Measurement of Infarct Volume in Stroke Patients Using Adaptive Segmentation of Diffusion Weighted MR Images

Background and Purpose— We investigated whether hyperintensities with a diameter of at least 3, 3.5, and 4 cm and visible on at least 3 slices on diffusion-weighted imaging enables patient selection with an infarct volume of ≥15 mL. Methods— Consecutive acute stroke patients were screened for the AXIS2 trial and examined according to a standardized magnetic resonance imaging protocol in 65 sites. Diffusion-weighted lesion diameters were measured and compared with volumetric assessments. Results— Out of 238 patients, 86.2% (N=206) had infarct diameter of at least 3 cm. Volumetric assessments showed infarct volume of ≥15 mL in 157 patients. A cut-off value of 3 cm led to 96.8% sensitivity and 33.3% specificity for predicting lesion volume of ≥15 mL. Analogously, a 3.5 cm cut-off led to 96.8% sensitivity and 50.6% specificity and a 4 cm cut-off led to 91.7% sensitivity and 61.7% specificity. Conclusions— Lesion diameter measures may enable multicentric patient recruitment with a prespecified minimal infarct volume. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00927836.

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The Added Value of Inflow-Based Vascular-Space-Occupancy and Diffusion-Weighted Imaging in Preoperative Grading of Gliomas

Neurodegenerative Diseases ◽

10.1159/000512545 ◽

2021 ◽

pp. 1-8

Author(s):

Haimei Cao ◽

Xiang Xiao ◽

Jun Hua ◽

Guanglong Huang ◽

Wenle He ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Roc Curve ◽

Diffusion Weighted Imaging ◽

Low Grade ◽

High Grade ◽

Mr Images ◽

Vascular Space ◽

Diffusion Weighted ◽

High Grade Gliomas ◽

And Diffusion

Objectives: The present study aimed to study whether combined inflow-based vascular-space-occupancy (iVASO) MR imaging (MRI) and diffusion-weighted imaging (DWI) improve the diagnostic accuracy in the preoperative grading of gliomas. Methods: Fifty-one patients with histopathologically confirmed diffuse gliomas underwent preoperative structural MRI, iVASO, and DWI. We performed 2 qualitative consensus reviews: (1) structural MR images alone and (2) structural MR images with iVASO and DWI. Relative arteriolar cerebral blood volume (rCBVa) and minimum apparent diffusion coefficient (mADC) were compared between low-grade and high-grade gliomas. Receiver operating characteristic (ROC) curve analysis was performed to compare the tumor grading efficiency of rCBVa, mADC, and the combination of the two parameters. Results: Two observers diagnosed accurate tumor grade in 40 of 51 (78.4%) patients in the first review and in 46 of 51 (90.2%) in the second review. Both rCBVa and mADC showed significant differences between low-grade and high-grade gliomas. ROC analysis gave a threshold value of 1.52 for rCBVa and 0.85 × 10−3 mm2/s for mADC to provide a sensitivity and specificity of 88.0 and 81.2% and 100.0 and 68.7%, respectively. The area under the ROC curve (AUC) was 0.87 and 0.85 for rCBVa and mADC, respectively. The combination of rCBVa and mADC values increased the AUC to 0.92. Conclusion: The combined application of iVASO and DWI may improve the diagnostic accuracy of glioma grading.

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Mapping gradient nonlinearity and miscalibration using diffusion‐weighted MR images of a uniform isotropic phantom

Magnetic Resonance in Medicine ◽

10.1002/mrm.28890 ◽

2021 ◽

Author(s):

Alan Seth Barnett ◽

M. Okan Irfanoglu ◽

Bennett Landman ◽

Baxter Rogers ◽

Carlo Pierpaoli

Keyword(s):

Mr Images ◽

Diffusion Weighted ◽

Gradient Nonlinearity

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Acute Cerebral Infarction: Quantification of Spin-Density and T2 Shine-through Phenomena on Diffusion-weighted MR Images

Radiology ◽

10.1148/radiology.212.2.r99au36333 ◽

1999 ◽

Vol 212 (2) ◽

pp. 333-339 ◽

Cited By ~ 152

Author(s):

Jonathan H. Burdette ◽

Allen D. Elster ◽

Peter E. Ricci

Keyword(s):

Cerebral Infarction ◽

Spin Density ◽

Acute Cerebral Infarction ◽

Mr Images ◽

Diffusion Weighted

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Differentiating benign and malignant inflammatory breast lesions: Value of T2 weighted and diffusion weighted MR images

Magnetic Resonance Imaging ◽

10.1016/j.mri.2018.03.012 ◽

2018 ◽

Vol 50 ◽

pp. 38-44 ◽

Cited By ~ 4

Author(s):

Shotaro Kanao ◽

Masako Kataoka ◽

Mami Iima ◽

Debra Masako Ikeda ◽

Masakazu Toi ◽

...

