Whole brain quantitative CBF, CBV, and MTT measurements using MRI bolus tracking: Implementation and application to data acquired from hyperacute stroke patients

ObjectiveTo study the association between poststroke cognitive impairment and defining a specific resting functional marker.MethodsThe resting-state functional connectivity 6 months after an ischemic stroke in 56 patients was investigated. Twenty-nine of the patients who had an impairment of one or several cognitive domains were compared to 27 without any cognitive deficit. We studied the whole-brain connectivity using 2 complementary approaches: graph theory to study the functional network organization and network-based statistics to explore connectivity between brain regions. We assessed the potential cortical atrophy using voxel-based morphometry analysis.ResultsThe overall topological organization of the functional network was not altered in cognitively impaired stroke patients, who had the same mean node degree, average clustering coefficient, and global efficiency as cognitively healthy stroke patients. Network-based statistics analysis showed that poststroke cognitive impairment was associated with dysfunction of a whole-brain network composed of 167 regions and 178 connections, and functional disconnections between superior, middle, and inferior frontal gyri and the superior and inferior temporal gyri. These regions had connections that were specifically and positively correlated with cognitive domain scores. No intergroup differences in overall gray matter thickness and ischemic infarct topography were observed. To assess the effect of prestroke white matter hyperintensities on connectivity, we included the initial Fazekas scale in the regression model for a second network-based analysis. The resulting network was associated with the same key alterations but had fewer connections.ConclusionsThe observed functional network alterations suggest that the appearance of a cognitive impairment following stroke may be associated with a particular functional alteration, shared specifically between cognitive domains.

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Quantitative CT Score in Predicting Outcome of Hyperacute Stroke

10.1093/med/9780190223700.003.0005 ◽

2016 ◽

Author(s):

Christoph I. Lee

Keyword(s):

Quantitative Computed Tomography ◽

Clinical Implications ◽

Clinical Context ◽

Stroke Patients ◽

Quantitative Ct ◽

Simple Method ◽

Additional Information ◽

Hyperacute Stroke ◽

Predicting Outcome ◽

Study Methodology

This chapter, found in the headache section of the book, provides a succinct synopsis of a key study examining the use of quantitative computed tomography (CT) scores in predicting outcomes of hyperacute stroke. This summary outlines the study methodology and design, major results, limitations and criticisms, related studies and additional information, and clinical implications. The study showed that the ASPECTS CT score may provide an objective, simple method for helping predict which acute stroke patients are unlikely to recover despite immediate thrombolytic therapy. In addition to outlining the most salient features of the study, a clinical vignette and imaging example are included in order to provide relevant clinical context.

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Comparing different analysis methods for quantifying the MRI amide proton transfer (APT) effect in hyperacute stroke patients

NMR in Biomedicine ◽

10.1002/nbm.3147 ◽

2014 ◽

Vol 27 (9) ◽

pp. 1019-1029 ◽

Cited By ~ 52

Author(s):

Y. K. Tee ◽

G. W. J. Harston ◽

N. Blockley ◽

Thomas W. Okell ◽

J. Levman ◽

...

Keyword(s):

Proton Transfer ◽

Amide Proton ◽

Stroke Patients ◽

Hyperacute Stroke ◽

Amide Proton Transfer ◽

Analysis Methods

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Magnetic resonance cerebral metabolic rate of oxygen utilization in hyperacute stroke patients

Annals of Neurology ◽

10.1002/ana.10433 ◽

2003 ◽

Vol 53 (2) ◽

pp. 227-232 ◽

Cited By ~ 69

Author(s):

Jin-Moo Lee ◽

Katie D. Vo ◽

Hongyu An ◽

Azim Celik ◽

Yueh Lee ◽

...

Keyword(s):

Magnetic Resonance ◽

Metabolic Rate ◽

Oxygen Utilization ◽

Stroke Patients ◽

Hyperacute Stroke ◽

Cerebral Metabolic Rate

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Hyperacute stroke patients and catheter thrombolysis therapy: correlation between computed tomography perfusion maps and final infarction

Radiation Medicine ◽

10.1007/s11604-007-0219-2 ◽

2008 ◽

Vol 26 (4) ◽

pp. 227-236 ◽

Cited By ~ 1

Author(s):

Yukari Naito ◽

Shigeko Tanaka ◽

Yuichi Inoue ◽

Shinsuke Ota ◽

Saburo Sakaki ◽

...

Keyword(s):

Computed Tomography ◽

Stroke Patients ◽

Computed Tomography Perfusion ◽

Hyperacute Stroke ◽

Perfusion Maps ◽

Catheter Thrombolysis ◽

Thrombolysis Therapy

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RAZER: A pulse sequence for whole-brain bolus tracking at high frame rates

Magnetic Resonance in Medicine ◽

10.1002/mrm.24882 ◽

2013 ◽

Vol 71 (6) ◽

pp. 2127-2138 ◽

Cited By ~ 5

Author(s):

Sumeeth V. Jonathan ◽

Parmede Vakil ◽

Yong I. Jeong ◽

Rajiv G. Menon ◽

Sameer A. Ansari ◽

...

Keyword(s):

Pulse Sequence ◽

Whole Brain ◽

Bolus Tracking

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P027: Development of a physician assistant lead stroke protocol to provide timely and equitable access to hyperacute stroke care in a telestroke community hospital

CJEM ◽

10.1017/cem.2020.234 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S74-S74

Author(s):

L. Shoots ◽

V. Bailey

Keyword(s):

Acute Stroke ◽

Local Community ◽

Community Hospital ◽

Stroke Care ◽

Physician Assistants ◽

Stroke Patients ◽

Acute Stroke Care ◽

Hyperacute Stroke ◽

Phone Calls ◽

Triage Time

Background: The Brant Community Healthcare System (BCHS) has consistently been well above the recommended 30 minute benchmark for door-to-needle (DTN) for eligible acute stroke patients. As a large community hospital with no neurologists, and like many other hospitals internationally, we rely on telestroke support for every stroke case. This is a time-consuming process that requires a multitude of phone calls, and pulls physicians from other acutely ill patients. We sought to develop a system that would streamline our approach and care for hyperacute stroke patients by targeting improvements in DTN. Aim Statement: We will decrease the door-to-needle (DTN) time for stroke patients arriving at the BCHS Emergency Department (ED) who are eligible for tissue plasminogen activator (tPA) by 25% from a median of 87 minutes to 50 minutes by March 31, 2018 and maintain that standard. Measures & Design: Outcome Measures: Door-to-needle time for acute stroke patients receiving tPA Process Measures: Door-to-triage time, Door-to-CT time, Door-to-CTA time; INR collection-to-verification time, telestroke callback time Balancing Measures: Number of stroke protocol patients per month Model Design: We simultaneously designed and implemented a robust program to train physician assistants in hyperacute stroke care. Evaluation/Results: Through vast stakeholder engagement and implementing a multitude of change ideas, by March of 2018 we had achieved an average DTN of 53 minutes. Our door-to-triage time went from an average of 7 minutes to 3 minutes. Our door-to-CT time decreased from 17 minutes to 7 minutes and our time between CT and CTA from an average of 13 minutes to 3 minutes. One and a half years later, our average DTN is maintained at 55 minutes and physician assistants continue to effectively lead and liaise with telestroke neurologists and stroke patients. Discussion/Impact: Prior to this program, acute stroke care was a very contentious topic at our local community hospital. Creating a program that streamlined the care and standardized the work has proven successful, and not only allowed for improved DTN times but also freed up physicians to better simultaneously care for other acutely ill patients.

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