar between the smartphone and the desktop PC monitor (vascular neurologist 1: 1.7 min vs 1.6 min; P=.64); vascular neurologist 2: 2.4 min vs 2.0 min; P=.14). Conclusions The use of a smartphone app enables vascular neurologists to estimate DWI-ASPECTS accurately and rapidly. The Join medical smartphone app shows great promise in the management of acute stroke.

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