Abstract 2546: Correlation Between Diffusion-weighted Imaging (DWI) Lesion Volume And Alberta Stroke Program Early CT Score (ASPECTS) In Patients Undergoing Acute Stroke Intervention

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ashutosh P Jadhav ◽  
Mouhammad Jumaa ◽  
Sayed Zaidi ◽  
Carlos L Salinas ◽  
Guangming Zhu ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Scan ◽  
Endovascular Therapy ◽  
Infarct Volume ◽  
Medical Center ◽  
Lesion Volume ◽  
Infarct Core ◽  
Mri Scan ◽  
Occlusion Time ◽  
Software Analysis

Background and Purpose: Selection of patients for endovascular acute stroke therapy is evolving into imaging based paradigms that quantitatively assess infarct core thresholds beyond which reperfusion is considered futile or detrimental. We sought to determine whether a correlation exists between pre-intervention infarct volume as measured by DWI MRI and ASPECT scores on CT in patients with acute stroke treated with endovascular therapy who underwent both a pre-procedure MRI scan and a non-contrast CT scan at our institution. Methods: Retrospective review of a prospectively maintained database of acute ischemic strokes treated with endovascular therapy at the University of Pittsburgh Medical Center during 2004-2011. CT-ASPECT scores were prospectively scored by blinded observers. Infarct volume on DWI was determined by automated software analysis (RAPID, n=25 and MIPAV, n=53). The following additional factors were considered: age, NIHSS, time from last seen well (TLSW) to angiography, site of clot occlusion, time between obtaining CT scan and MRI, and parenchymal hematoma (PH) formation. Results: Of 77 patients included in the study, there was a significant negative correlation between CT-ASPECT score and DWI volume size (p<0.0001, by ANOVA). Table 1 outlines the distribution of ASPECTS scores and corresponding mean DWI volumes along with other variables of interest. The mean time between obtaining the CT and MRI scan was 207 minutes. Conclusions: A CT-ASPECT score of 7 or greater corresponds to an average DWI volume of 23 ml or less. Recent studies have shown that a pre treatment DWI volume of <25 ml is predictive of favorable outcomes. Therefore, our findings provide further support of the concept that an ASPECT score cut off of 7 or greater corresponds to core volume thresholds that are predictive of good outcomes following revascularization. Future prospective studies are needed to compare the benefit of CT ASPECTS scores alone versus DWI MRI or other advanced imaging modalities as selection tool for acute stroke endovascular therapy.

Abstract WMP44: Functional Recovery Following a Combination of Thrombin Inhibitor Argatroban and Tissue Plasminogen Activator (tPA) in Thromboembolic Stroke in Nonhuman Primates

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Junko Suzuki ◽  
Yoshitaka Itani ◽  
Shinya Ogawa ◽  
Kazunori Yamanaka ◽  
Ikuo Hayashi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Plasminogen Activator ◽  
Functional Recovery ◽  
Nonhuman Primates ◽  
Infarct Volume ◽  
Thrombin Inhibitor ◽  
Thromboembolic Stroke ◽  
Brain Infarct ◽  
Occlusion Time ◽  
Tissue Plasminogen

Introduction: Early treatment following an acute stroke with the thrombolytic tissue plasminogen activator (tPA) increases functional recovery. Complications of tPA treatment include hemorrhaging and narrow therapeutic time window. Thus, better treatments for acute stroke are needed. While a number of novel treatments for acute ischemic stroke have been derived from preclinical rodent stroke models, to date, none have succeeded in clinical studies. Nonhuman primates are phylogenetically closer to humans than rodents, which could narrow the current translational shortfall between preclinical and clinical findings. The goal of the current study was to test the effect of a combination of argatroban, a thrombin inhibitor, and tPA on functional recovery and brain infarction size following thromboembolic ischemia in nonhuman primates. Methods: Autologous blood clots were injected into the internal carotid artery of cynomolgus macaques to induced a thromboembolic stroke. Either tPA (0.9 mg/kg; n = 8) or vehicle (n = 8) was intravenously infused for one hour an hour following the induction of ischemia. In a third group, after completion of tPA infusion, argatroban (0.6 mg/kg; n= 7) was intravenously infused for 22 hours. Doppler ultrasound recorded middle cerebral artery (MCA) blood flow for six hours following induction of stroke. In addition, brain infarct volume (TTC staining) and functional assessment (Neurologic Deficit Score; NDS) were determined 24 hours after ischemia. Results: Compared to vehicle treatment, tPA treatment significantly decreased MCA occlusion time, brain infarct volume and NDS. Treatment with the combination of argatroban and tPA decreased occlusion time, brain infarct volume and NDS similar to tPA treatment alone. Conclusion: The current study suggests that the addition of argatroban could enhance recanalization rates observed with tPA treatment alone. However, in contrast to previous findings in rats, the combination of argatroban and tPA does not appear to further enhance tissue or functional recovery from a thromboembolic stroke compared to tPA treatment alone.