Keyword(s):

Breast Lesions ◽

Mr Images ◽

Diffusion Weighted ◽

And Diffusion

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Outcomes of intra-arterial thrombolytic treatment in acute ischemic stroke patients with a matched defect on diffusion and perfusion MR images

Journal of NeuroInterventional Surgery ◽

10.1136/jnis.2010.004168 ◽

2011 ◽

Vol 4 (2) ◽

pp. 105-109 ◽

Cited By ~ 6

Author(s):

Gurpreet S Sandhu ◽

Pankit T Parikh ◽

Daniel P Hsu ◽

Kristine A Blackham ◽

Robert W Tarr ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Thrombolytic Treatment ◽

Mr Images ◽

Stroke Patients ◽

Perfusion Mr

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Failure of diffusion-weighted imaging in intraoperative 3 Tesla MRI to identify hyperacute strokes during glioma surgery

Scientific Reports ◽

10.1038/s41598-021-95505-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Stefanos Voglis ◽

Aimee Hiller ◽

Anna-Sophie Hofer ◽

Lazar Tosic ◽

Oliver Bozinov ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Brain Injuries ◽

Infarct Volume ◽

False Negative ◽

Size Estimation ◽

Glioma Surgery ◽

Postoperative Mri ◽

Diffusion Weighted ◽

Tumor Types ◽

Additional Resection

AbstractIntraoperatively acquired diffusion-weighted imaging (DWI) sequences in cranial tumor surgery are used for early detection of ischemic brain injuries, which could result in impaired neurological outcome and their presence might thus influence the neurosurgeon’s decision on further resection. The phenomenon of false-negative DWI findings in intraoperative magnetic resonance imaging (ioMRI) has only been reported in single cases and therefore yet needs to be further analyzed. This retrospective single-center study’s objective was the identification and characterization of false-negative DWI findings in ioMRI with new or enlarged ischemic areas on postoperative MRI (poMRI). Out of 225 cranial tumor surgeries with intraoperative DWI sequences, 16 cases with no additional resection after ioMRI and available in-time poMRI (< 14 days) were identified. Of these, a total of 12 cases showed false-negative DWI in ioMRI (75%). The most frequent tumor types were oligodendrogliomas and glioblastomas (4 each). In 5/12 cases (41.7%), an ischemic area was already present in ioMRI, however, volumetrically increased in poMRI (mean infarct growth + 2.1 cm3; 0.48–3.6), whereas 7 cases (58.3%) harbored totally new infarcts on poMRI (mean infarct volume 0.77 cm3; 0.05–1.93). With this study we provide the most comprehensive series of false-negative DWI findings in ioMRI that were not followed by additional resection. Our study underlines the limitations of intraoperative DWI sequences for the detection and size-estimation of hyperacute infarction. The awareness of this phenomenon is crucial for any neurosurgeon utilizing ioMRI.

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Abstract WP47: Reperfusion Following Ischemic Stroke is Associated with Reduced Brain Edema

Stroke ◽

10.1161/str.48.suppl_1.wp47 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Hannah J Irvine ◽

Thomas W Battey ◽

Ann-Christin Ostwaldt ◽

Bruce C Campbell ◽

Stephen M Davis ◽

...

Keyword(s):

Ischemic Stroke ◽

Brain Edema ◽

Infarct Volume ◽

Brain Magnetic Resonance Imaging ◽

Lesion Volume ◽

Stroke Patients ◽

Early Reperfusion ◽

Echoplanar Imaging ◽

Swelling Volume

Introduction: Revascularization is a robust therapy for acute ischemic stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. In stroke patients, early reperfusion consistently reduces infarct volume and improves long-term functional outcome, but there is little clinical data available regarding reperfusion edema. We sought to elucidate the relationship between reperfusion and brain edema in a patient cohort of moderate to severe stroke. Methods: Seventy-one patients enrolled in the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) with serial brain magnetic resonance imaging and perfusion-weighted imaging (PWI) were analyzed. Reperfusion percentage was calculated based on the difference in PWI lesion volume at baseline and follow-up (day 3-5). Midline shift (MLS) was measured on the day 3-5 fluid attenuated inversion recovery (FLAIR) sequence. Swelling volume and infarct growth volume were assessed using region-of-interest analysis on the baseline and follow-up DWI scans based on our prior methods. Results: Greater percentage of reperfusion was associated with less MLS (Spearman ρ = -0.46; P <0.0001) and reduced swelling volume (Spearman ρ = -0.56; P <0.0001). In multivariate analysis, reperfusion was an independent predictor of less MLS ( P <0.006) and decreased swelling volume ( P <0.0054), after adjusting for age, baseline NIHSS, admission blood glucose, baseline DWI volume, and IV tPA treatment. Conclusions: Reperfusion is associated with reduced brain edema as measured by MLS and swelling volume. While our data do not exclude the possibility of reperfusion edema in certain circumstances, in stroke patients, reperfusion following acute stroke is predominantly linked to less brain swelling.

