scholarly journals The Potential Roles of18F-FDG-PET in Management of Acute Stroke Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-14 ◽  
Author(s):  
Adomas Bunevicius ◽  
Hong Yuan ◽  
Weili Lin
Keyword(s):  
Acute Stroke ◽  
Fdg Pet ◽  
Time Window ◽  
Clinical Settings ◽  
Stroke Patients ◽  
Cellular Mechanisms ◽  
Fdg Uptake ◽  
Non Invasive ◽  
Wide Availability ◽  
Human Stroke

Extensive efforts have recently been devoted to developing noninvasive imaging tools capable of delineating brain tissue viability (penumbra) during acute ischemic stroke. These efforts could have profound clinical implications for identifying patients who may benefit from tPA beyond the currently approved therapeutic time window and/or patients undergoing neuroendovascular treatments. To date, the DWI/PWI MRI and perfusion CT have received the most attention for identifying ischemic penumbra. However, their routine use in clinical settings remains limited. Preclinical and clinical PET studies with [18F]-fluoro-2-deoxy-D-glucose (18F-FDG) have consistently revealed a decreased18F-FDG uptake in regions of presumed ischemic core. More importantly, an elevated18F-FDG uptake in the peri-ischemic regions has been reported, potentially reflecting viable tissues. To this end, this paper provides a comprehensive review of the literature on the utilization of14C-2-DG and18F-FDG-PET in experimental as well as human stroke studies. Possible cellular mechanisms and physiological underpinnings attributed to the reported temporal and spatial uptake patterns of18F-FDG are addressed. Given the wide availability of18F-FDG in routine clinical settings,18F-FDG PET may serve as an alternative, non-invasive tool to MRI and CT for the management of acute stroke patients.

Abstract TP372: Implementation of a New Intermittent Pneumatic Compression Protocol in a Stroke Unit

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Estela Sanjuan Menendez ◽  
Katherine E Santana Roman ◽  
Carlos A Molina ◽  
Pilar Giron Espot ◽  
Marc Ribo ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Stroke Unit ◽  
Intermittent Pneumatic Compression ◽  
Stroke Patients ◽  
Duration Of Treatment ◽  
Implementation Phase ◽  
Non Invasive ◽  
Dvt Prophylaxis ◽  
Hemodynamic Variables ◽  
Work Burden

Introduction: Intermittent pneumatic compression (IPC) has demonstrated to prevent deep venous thrombosis (DVT) and improve survival in acute stroke. Objective: We aimed to implement a new IPC protocol in our non-invasive stroke unit by applying IPC in the hyperacute stroke phase. Methods: All acute stroke patients with high DVT risk and contraindication for pharmacological DVT prophylaxis received IPC treatment. In ischemic stroke patients treated with reperfusion therapies, IPC protocol was planned for 24hours; intracraneal hemorrhage (ICH) patients were treated with IPC during 72hours. Clinical and hemodynamic variables were recorded. Nurses and patients were interviewed for satisfaction with the new protocol. Results: From March to August 2015, we enrolled 132 patients: 75 male (56.4%), mean age 71+/-15 y.o., ischemic strokes 103 (79.2%). Time from admission to IPC application 102+/-375min. Duration of treatment in ischemic patients was 37+/-21hours while in ICH was 44+/-26hours. No patient presented DVT in our series. We observed 6 deaths (4.5%) and 66 patients (56.4%) presented other complications, none of them related to IPC. Only at implementation phase nurses referred a relevant work burden with the new protocol compared to classical low-weighed-heparin DVT prophylaxis. After training it only takes a mean of 6±1.5 minutes to apply the treatment. Only 3 patients (2.3%) presented discomfort, 2 of them with early IPC drop off. Conclusion: IPC treatment is feasible, safe, and comfortable for stroke patients in the hyperacute phase. It increases work burden for nurses only at the implementation phase.