scholarly journals CTA Source Images as a Predictor of Final Infarct Volume are Time-Dependent

2010 ◽  
Vol 37 (6) ◽  
pp. 866-867 ◽  
Author(s):  
Dylan Blacquiere ◽  
Miguel Bussière ◽  
Cheemun Lum ◽  
Dar Dowlatshahi
Keyword(s):  
Acute Stroke ◽  
Ct Angiography ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Artery Occlusion ◽  
Time Dependent ◽  
Infarct Core ◽  
Time Resolved

Avascularity on CT angiography source images (CTASI) may better predict final infarct volume in acute stroke as compared to early ischemic changes on non-contract CT. These CTASI findings may represent infarct core and help determine the extent of salvageable tissue. However, the extent of avascularity on CTASI may overestimate infarct volume if transit of contrast is prolonged due to proximal artery occlusion. We present a case where CT-perfusion (CTP) and time-resolved CT-angiography (CTA) identified salvageable tissue thought to be infarcted on CTASI.

Abstract 38: Brain CT Perfusion is Superior to Non-contrast CT Aspects in the Evaluation of Hyperacute Infarct Volume

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jelle Demeestere ◽  
Carlos Garcia-Esperon ◽  
Pablo Garcia-Bermejo ◽  
Fouke Ombelet ◽  
Patrick McElduff ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Ct Perfusion ◽  
Infarct Volume ◽  
Lesion Volume ◽  
Infarct Core ◽  
Anterior Circulation ◽  
C Statistic ◽  
Contrast Ct ◽  
Core Volume

Objective: To compare the predictive capacity to detect established infarct in acute anterior circulation stroke between the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) on non-contrast computed tomography (CT) and CT perfusion. Methods: Fifty-nine acute anterior circulation ischemic stroke patients received brain non-contrast CT, CT perfusion and hyperacute magnetic resonance imaging (MRI) within 100 minutes from CT imaging. ASPECTS scores were calculated by 4 independent vascular neurologists, blinded from CT perfusion and MRI data. CT perfusion infarct core volumes were calculated by MIStar software. The accuracy of commonly used ASPECTS cut-off scores and a CT perfusion core volume of ≥ 70 mL to detect a hyperacute MRI diffusion lesion of ≥ 70 ml was evaluated. Results: Median ASPECTS score was 9 (IQR 7-10). Median CT perfusion core volume was 22 ml (IQR 10.4-71.9). Median MRI diffusion lesion volume was 24,5 ml (IQR 10-63.9). ASPECTS score of < 6 had a sensitivity of 0.37, specificity of 0.95 and c-statistic of 0.66 to predict an acute MRI lesion ≥ 70 ml. In comparison, a CT perfusion core lesion of ≥ 70 ml had a sensitivity of 0.76, specificity of 0.98 and c-statistic of 0.92. The CT perfusion core lesion covered a median of 100% of the acute MRI lesion volume (IQR 86-100%). Conclusions: CT perfusion is superior to ASPECTS to predict hyperacute MRI lesion volume in ischemic stroke.

Abstract W P14: Significant Correlation between Neurological and Functional Recoveries in the Natural History of Acute Ischemic Stroke from Large Vessel Occlusion

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Vallabh Janardhan ◽  
Albert J Yoo ◽  
Donald F Frei ◽  
Lynne Ammar ◽  
Sophia S Kuo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Natural History ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Strong Correlation ◽  
Infarct Volume ◽  
Large Vessel ◽  
Infarct Core ◽  
Nihss Score ◽  
History Of

