Improving acute stroke assessment in non-enhanced CT: Automated tool for early ischemic lesion volume detection

2021 ◽  
Vol 429 ◽  
pp. 119611
Author(s):  
Giovanni Furlanis ◽  
Mara Bernardi ◽  
Alex Rodriguez ◽  
Paola Caruso ◽  
Marcello Naccarato ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Enhanced Ct ◽  
Automated Tool ◽  
Stroke Assessment

Elevated Circulating Endothelial Microparticles in Acute Stroke Patients: A Correlation with Brain Lesion Volume and Outcome.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3504-3504 ◽  
Author(s):  
Jan Simak ◽  
Monique P. Gelderman ◽  
Hua Yu ◽  
Violet Wright ◽  
Noah Alberts-Grill ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Hospital Discharge ◽  
Vascular Injury ◽  
Brain Lesion ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Disability Score ◽  
Ischemic Lesion ◽  
Blood Samples

Abstract Elevated endothelial cell membrane microparticles (EC MP) in blood have been demonstrated in various diseases with a vascular injury component. The aim of this study was to investigate if circulating EC MP show a relationship with outcome after acute stroke and with the ischemic brain lesion volume measured by magnetic resonance diffusion-weighted imaging (DWI). We analyzed EC MP in the blood of 42 acute stroke patients (AS): 20 patients with National Institutes of Health Stroke Scale (NIHSS) scores < 5 were classified as mild stroke (MS) (median NIHSS= 2; 25th–75th%: 0–2), while the other 22 patients with NIHSS ≥5 (NIHSS=12; 6–21) were classified as moderate to severe stroke (SS). Peripheral venous blood samples were collected at a median time of 36 hours (18–52) after the onset of clinical symptoms. The patients outcome was based on the Rankin disability score at the time of hospital discharge. Blood samples of 23 age matched control volunteers (CTRL) were used for comparison. EC MP analysis used a three-color flow cytometry assay (Simak et al, British J Haematol125, 804–813, 2004). EC MP were identified by antibodies to EC antigen CD105 (endoglin) and the highly specific CD144 (VE-cadherin). Platelet, white, and red blood cell MP were identified using cell specific antibodies to CD41, CD45, and CD235a, respectively. Plasma counts of CD105+CD41−CD45- EC MP were elevated in SS (median: 840/μL; 25th–75th%: 565–1079/μL) as compared to CTRL (415/μL; 201–624/μL; p=0.014). Moreover, CD105+CD144+ EC MP were elevated in SS (261/μL; 137–433/μL) when compared to MS (154/μL; 99–182/μL; p=0.031) or CTRL group (140/μL; 79–247/μL; p=0.031). Interestingly, CD105+CD41−CD45- EC MP, but not CD105+CD144+ EC MP, exhibited a significant correlation (p=0.005; r=0.45) with DWI brain lesion volume in AS group. However, CD105+CD144+ EC MP in the admission samples highly correlated (p=0.0007; r=0.54) with the Rankin disability score in the AS group at hospital discharge, while correlation of CD105+CD41−CD45- EC MP with the Rankin score was not as significant (p=0.007; r=0.44). We further analyzed 12 MS and 12 SS follow-up samples collected at a median period of 10 days (7–14) after the first sampling. Surprisingly, in SS follow-up samples, CD105+ EC MP populations decreased, while CD144+CD105−CD41- EC MP significantly increased, as compared to the samples at admission. In conclusion, the SS patient group had elevated different phenotypes of EC MP in the plasma samples at admission when compared to MS or CTRL groups. This is likely a reflection of the severity of ischemic-reperfusion injury of the brain vasculature. Elevated endoglin-positive EC MP were associated with brain ischemic lesion volume, whereas EC MP positive for both endoglin and VE-cadherin in the admission samples showed highly significant correlation with the patients disability outcome. The increased VE-cadherin-positive EC MP in follow-up samples may reflect a continuing endothelial injury in SS patients. Analysis of different phenotypes of EC MP in peripheral blood of stroke patients may be indicative of volume, character and severity of brain vascular injury and could be of diagnostic and prognostic use.

scholarly journals Quantitative Measurements of Relative Fluid-Attenuated Inversion Recovery (FLAIR) Signal Intensities in Acute Stroke for the Prediction of Time from Symptom Onset

2012 ◽  
Vol 33 (1) ◽  
pp. 76-84 ◽  
Author(s):  
Bastian Cheng ◽  
Mathias Brinkmann ◽  
Nils D Forkert ◽  
Andras Treszl ◽  
Martin Ebinger ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Symptom Onset ◽  
Visual Analysis ◽  
Onset Time ◽  
Inversion Recovery ◽  
Classification And Regression Tree ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Quantitative Measurements ◽  
Fluid Attenuated Inversion Recovery