Abstract TMP87: Non-Invasive Respiratory Impedance Enhances Cerebral Perfusion in Acute Stroke Patients

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Christopher G Favilla ◽  
Rodrigo M Forti ◽  
Ahmad Zamzam ◽  
John A Detre ◽  
Michael T Mullen ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Cerebral Perfusion ◽  
Respiratory Impedance ◽  
Stroke Patients ◽  
Non Invasive

Noninvasive Assessment of Intestinal Graft-Versus-Host Disease Activity by 18F-Fluorodeoxyglucose Positron Emission Tomography.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3230-3230
Author(s):  
Matthias Stelljes ◽  
Jorn Albring ◽  
Sven Hermann ◽  
Christopher Poremba ◽  
Gabiele Kohler ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Low Dose ◽  
Emission Tomography ◽  
Control Group ◽  
Pathological Findings ◽  
Graft Versus Host ◽  
Fdg Uptake ◽  
Non Invasive ◽  
Positron Emission ◽  
Low Dose Computed Tomography

Abstract Gastrointestinal graft-versus-host disease (GI-GvHD) is a common and potentially life-threatening complication after allogeneic hematopoietic stem cell transplantation (HSCT). Detection of disease activity is pivotal for diagnosis and management of this condition. Despite methodical and technical limitations, histological analysis of endoscopically obtained specimens of the gut is still the gold standard in the diagnosis of GI-GvHD. Non-invasive objective tests for monitoring GvHD activity that cover the entire intestine are desirable but lacking. In the preclinical phase of our study, (C57BL/6 × BALB/c)F1 mice were transplanted with bone marrow and additional spleen cells (GvHD group) or with marrow grafts alone (control group) from allogeneic BALB/c donors. Serial measurements with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed a significant uptake of FDG in the GvHD group, predominantly of the colon. Histology of the whole gut revealed GvHD-associated inflammatory changes in the colon with normal findings in the small intestine. Analyses of the control group by FDG-PET, histology, and clinical assessment gave no evidence for GvHD. Bioluminescence imaging of the gut from F1 recipients transplanted from allogeneic C57BL/6-Tg(ACTB-EGFP) donors showed a significant infiltration, again predominantly of the colon, by EGFP positive donor cells and a matching FDG uptake in following PET examinations. In a subsequent clinical study, 22 patients with suspected GI-GvHD were examined by FDG-PET in combination with low-dose computed tomography (n=12) or by FDG-PET alone (n=10). Endoscopy of the rectum and sigmoid (n=13) or the entire colon (n=7) with assessment of mucosal specimens was performed in 20 patients. The two patients without endoscopic evaluation had normal FDG-PET results and showed normalisation of initial symptoms without further treatment. In addition, serial tests of stool for viral, bacterial or fungal infections and analyses of blood for CMV (pp65 and CMV-PCR), were without any pathological findings in all patients. In patients with proven GI-GvHD (progressive diarrhea, histology results conclusive for GvHD and positive FDG-PET results), therapy with corticosteroids was started, whereas in the absence of pathological findings no further therapy was given. Twelve of the 22 patients showed a significant FDG uptake of the gut, again predominantly in the colon. In all of these patients, GvHD responded to immunosuppressive treatment, and re-evaluation with FDG-PET showed markedly decreased FDG uptake in 6 out of 6 patients. None of the 10 patients with normal FDG-PET findings developed GvHD of the gut. The findings indicate that diagnostic imaging using FDG-PET with or without low-dose computed tomography is a sensitive, non-invasive procedure to assess localization and activity of GI-GvHD, with the potential for widespread clinical use following allogeneic HSCT.

scholarly journals THE REASONS ACUTE STROKE PATIENTS NOT RECEIVING THROMBOLYSIS IN AN INDONESIAN REFERRAL HOSPITAL

2019 ◽  
pp. 43-46
Author(s):  
AL RASYID ◽  
SALIM HARRIS ◽  
MOHAMMAD KURNIAWAN ◽  
TAUFIK MESIANO ◽  
RAKHMAD HIDAYAT ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
General Hospital ◽  
Time Window ◽  
National Institutes Of Health ◽  
Common Reason ◽  
Stroke Patients ◽  
Nihss Score ◽  
Stroke Registry ◽  
Activation Criteria