Purpose: There have been conflicting reports on the correlation between neurological and functional recoveries in acute ischemic stroke. NIHSS and mRS scores not always correlated in patients after treatment. Since the inconsistencies could be related to the variable effectiveness of treatments, the aim of this study was to test their correlation in patients with large vessel proximal occlusion who are eligible but not treated with endovascular therapy. In addition, we analyzed the data based on trichotomized ASPECTS scores to minimize the confounding influence of the infarct core. Methods: The FIRST Trial is a prospective natural history study of a stroke cohort eligible for but untreated by endovascular therapy and ineligible or refractory to IV rtPA. NIHSS and mRS scores were measured in 93 patients at admission, 24 hour and 7 days after hospital presentation and were analyzed by logistic regression against different core infarct volume as indexed by ASPECTS scores of 8-10, 5-7, and 0-4. Results: Median admission NIHSS score was 18 (IQR 14-23, N=93). The mean and mean increase at 24 h NIHSS both showed correlations with trichotomized ASPECTS, p=0.0064 and 0.0202, respectively. NIHSS at 24 h and 7 days displayed a strong relationship with 90 day mRS 0-2 (p=0.0002, N=67; p=0.0003, N=66). NIHSS had a strong correlation to 90 day mRS scores (continuous), with high 7 day scores correlated with high mRS scores and 7 day NIHSS change negatively correlated to 90 day mRS scores (Spearman correlations, all p<0.0001). Significant correlations were seen between 24 h and 7 day NIHSS and 90 day mRS by trichotomized ASPECTS (both p=0.04275). In addition, controlling for trichotomous ASPECTS groups, 7 Day NIHSS score was the best predictor of mRS 90d 0-2 (OR= 0.717, p= 0.0018). Conclusion: These data indicate that there is a strong correlation between neurological and functional recoveries in the natural history of acute ischemic when the confounding influences of treatment and the infarct core are taken into account.

Abstract WP83: Validation of a Relative Non-Contrast CT Map to Detect Early Ischemic Changes in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Margy E McCullough-Hicks ◽  
Soren Christensen ◽  
Aditya Srivatsan ◽  
Gregory W Albers ◽  
Maarten Lansberg
Keyword(s):  
Acute Stroke ◽  
Brain Regions ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Test Characteristics ◽  
Contrast Ct ◽  
Sensitivity Specificity ◽  
Early Infarction

Background: Discerning signs of early infarct on the non-contrast CT (NCCT) can be difficult. To facilitate interpretation of the NCCT we previously developed a technique to generate symmetry ratio maps of the NCCT (rNCCT maps) on which subtle (≥5%) differences in density between symmetric brain regions are enhanced. We sought to validate the rNCCT map against other measures of early infarction in a large cohort. Methods: rNCCT maps were generated for 146 ischemic stroke patients. We assessed how often a neurologist’s interpretation of the NCCT was changed when provided with the rNCCT map. The neurologist was blinded to CTP and DWI but was given the infarct hemisphere. In addition, using the 24-hour DWI as the gold standard, we assessed the sensitivity, specificity and volumetric accuracy of the rNCCT-defined infarct core and compared this to the test characteristics of CTP-defined infarct core (CBF<38% threshold). Results: Addition of rNCCT overlay map changed clinician’s initial read 64.4% of the time (95% CI 56-72%); the rNCCT identified new areas of ischemia not appreciated on blinded review 86.2% of the time (95% CI 78-92%) and in 35.1% helped rule out early ischemia where the reader was unsure of its presence (95% CI 26-45%). In the 53 patients with reperfusion and follow-up MRI, specificity of rNCCT for final lesion volume was 99.5% for rNCCT [98.5-99.8%] vs. 99.8% [IQR 98.8-99.9%] for CTP (P=0.08). Sensitivity for rNCCT was 19.9% [7.1-28.1%] vs. 17.5% [4.7-32.2%] for CTP (P=0.56). Conclusions: This study validates the rNCCT map for detection of early ischemic changes. It is more quantitative and objective than a clinician’s read of the NCCT alone. The sensitivity and specificity for detecting early ischemic changes on rNCCT were comparable to those achieved with CTP. This indicates that the rNCCT could be a valuable tool in the evaluation of acute stroke patients.

