Automated quantitative lesion water uptake in acute stroke is a predictor of malignant cerebral edema

2022 ◽  
Author(s):  
JiaQian Shi ◽  
Hang Wu ◽  
Zheng Dong ◽  
XianXian Liang ◽  
QuanHui Liu ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Water Uptake ◽  
Cerebral Edema

scholarly journals Ischemic Lesion Water Uptake in Acute Stroke: Is Blood Glucose Related to Cause and Effect?

2019 ◽  
Vol 21 (3) ◽  
pp. 347-349 ◽  
Author(s):  
Gabriel Broocks ◽  
Andre Kemmling ◽  
Jens Aberle ◽  
Helge Kniep ◽  
Matthias Bechstein ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Acute Stroke ◽  
Water Uptake ◽  
Ischemic Lesion ◽  
Cause And Effect

scholarly journals Plasma kallikrein mediates brain hemorrhage and edema caused by tissue plasminogen activator therapy in mice after stroke

Blood ◽  
2017 ◽  
Vol 129 (16) ◽  
pp. 2280-2290 ◽  
Author(s):  
Fabrício Simão ◽  
Tuna Ustunkaya ◽  
Allen C. Clermont ◽  
Edward P. Feener
Keyword(s):  
Acute Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cerebral Edema ◽  
Hemorrhagic Transformation ◽  
Contact System ◽  
Plasma Kallikrein ◽  
Brain Hemorrhage ◽  
Key Points ◽  
Tissue Plasminogen

Key Points tPA activates the contact system, and PKal blockade enhances tPA-mediated thrombolysis. PKal contributes to hemorrhagic transformation and cerebral edema in mice with acute stroke receiving tPA.

Elevated early lesion water uptake in acute stroke predicts poor outcome despite successful recanalization – When “tissue clock” and “time clock” are desynchronized

2019 ◽  
pp. 174749301988452 ◽  
Author(s):  
Jawed Nawabi ◽  
Fabian Flottmann ◽  
Andre Kemmling ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Water Uptake ◽  
Quantitative Imaging ◽  
Receiver Operating Curve ◽  
Imaging Biomarker ◽  
Poor Clinical Outcome ◽  
Similar Time ◽  
Poor Outcome ◽  
Malignant Infarction

Background Ischemic water uptake in acute stroke is a reliable indicator of lesion age. Nevertheless, inter-individually varying edema progression has been observed and elevated water uptake has recently been described as predictor of malignant infarction. Aims We hypothesized that early-elevated lesion water uptake indicates accelerated “tissue clock” desynchronized with “time clock” and therefore predicts poor clinical outcome despite successful recanalization. Methods Acute middle cerebral artery stroke patients with multimodal admission-CT who received successful thrombectomy (TICI 2b/3) were analyzed. Net water uptake (NWU), a quantitative imaging biomarker of ischemic edema, was determined in admission-CT and tested as predictor of clinical outcome using modified Rankin Scale (mRS) after 90 days. A binary outcome was defined for mRS 0–4 and mRS 5–6. Results Seventy-two patients were included. The mean NWU (SD) in patients with mRS 0–4 was lower compared to patients with mRS 5–6 (5.0% vs. 12.1%; p < 0.001) with similar time from symptom onset to imaging (2.6 h vs. 2.4 h; p = 0.7). Based on receiver operating curve analysis, NWU above 10% identified patients with very poor outcome with high discriminative power (AUC 0.85), followed by Alberta Stroke Program Early CT Score (ASPECTS) (AUC: 0.72) and National Institutes of Health Stroke Scale (NIHSS) (AUC: 0.72). Conclusions Quantitative NWU may serve as an indicator of “tissue clock” and pronounced early brain edema with elevated NWU might suggest a desynchronized “tissue clock” with real “time clock” and therefore predict futile recanalization with poor clinical outcome.

scholarly journals Lesion Age Imaging in Acute Stroke: Water Uptake in CT Versus DWI‐FLAIR Mismatch

2020 ◽  
Vol 88 (6) ◽  
pp. 1144-1152 ◽  
Author(s):  
Gabriel Broocks ◽  
Hannes Leischner ◽  
Uta Hanning ◽  
Fabian Flottmann ◽  
Tobias D. Faizy ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Water Uptake

scholarly journals Quantitative Lesion Water Uptake in Acute Stroke Computed Tomography Is a Predictor of Malignant Infarction

Stroke ◽  
2018 ◽  
Vol 49 (8) ◽  
pp. 1906-1912 ◽  
Author(s):  
Gabriel Broocks ◽  
Fabian Flottmann ◽  
Alexandra Scheibel ◽  
Annette Aigner ◽  
Tobias D. Faizy ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Stroke ◽  
Water Uptake ◽  
Malignant Infarction

scholarly journals Image Patch-Based Net Water Uptake and Radiomics Models Predict Malignant Cerebral Edema After Ischemic Stroke

2020 ◽  
Vol 11 ◽  
Author(s):  
Bowen Fu ◽  
Shouliang Qi ◽  
Lin Tao ◽  
Haibin Xu ◽  
Yan Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Water Uptake ◽  
Cerebral Edema ◽  
Intraclass Correlation ◽  
Ct Images ◽  
Imaging Features ◽  
Lesion Segmentation ◽  
Image Patch ◽  
Ischemic Lesion ◽  
Significant Difference