Objective: The aim of this study was to identify reasons acute stroke patients did not receive thrombolysis despite meeting Code Stroke activation criteria in Cipto Mangunkusumo General Hospital during November 2015 until February 2019. Methods: This study retrospectively collected data of adult (aged>18 y old) acute stroke patients admitted to Cipto Mangunkusumo General Hospital from November 2015 to February 2019 who met criteria for Code Stroke activation but did not undergo thrombolysis. Patient’ data were collected from Code Stroke Registry of Cipto Mangunkusumo General Hospital. Results: There were 518 acute stroke patients who had Code Stroke activated in Cipto Mangunkusumo General Hospital from November 2015 to February 2019. 76.3% of acute stroke patients did not receive thrombolytic therapy (n=395). Hemorrhage on computed tomography (CT) scan was the most common reason patients did not receive thrombolysis. The following most common reasons were low or improved National Institutes of Health Stroke Scale (NIHSS) score, family refusal, and exceedance of time window. Conclusion: Hemorrhage on CT scan was the most common reason patients did not receive thrombolysis following by low or improved NIHSS score, family refusal, and exceedance of time window.

Abstract NS 4: Non-Invasive Oscillometric Blood Pressure Monitoring in tPA Treated Patients: Is Mean Arterial Pressure Associated with Patient Outcomes?

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Anne W Alexandrov ◽  
Asad A Chaudhary ◽  
April Sisson ◽  
Kara Sands ◽  
Pawan Rawal ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
National Standard ◽  
Stroke Patients ◽  
Non Invasive ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Center

Background: Blood pressure (BP) parameters for management of tPA treated patients are well known among experienced stroke clinicians, and violation of systolic and diastolic BP limits have previously been shown to be associated with symptomatic intracerebral hemorrhage (sICH) in tPA treated patients. Non-invasive oscillometric BP monitoring measures a “true” mean arterial pressure (MAP), and then algorithmically defines what systolic and diastolic pressure "might" be. Because this form of BP monitoring has become the national standard, we examined the occurrence of MAP BP elevations to determine their association with sICH and treatment outcome in acute ischemic stroke patients that received systemic tPA. Methods: Two-years of consecutive systemic tPA cases were retrieved from our Stroke Center database and arterial blood pressures for the first 24 hours from time of bolus were entered from auto-recordings in our electronic medical records. Protocol violations in MAP were defined as greater than 120 mm Hg at any point in the first 24 hours from time of bolus. Off-label treatment with intravenous tPA beyond 4.5 hours from symptom onset was identified a priori as a potential counfounder to stroke outcome. Symptomatic intracerebral hemorrhage was defined as an increase in the NIHSS of ≥ 4 points. Spearman’s correlation was used to assess the relationship between MAP and post-tPA NIHSS score. Results: 191 tPA cases were identified for inclusion in the analysis with 150 (79%) receiving their tPA at our Comprehensive Stroke Center and another 41 (21%) administered as a telephone-consult supported drip and ship. Patients were 65.5±16 years of age with median admission NIHSS scores of 12 (IQR=7-17). All patients had normal CT scans or minor changes consistent with acute stroke without hypo-attenuation. A total of 77 (40%) patients experienced a MAP violation overall. There were 11 isolated systolic BP violations, 4 isolated diastolic BP violations, and 21 isolated MAP violations that were otherwise not detectable by a violation in systolic or diastolic parameters, averaging 123.3±2 mm Hg. A total of 2 (1%) sICHs occurred in the sample, and of these 1 was associated with on-label peri-treatment BP protocol violations affecting systolic, diastolic and MAP parameters. An increased reduction in post-tPA NIHSS points was significantly associated with higher MAPs (r=.92; p=.008). Conclusions: Evidence-based guidelines are silent on MAP limits, and MAP is rarely monitored clinically in tPA treated patients despite dependence on the MAP for assignment of systolic and diastolic pressures in oscillometric BP monitoring. Our findings suggest that an improved understanding of the contribution of MAP-dependent oscillometric methods to BP monitoring in acute stroke patients is warranted.