Abstract 2697: Fully-automated Identification of Acute Stroke Lesion Volumes with CT Perfusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Matus Straka ◽  
Gregory W Albers ◽  
Maarten G Lansberg ◽  
Stephanie M Kemp ◽  
Michael P Marks ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Automated Image Analysis ◽  
Great Promise ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Median Volume ◽  
Stroke Lesion ◽  
Volume Difference

Purpose: Mismatch between volumes of infarct core and critically hypoperfused tissue (CHT) may be used to identify acute stroke patients who could benefit from reperfusion therapies. We present a fully-automated, operator-free approach for identifying the core and CHT lesion volumes with CT perfusion (CTP). Methods: 31 scans of 25 acute stroke patients who underwent CTP followed by MRI (range: 23-120 min) were analyzed. CTP was obtained as a one or two 2cm slabs. MRI included DWI and PWI. Reference stroke lesion metrics were MRI-based: core via DWI (ADC<615x10 -6 mm 2 /s), and CHT via PWI (Tmax>6s). CTP and PWI scans were processed with an automated image analysis program (RAPID) with delay-independent deconvolution. MRI maps were coregistered to CTP. Contralaterally-relative CBV CT and CBF CT ( cr CBF CT , cr CBF CT ) maps were computed by putting into ratio the original and corresponding laterally-mirrored and smoothed rCBV CT and rCBF CT maps (obtained by vertical flip and coregistration of the anatomic images, see Fig). Stroke core in CTP was delineated by thresholding cr CBV CT and cr CBF CT , and CHT by thresholding Tmax CT . Optimal thresholds were obtained by ROC analysis and minimization of lesion volume differences between CT and MRI. Results: For identification of stroke core in CTP, cr CBF CT performed better than cr CBV CT . Optimal threshold was cr CBF CT < 0.30 with sensitivity 60% (CI 95% 57-63%) and specificity 88%, (CI 95% 87-89%); median volume difference between CBF CT and DWI lesions was 0 ml (IQR: -6ml to 6 ml); correlation of volumes was r 2 =0.72 ( p <0.0001). For identification of CHT, reference MRI lesions (Tmax MR >6s) were most accurately identified by Tmax CT >6s with sensitivity 72% (CI 95% 70-74%), specificity 97% (CI 95% 96-97%); median volume difference between Tmax CT and Tmax MR was -3ml (IQR: -10ml to 0ml); correlation of CHT volumes r 2 =0.89 (p<0.0001). Conclusions: The processing methods and CTP thresholds presented in this study show a great promise for fully-automated outlining of stroke lesions using CTP. Such a technique could be of great value for CTP-based patient selection in clinical trials and clinical practice.

scholarly journals Neurofilament Proteolysis after Focal Ischemia; When Do Cells Die after Experimental Stroke?

1999 ◽  
Vol 19 (6) ◽  
pp. 652-660 ◽  
Author(s):  
Jaroslaw Aronowski ◽  
Ki-Hyun Cho ◽  
Roger Strong ◽  
James C. Grotta
Keyword(s):  
Time Course ◽  
Infarct Volume ◽  
Focal Ischemia ◽  
Cellular Damage ◽  
Experimental Stroke ◽  
Infarct Core ◽  
Similar Time ◽  
The Core ◽  
Tetrazolium Staining ◽  
Previous Demonstration

To determine the occurrence and time-course of presumably irreversible subcellular damage after moderate focal ischemia, rats were subjected to 1, 3, 6, 9, or 24 hours of permanent unilateral middle cerebral and common carotid occlusion or 3 hours of reversible occlusion followed by 3, 6, or 21 hours of reperfusion. The topography and the extent of damage were analyzed with tetrazolium staining and immunoblot using an antibody capable of detecting breakdown of neurofilament. Neurofilament proteolysis began after 3 hours in the infarct core but was still incomplete in penumbral regions up to 9 hours. Similarly, tetrazolium-staining abnormalities were observed in the core of 50% of animals after 3 hours of ischemia. At 6 hours of permanent ischemia, infarct volume was maximal, and further prolongation of occlusion to 9 or 24 hours did not increase abnormal tetrazolium staining. In contrast to permanent ischemia and in agreement with the authors' previous demonstration of “reperfusion injury” in this model, prolongation of reperfusion from 3 hours to 6 and 21 hours after 3 hours of reversible occlusion gradually augmented infarct volume by 203% and 324%, respectively. Neurofilament proteolysis initiated approximately 3 hours after ischemia was quantitatively greatest in the core and extended during reperfusion to incorporate penumbra with a similar time course to that of tetrazolium abnormalities. These data demonstrate that, at least as measured by neurofilament breakdown and mitochondrial failure, extensive cellular damage is not present in penumbral regions for up to 9 hours, suggesting the potential for rescuing these regions by appropriate and timely neuroprotective strategies.

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.

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

Stroke ◽  
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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