In acute stroke magnetic resonance imaging, a ‘mismatch’ between visibility of an ischemic lesion on diffusion-weighted imaging (DWI) and missing corresponding parenchymal hyperintensities on fluid-attenuated inversion recovery (FLAIR) data sets was shown to identify patients with time from symptom onset ≤4.5 hours with high specificity. However, moderate sensitivity and suboptimal interpreter agreement are limitations of a visual rating of FLAIR lesion visibility. We tested refined image analysis methods in patients included in the previously published PREFLAIR study using refined visual analysis and quantitative measurements of relative FLAIR signal intensity (rSI) from a three-dimensional, segmented stroke lesion volume. A total of 399 patients were included. The rSI of FLAIR lesions showed a moderate correlation with time from symptom onset ( r = 0.382, P < 0.001). A FLAIR rSI threshold of <1.0721 predicted symptom onset ≤4.5 hours with slightly increased specificity (0.85 versus 0.78) but also slightly decreased sensitivity (0.47 versus 0.58) as compared with visual analysis. Refined visual analysis differentiating between ‘subtle’ and ‘obvious’ FLAIR hyperintensities and classification and regression tree algorithms combining information from visual and quantitative analysis also did not improve diagnostic accuracy. Our results raise doubts whether the prediction of stroke onset time by visual image judgment can be improved by quantitative rSI measurements.

scholarly journals Neuroprotective mechanisms of erythropoietin in a rat stroke model

2020 ◽  
Vol 11 (1) ◽  
pp. 48-59
Author(s):  
Martin Juenemann ◽  
Tobias Braun ◽  
Nadine Schleicher ◽  
Mesut Yeniguen ◽  
Patrick Schramm ◽  
...  
Keyword(s):  
Blood Flow ◽  
Infarct Size ◽  
Cerebral Edema ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Lesion Volume ◽  
Ischemic Lesion ◽  
Human Erythropoietin ◽  
Male Wistar Rats ◽  
Cerebral Artery Occlusion

AbstractObjectiveThis study was designed to investigate the indirect neuroprotective properties of recombinant human erythropoietin (rhEPO) pretreatment in a rat model of transient middle cerebral artery occlusion (MCAO).MethodsOne hundred and ten male Wistar rats were randomly assigned to four groups receiving either 5,000 IU/kg rhEPO intravenously or saline 15 minutes prior to MCAO and bilateral craniectomy or sham craniectomy. Bilateral craniectomy aimed at elimination of the space-consuming effect of postischemic edema. Diagnostic workup included neurological examination, assessment of infarct size and cerebral edema by magnetic resonance imaging, wet–dry technique, and quantification of hemispheric and local cerebral blood flow (CBF) by flat-panel volumetric computed tomography.ResultsIn the absence of craniectomy, EPO pretreatment led to a significant reduction in infarct volume (34.83 ± 9.84% vs. 25.28 ± 7.03%; p = 0.022) and midline shift (0.114 ± 0.023 cm vs. 0.083 ± 0.027 cm; p = 0.013). We observed a significant increase in regional CBF in cortical areas of the ischemic infarct (72.29 ± 24.00% vs. 105.53 ± 33.10%; p = 0.043) but not the whole hemispheres. Infarct size-independent parameters could not demonstrate a statistically significant reduction in cerebral edema with EPO treatment.ConclusionsSingle-dose pretreatment with rhEPO 5,000 IU/kg significantly reduces ischemic lesion volume and increases local CBF in penumbral areas of ischemia 24 h after transient MCAO in rats. Data suggest indirect neuroprotection from edema and the resultant pressure-reducing and blood flow-increasing effects mediated by EPO.

scholarly journals Associations of Ischemic Lesion Volume With Functional Outcome in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 1233-1240 ◽  
Author(s):  
Amber Bucker ◽  
Anna M. Boers ◽  
Joseph C.J. Bot ◽  
Olvert A. Berkhemer ◽  
Hester F. Lingsma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Lesion Volume ◽  
Ischemic Lesion

Variability assessment of manual segmentations of ischemic lesion volume on 24-h non-contrast CT

2021 ◽  
Author(s):  
Petra Cimflova ◽  
Johanna M. Ospel ◽  
Martha Marko ◽  
Bijoy K. Menon ◽  
Wu Qiu
Keyword(s):  
Lesion Volume ◽  
Ischemic Lesion ◽  
Contrast Ct

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 Clinical and Radiological Correlates of Reduced CBF Measured Using MRI