Abstract TP56: Insight Into Human Ischemia Reperfusion Injury in Acute Stroke: A Voxel-Based MRI Analysis of Tissue Fate

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
May Nour ◽  
Fabien Scalzo ◽  
Jeffery R Alger ◽  
Sidney Starkman ◽  
Latisha K Ali ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Reperfusion Injury ◽  
Mechanical Thrombectomy ◽  
Ischemia Reperfusion Injury ◽  
Tissue Injury ◽  
Ischemia Reperfusion ◽  
Stroke Patients ◽  
Flair Imaging ◽  
Human Stroke ◽  
Iv Tpa

Background: Reperfusion is characterized by initial restriction of blood supply followed by subsequent vascular restoration and concomitant reoxygenation of downstream tissue. In spite of mitigating initial tissue hypoxia, exacerbation of tissue injury may occur. Animal models have delineated reperfusion injury on the cellular and molecular levels, yet, no study has quantified voxel-based analyses of tissue fate due to reperfusion injury in human stroke. Methods: Evaluation included 58 stroke patients with an age range of 65±18 years, 65% of whom were woman and 35% men. All patients presented with M1 MCA occlusion and a subset received mechanical thrombectomy (38) while another received intravenous tPA followed by mechanical thrombectomy (20). Serial perfusion MRI images were obtained on presentation as well as 3-6 hours following reperfusion and processed to extract Tmax parameters. These images were co-registered serially at the voxel level with tissue fate outcomes on FLAIR and GRE 4-5 days following presentation. Reperfusion was defined by serial changes observed in Tmax voxels. The volume of reperfusion, injury, as well as tissue fate relative to initial perfusion were calculated. Results: Hemorrhage was noted on GRE in 28.9% of the patients who received thrombectomy alone and in 20% of those who received IV tPA followed by thrombectomy. In pure thrombectomy cases without later hemorrhage, average voxel-based reperfusion was 72.3% with 18% demonstrating reperfusion injury and tissue death as assessed by FLAIR imaging 4-5 days following presentation, averaging 86.2%. In patients who received IV tPA followed by mechanical thrombectomy without any subsequent hemorrhage, average voxel-based reperfusion was 66.0% with 6.2% demonstrating reperfusion injury in reperfused voxels and tissue death as assessed by FLAIR imaging 4-5 following presentation, averaging 90.3%. Conclusions: Non-hemorrhagic forms of reperfusion injury are common in acute stroke patients treated with standard therapies. Despite reperfusion and irrespective of treatment modality, substantial amounts of tissue are destined to infarct. Voxel-based analyses of serial imaging studies may provide a framework to develop therapies for reperfusion injury.

scholarly journals Neurovascular, Muscle, and Skin Changes on [18f]FDG PET/MRI in Foot Complex Regional Pain Syndrome (CRPS)

2020 ◽  
Author(s):  
Daehyun Yoon ◽  
Yingding Xu ◽  
Peter W. Cipriano ◽  
Israt S. Alam ◽  
Carina Mari Aparici ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Fdg Pet ◽  
Pain Syndrome ◽  
Whole Body ◽  
Mri Imaging ◽  
Skin Changes ◽  
Fdg Uptake ◽  
Non Invasive ◽  
Skin Abnormalities ◽  
18F Fdg

Abstract Background: The goal of this study is to demonstrate the feasibility of [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) for non-invasive visualization of muscular, neurovascular, and skin changes secondary to complex regional pain syndrome (CRPS). Methods: Seven adult patients with CRPS in the lower extremity and seven healthy adult controls participated in our [18F]FDG PET/MRI study. All participants received whole-body PET/MRI scans one hour after the injection of 10mCi [18F]FDG. Resulting PET/MRI images were reviewed by two radiologists. Metabolic and anatomic abnormalities identified, were grouped into muscular, neurovascular, and skin lesions. The [18F]FDG uptake of each lesion was compared with that of corresponding areas in controls using a Mann-Whitney U-test. Results: On PET images, muscular, neurovascular, and skin abnormalities were found in 5, 4 and 2 patients, respectively. However, on MRI images, no muscular abnormalities were detected. Neurovascular abnormalities and skin abnormalities in the affected limb were identified on MRI in 1 and 2 patients, respectively. The difference in [18F]FDG uptake between the patients and the controls was significant in muscle (p = 0.018) and neurovascular bundle (p = 0.0005).Conclusions: The increased uptake of [18F]FDG in the symptomatic areas likely reflects the increased metabolism due to the inflammatory response causing pain. Therefore, our approach combining metabolic ([18F]FDG PET) and anatomic (MRI) imaging may offer non-invasive monitoring of the distribution and progression of inflammatory changes associated with CRPS. Trial registration: ClinicalTrials.gov, NCT03195270. Registered 19 June 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03195270

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