Malignant cerebral edema (MCE) after an ischemic stroke results in a poor outcome or death. Early prediction of MCE helps to identify subjects that could benefit from a surgical decompressive craniectomy. Net water uptake (NWU) in an ischemic lesion is a predictor of MCE; however, CT perfusion and lesion segmentation are required. This paper proposes a new Image Patch-based Net Water Uptake (IP-NWU) procedure that only uses non-enhanced admission CT and does not need lesion segmentation. IP-NWU is calculated by comparing the density of ischemic and contralateral normal patches selected from the middle cerebral artery (MCA) area using standard reference images. We also compared IP-NWU with the Segmented Region-based NWU (SR-NWU) procedure in which segmented ischemic regions from follow-up CT images are overlaid onto admission images. Furthermore, IP-NWU and its combination with imaging features are used to construct predictive models of MCE with a radiomics approach. In total, 116 patients with an MCA infarction (39 with MCE and 77 without MCE) were included in the study. IP-NWU was significantly higher for patients with MCE than those without MCE (p &lt; 0.05). IP-NWU can predict MCE with an AUC of 0.86. There was no significant difference between IP-NWU and SR-NWU, nor between their predictive efficacy for MCE. The inter-reader and interoperation agreement of IP-NWU was exceptional according to the Intraclass Correlation Coefficient (ICC) analysis (inter-reader: ICC = 0.92; interoperation: ICC = 0.95). By combining IP-NWU with imaging features through a random forest classifier, the radiomics model achieved the highest AUC (0.96). In summary, IP-NWU and radiomics models that combine IP-NWU with imaging features can precisely predict MCE using only admission non-enhanced CT images scanned within 24 h from onset.

scholarly journals Impact of endovascular recanalization on quantitative lesion water uptake in ischemic anterior circulation strokes

2019 ◽  
Vol 40 (2) ◽  
pp. 437-445 ◽  
Author(s):  
Gabriel Broocks ◽  
Fabian Flottmann ◽  
Uta Hanning ◽  
Gerhard Schön ◽  
Peter Sporns ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Brain Edema ◽  
Water Uptake ◽  
Imaging Biomarker ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Ischemic Brain ◽  
Multicenter Observational Study ◽  
Endovascular Recanalization ◽  
Ischemic Brain Edema

Studies evaluating the effect of reperfusion on ischemic edema in acute stroke described conflicting results. Net water uptake (NWU) per brain volume is a new quantitative imaging biomarker of space-occupying ischemic edema, which can be measured in computed tomography (CT). We sought to investigate the effects of vessel recanalization on the formation of ischemic brain edema using quantitative NWU. In this multicenter observational study, acute ischemic stroke patients with a large vessel occlusion (LVO) in the anterior circulation were consecutively screened. Patients with vessel recanalization (thrombolysis in cerebral infarction (TICI) 2 b or 3) versus persistent vessel occlusion (no thrombectomy, TICI 0-1) were compared. Lesion-NWU was quantified in multimodal admission CT and follow-up CT (FCT), and ΔNWU was calculated as difference. Of 194 included patients, 150 had successful endovascular recanalization and 44 persistent LVO. In FCT after treatment, the mean (standard deviation) ΔNWU was 15.8% (5.7) in patients with persistent LVO and 9.8% (5.8) with vessel recanalization ( p < 0.001). In multivariate regression analysis, vessel recanalization was independently associated with a lowered ΔNWU by 6.3% compared to LVO (95% confidence interval: 3.7–9.0, p < 0.001). Successful vessel recanalization was associated with a significantly reduced formation of ischemic brain edema. Quantitative NWU may be used to compare the treatment effects in acute stroke.

Reversible Ischemic Lesion Hypodensity in Acute Stroke CT Following Endovascular Reperfusion

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012484
Author(s):  
Gabriel Broocks ◽  
Rosalie McDonough ◽  
Lukas Meyer ◽  
Matthias Bechstein ◽  
Helge Kniep Dipl.Ing ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Water Uptake ◽  
Vasogenic Edema ◽  
Brain Infarction ◽  
Future Research ◽  
Anterior Circulation ◽  
Ischemic Lesion ◽  
Ischemic Brain Edema ◽  
The Difference

Background and ObjectivesIn acute stroke, early ischemic lesion hypodensity in computed tomography (CT) is considered the imaging hallmark of brain infarction, representing a state of irreversible tissue damage with a continual increase of net water uptake. This dogma is however challenged by rare cases of apparently reversed early lesion hypodensity following complete reperfusion. The purpose of this study was to investigate the occurrence of reversible ischemic edema after endovascular treatment.Methods184 acute ischemic anterior circulation stroke patients were included after consecutive screening. Ischemic brain edema was determined using quantitative lesion net water uptake (NWU) in admission-CT and follow-up CT based on CT-densitometry and ΔNWU was calculated as the difference. The association of edema progression to imaging and clinical parameters was investigated. Clinical outcome was assessed using modified Ranking Scale (mRS) scores at day 90.Results27/184 patients (14.7%) showed edema arrest and 3 patients (1.6%) exhibited significant edema reversibility. Higher degree of recanalization (odds ratio (OR): 2.96, 95%CI: 1.46-6.01, p<0.01) and shorter time from imaging to recanalization (OR/hour: 0.32, 95%CI: 0.18-0.54, p<0.0001) were significantly associated with edema arrest or reversibility. Clinical outcome was significantly better in patients without edema progression (median mRS 2 versus mRS 5, p=0.004).DiscussionAlbeit rare, lesion hypodensity considered to be representative of early infarct in acute stroke CT may be reversible following complete recanalization. Arrest of edema progression of acute brain infarct lesions may occur after successful rapid vessel recanalization, resulting in improved functional outcome. Future research is needed to investigate conditions where early revascularization may halt or even reverse vasogenic edema of ischemic tissue.

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