SPET brain imaging with 201 diethyldithiocarbamate in acute ischaemic stroke

Aim To evaluate voxelwise computed diffusion-weighted imaging (vcDWI) for the detection of cytotoxic oedema in brain imaging and to quantify the benefit of lesion contrast in comparison to standard b = 1000 s/mm2 by the example of acute ischaemic stroke. Materials and methods A retrospective evaluation of 66 patients (63 ± 15.9 years) suspected for acute ischaemic stroke who received diffusion-weighted magnetic resonance imaging and fluid-attenuated inversion recovery sequence. A neuroradiologist evaluated all examinations for acute ischaemic stroke based on diffusion-weighted imaging, the apparent diffusion coefficient and fluid-attenuated inversion recovery (reference standard) and 6 weeks later the vcDWI in a randomised manner. Time of analysis was noted. Signal intensities were acquired in lesions, in healthy tissue as well as in the cerebrospinal fluid. Contrast ratios and coefficients of variation were computed. Results A total of 218 lesions was found in 46/66 patients. vcDWI identified all patients and lesions correctly. The median evaluation time was 36 seconds (4–126 s) for the vcDWI and 44 seconds (9–186 s; P < 0.001) for the diffusion-weighted imaging/apparent diffusion coefficient reading. The contrast ratio in vcDWI (mean value 2.57, range 1.73–4.11) was higher than in b = 1000 s/mm2 (2.33, 0.83–3.85, P = 0.03) and the apparent diffusion coefficient map (1.83, 1.00–3.00, P < 0.001), respectively. Coefficients of variation in lesions and tissue did not differ significantly between vcDWI and b = 1000 s/mm2 ( P = 0.81/ P = 0.26). The signal intensity of cerebrospinal fluid was lower in vcDWI than in b = 1000 mm2/s (0.08 and 34.8, P < 0.001). Conclusion It could be shown that vcDWI has the potential to accelerate the detection of diffusion-restricted lesions in neuroimaging by improving the contrast ratios and reducing the T2 shine-through effect in comparison to standard diffusion-weighted imaging in brain imaging.

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Brain imaging abnormalities and outcome after acute ischaemic stroke: the ENCHANTED trial

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-323015 ◽

2020 ◽

Vol 91 (12) ◽

pp. 1290-1296 ◽

Cited By ~ 2

Author(s):

Candice Delcourt ◽

Xia Wang ◽

Zien Zhou ◽

Joanna M Wardlaw ◽

Grant Mair ◽

...

Keyword(s):

Ischaemic Stroke ◽

Brain Imaging ◽

Acute Ischaemic Stroke ◽

Imaging Features ◽

Acute Ischaemia ◽

Logistic Regression Models ◽

Stroke Study ◽

Scale Scores ◽

Ischaemic Lesion ◽

Imaging Signs

ObjectiveTo test the hypothesis that imaging signs of ‘brain frailty’ and acute ischaemia predict clinical outcomes and symptomatic intracranial haemorrhage (sICH) after thrombolysis for acute ischaemic stroke (AIS) in the alteplase dose arm of ENhanced Control of Hypertension ANd Thrombolysis strokE stuDy (ENCHANTED).MethodsBlinded assessors coded baseline images for acute ischaemic signs (presence, extent, swelling and attenuation of acute lesions; and hyperattenuated arteries) and pre-existing changes (atrophy, leucoaraiosis and old ischaemic lesions). Logistic regression models assessed associations between imaging features and death at 7 and 90 days; good recovery (modified Rankin Scale scores 0–2 at 90 days) and sICH. Data are reported with adjusted ORs and 95% CIs.Results2916 patients (67±13 years, National Institutes of Health Stroke Scale 8 (5–14)) were included. Visible ischaemic lesions, severe hypoattenuation, large ischaemic lesion, swelling and hyperattenuated arteries were associated with 7-day death (OR (95% CI): 1.52 (1.06 to 2.18); 1.51 (1.01 to 2.18); 2.67 (1.52 to 4.71); 1.49 (1.03 to 2.14) and 2.17 (1.48 to 3.18)) and inversely with good outcome. Severe atrophy was inversely associated with 7-day death (0.52 (0.29 to 0.96)). Atrophy (1.52 (1.08 to 2.15)) and severe leucoaraiosis (1.74 (1.20 to 2.54)) were associated with 90-day death. Hyperattenuated arteries were associated with sICH (1.71 (1.01 to 2.89)). No imaging features modified the effect of alteplase dose.ConclusionsNon-expert-defined brain imaging signs of brain frailty and acute ischaemia contribute to the prognosis of thrombolysis-treated AIS patients for sICH and mortality. However, these imaging features showed no interaction with alteplase dose.

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Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽

10.1024/0301-1526/a000601 ◽

2017 ◽

Vol 46 (2) ◽

pp. 116-120 ◽

Cited By ~ 4

Author(s):

Naz Ahmed ◽

Damian Kelleher ◽

Manmohan Madan ◽

Sarita Sochart ◽

George A. Antoniou

Keyword(s):

Ischaemic Stroke ◽

Carotid Endarterectomy ◽

Acute Ischaemic Stroke ◽

Intravenous Thrombolysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Wound Complications ◽

Cardiac Complications ◽

High Dependency ◽

Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

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