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 317-318
Author(s):  
Vincent N Thijs ◽  
Tobias Neumann-Haefelin ◽  
Michael E Moseley ◽  
Michael P Marks ◽  
Gregory W Albers
Keyword(s):  
Symptom Onset ◽  
Cerebral Blood Volume ◽  
Arterial Input Function ◽  
Mean Transit Time ◽  
Input Function ◽  
Lesion Volume ◽  
Time Curve ◽  
Measured Concentration ◽  
Ischemic Lesion ◽  
Adc Values

11 Background and purpose Methods for determining CBF using IV bolus tracking MRI have recently become available. Reduced apparent diffusion coefficient (ADC) values of brain tissue are associated with reductions in regional cerebral blood flow (rCBF). We studied the clinical and radiological features of patients with severe reductions of rCBF on MRI and analysed the relationship between reduced rCBF and ADC. Methods We studied patients with non-lacunar acute ischemic stroke in whom PWI and DWI MRI were performed within 7 hours after symptom onset. A PWI>DWI mismatch of >20% was required. Maps of rCBF, cerebral blood volume (rCBV) and mean transit time (rMTT) were generated after deconvoluting the measured concentration-time curve with the arterial input function using singular value decomposition. The ischemic lesion was outlined on the MTT map and the region of interest (ROI) transferred to the rCBF and rCBV map. ADC-maps were calculated. ADC lesions were defined as regions with ADC values ≤ 550 μm m2/sec. We compared the characteristics of patients with ischemic lesions that had a relative CBF of <50% to the contralateral hemisphere to patients with lesions that had relative CBF of >50%. Characteristics analysed included age, time to MRI, baseline NIHSS, mean ADC, DWI lesion volume, PWI lesion volume and absolute mismatch volume. Results Fifteen patients with an initial PWI>DWI mismatch of >20% were included. Ten had lesions with rCBF of >50% (median 60%) and five patients had rCBF of <50% (median 27.7%). Patients with rCBF <50% had lower ADC values (median 431 μmm2/sec versus 506 μ mm2/sec, p=0.028), larger DWI volumes (median 75.6 cm 3 versus 8.6 cm 3 , p=0.001) and larger PWI lesions as defined by the MTT volume (median 193 cm 3 versus 69 cm 3 , p=0.028) and more severe baseline NIHSS scores (median 18 versus 9, p=0.019). The rMTT and rCBV of the lesions were similar in both groups, as were the age, the absolute mismatch volume and the time from symptom onset to MRI. Conclusion These data indicate that ischemic lesions with severe CBF reductions, measured with new MRI techniques, are associated with a lower mean ADC, larger DWI and PWI lesion volumes and a higher NIHSS score.

scholarly journals An exploratory investigation of brain collateral circulation plasticity after cerebral ischemia in two experimental C57BL/6 mouse models

2019 ◽  
Vol 40 (2) ◽  
pp. 276-287 ◽  
Author(s):  
Marco Foddis ◽  
Katarzyna Winek ◽  
Kajetan Bentele ◽  
Susanne Mueller ◽  
Sonja Blumenau ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Mouse Models ◽  
Collateral Circulation ◽  
Artery Occlusion ◽  
External Carotid Artery ◽  
External Carotid ◽  
Lesion Volume ◽  
Compensatory Mechanism ◽  
Ischemic Lesion ◽  
Acute Brain Ischemia

Brain collateral circulation is an essential compensatory mechanism in response to acute brain ischemia. To study the temporal evolution of brain macro and microcollateral recruitment and their reciprocal interactions in response to different ischemic conditions, we applied a combination of complementary techniques (T2-weighted magnetic resonance imaging [MRI], time of flight [TOF] angiography [MRA], cerebral blood flow [CBF] imaging and histology) in two different mouse models. Hypoperfusion was either induced by permanent bilateral common carotid artery stenosis (BCCAS) or 60-min transient unilateral middle cerebral artery occlusion (MCAO). In both models, collateralization is a very dynamic phenomenon with a global effect affecting both hemispheres. Patency of ipsilateral posterior communicating artery (PcomA) represents the main variable survival mechanism and the main determinant of stroke lesion volume and recovery in MCAO, whereas the promptness of external carotid artery retrograde flow recruitment together with PcomA patency, critically influence survival, brain ischemic lesion volume and retinopathy in BCCAS mice. Finally, different ischemic gradients shape microcollateral density and size.

scholarly journals Machine Learning for Detecting Early Infarction in Acute Stroke with Non–Contrast-enhanced CT

Radiology ◽  
2020 ◽  
Vol 294 (3) ◽  
pp. 638-644 ◽  
Author(s):  
Wu Qiu ◽  
Hulin Kuang ◽  
Ericka Teleg ◽  
Johanna M. Ospel ◽  
Sung Il Sohn ◽  
...  
Keyword(s):  
Machine Learning ◽  
Acute Stroke ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Early Infarction
Sign in / Sign up

Export Citation Format

Share Document