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Abstract 14793: Association Between Cardiac Ejection Fraction and the Size of Stroke

Circulation ◽

10.1161/circ.142.suppl_3.14793 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Muhammad M Alvi ◽

Tamra Ranasinghe ◽

Yasser Kabbani ◽

Mohamad Adnan Alkhouli ◽

Abdul Rahman Tarabishy

Keyword(s):

Atrial Fibrillation ◽

Ejection Fraction ◽

Thrombus Formation ◽

Infarct Volume ◽

Inverse Correlation ◽

Stroke Patients ◽

Increased Risk ◽

Median Volume ◽

Cardiac Ejection Fraction ◽

Low Ejection Fraction

Introduction: Heart failure with low ejection fraction (EF) is a known risk factor for stroke. Low EF is associated with increased risk of thrombus formation and is accompanied with 2 to 3 fold increased risk of stroke. This can happen even in the absence of atrial fibrillation. Hypothesis: Our hypothesis was that size of the stroke will be larger in patients with reduction in EF as compared with cardioembolic strokes in preserved EF. The worse the EF, the more stagnation of blood and poor cardiac output leading higher risk of thrombus formation. It’s also likely that the group with reduced EF form a larger thrombus leading to larger stroke as compared to the group with preserved EF. Methods: For our analysis, we retrospectively reviewed charts for 49 acute ischemic stroke patients without atrial fibrillation. We used transthoracic echocardiogram to determine the EF. There are 25 patients with preserved EF, cutoff > 50%. There were 24 patients in reduced EF group. Both groups were matched for age and cardiovascular risk factors. Infarct volume was manually calculated from T1 MRI using BrainLab software. Results: There is an inverse correlation between EF and infarct volume (r=-.283, p=.048) meaning patients with reduced EF had greater infarct volume. Median infarct volume is higher in reduced EF group (median volume = 36 cm 3 ) compared to patients with preserved EF (median volume = 11 cm 3 ) (p=.117). Conclusions: In our patient’s sample, there seems to be an inverse correlation between EF and size of stroke. Patients with reduced EF were associated with larger strokes. Larger studies need to be performed to establish a correlation.

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Abstract P327: Utilizing Iodine Contrast Extravasation Post Reperfusion and Dual Energy Ct Imaging to Predict Risk of Hemorrhagic Conversion in Acute Stroke Patients

Stroke ◽

10.1161/str.52.suppl_1.p327 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Tri Huynh* ◽

Niran Vijayaraghavan* ◽

Hannah Branstetter ◽

Natalie Buchwald ◽

Justin De Prey ◽

...

Keyword(s):

Acute Stroke ◽

Infarct Volume ◽

Reperfusion Therapy ◽

Dual Energy ◽

Ct Imaging ◽

Dual Energy Ct ◽

Stroke Patients ◽

Post Intervention ◽

Contrast Extravasation ◽

Post Contrast

Introduction: Hyperintense acute reperfusion marker (HARM) has been identified on post-contrast magnetic resonance imaging (MRI) to be a marker of hemorrhagic conversion (HC) post reperfusion therapy in acute stroke patients. We have previously described a case where MRI HARM was mimicked on post contrast computed topography (CT) imaging in an acute stroke patient post reperfusion. Dual-Energy (DECT) allows for differentiation between acute blood and iodine contrast extravasation (ICE), and thus can have utility when ICE is present. Here we sought to validate whether post-intervention ICE/CT hyperdensity reperfusion maker (CT HARM), and contrast subtracted on DECT is associated with HC in acute stroke patients. Method: Data was obtained from our Institutional Review Board approved stroke admission database from January 2017 to November 2019, including ischemic stroke patients that received thrombolysis or thrombectomy, had evaluable images within 24 hours of admission, and received a DECT. Ischemic volumes of the stroke was measured on diffusion-weighted image (DWI). ICE was measured on CT head and DECT using the freehand 3D region of interest tool on the Visage Imaging PACS System. Susceptibility weighted MRI sequences were used to grade HC. Data analysis was conducted with regression modeling. Results: A total of 82 patients were included, 49% women, median age 73 (interquartile range (IQR), 61- 77), admission NIHSS 12 (IQR, 7 - 21), 24 hour change in NIHSS 4 (IQR, 0 -13), glucose 125 (IQR, 106 -158), creatinine 1.0 (IQR, 0.8 - 1.2), infarct volume 50.6 ± 7.1 mL, 48% treated with thrombectomy, 7% with PH-1 or PH-2 identified on MRI, and 56% with MCA infarcts. ICE volume was 2.6 ± 1.0 mL and DECT volume was 2.2 ± 1.1mL. ICE increased the likelihood of MRI confirmed PH-1 or PH-2 hemorrhagic conversion (odds ratio (OR) 14.34, 95% confidence interval (CI) 5.74 - 22.94) and decreased likelihood of increase in NIHSS at 24 hours (OR 0.20, 95% CI 0.01 to 0.40). There were no other significant associations with ICE or DECT volumes. Conclusion: Our results are supportive of our proposed association between CT HARM and risk of HC. More studies are needed to study whether quantitative of DECT can be predictive of stroke outcomes post reperfusion therapy.

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