Abstract 61: MR Perfusion to Determine the Status of Collaterals in Patients With Acute Ischemic Stroke: Look Beyond Perfusion Time-maps

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Kambiz Nael ◽  
James Knitter ◽  
Amish Doshi ◽  
J Mocco ◽  
Thomas Naidich
Keyword(s):  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Cerebral Angiography ◽  
Independent Predictor ◽  
Collateral Flow ◽  
Mr Perfusion ◽  
The Status ◽  
Perfusion Time ◽  
Sensitivity Specificity ◽  
Angiographic Findings

Purpose: Collateral flow is an independent predictor of reperfusion and infarct size in patients with acute ischemic stroke (AIS). MR perfusion time-maps show delayed perfusion but unable to differentiate antegrade from collateral flow if used alone. Using a multiparametric approach, we aimed to identify a perfusion biomarker that can represent the extent of collaterals in comparison to angiographic findings. Methods: AIS patients with MCA proximal occlusion who had baseline MRI and cerebral angiography included. MR perfusion data were processed by Bayesian method to generate arterial tissue delay (ATD) maps at thresholds of 2 & 6 seconds. The volume of delayed perfusion (Vol-ATD 2sec ), critical hypoperfusion (Vol-ATD 6sec ), and hypoperfusion (Vol-ATD 2sec-6sec ) in addition to corresponding rCBV and rCBF were calculated. Baseline angiography collaterals were dichotomized to poor (TICI ≤2a) or good collaterals (TICI≥ 2b). The association of perfusion biomarkers and status of collaterals was assessed by repeated measure of analyses and receiver operating characteristic (ROC) to determine the optimal parameters for predicting the status of collaterals. Results: In 37 patients included, 20 had good collaterals on cerebral angiography. After controlling for age, baseline NIHSS and infarct volume, multivariate logistic regression analysis identified rCBV (p=0.001) and hypoperfused volume (Vol-ATD 2sec-6sec ), but not rCBF, Vol-ATD 2sec or Vol-ATD 6sec , as independent predictors of good collaterals. ROC analysis showed AUC of 0.89 (sensitivity/specificity: 85%90%) for rCBV and AUC of 0.78 (sensitivity/specificity: 70%82%) for Vol-ATD 2sec-6sec . Hypoperfused tissue volume (Vol-ATD 2sec-6sec ) x its rCBV, termed hypoperfused tissue collateral index , remained an independent predictor of good collaterals with improved diagnostic accuracy over each measure alone (AUC: 0.96, sensitivity/specificity: 91%100%). Conclusions: Multiparametric MR perfusion can be used to assess the status of collaterals in patients with AIS. Hypoperfused tissue collateral index defined as hypoperfused volume (Vol-ATD 2sec-6sec ) x rCBV is a new perfusion index with diagnostic accuracy of 96% compared to angiographic findings to predict status of collaterals.

Abstract WMP22: Multiparametric CT Perfusion to Determine the Collaterals Status in Patients With Acute Ischemic Stroke: A New Perfusion Index

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ahmed J Awad ◽  
Sayedhedayatollah E Tadayon ◽  
Daniel Wei ◽  
Reham R Haroun ◽  
Thomas J Oxley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Diagnostic Accuracy ◽  
Acute Ischemic Stroke ◽  
Independent Predictor ◽  
Ct Perfusion ◽  
Multivariate Logistic Regression Analysis ◽  
Perfusion Index ◽  
Repeated Measure ◽  
Collateral Flow ◽  
Sensitivity Specificity

Introduction: Good collateral flow is an independent predictor of reperfusion that can be used to extend the treatment window in the new era of endovascular therapies for patients with acute ischemic stroke (AIS). Using a multiparametric approach, we aimed to identify perfusion parameter/s that can represent the extent of collaterals in comparison to CTA. Methods: AIS patients with anterior circulation large vessel occlusion who had baseline CTA and CT perfusion were included. CT perfusion data were processed by Bayesian method to generate arterial tissue delay (ATD) maps at thresholds of 2 & 6 seconds. The volume of mild delayed perfusion (Vol-ATD >2sec ), moderate delayed (Vol-ATD 2-6sec ) and critical delayed perfusion (Vol-ATD >6sec ) in addition to corresponding rCBV and rCBF were calculated. Baseline CTA collaterals were scored using an established scoring scale1 and dichotomized to poor or good. The association of perfusion parameters and status of collaterals was assessed by repeated measure of analyses and receiver operating characteristic (ROC). Results: In 28 patients included, 16 had good collaterals on CTA. After controlling for age, sex, baseline NIHSS and type of treatment, multivariate logistic regression analysis identified rCBV (p<0.001) and ATD 2-6sec (p=0.003), but not rCBF, Vol-ATD > 2sec or Vol-ATD >6sec , as independent predictors of good collaterals. ROC analysis showed AUC of 0.88 (sensitivity/specificity: 75%/100%) for rCBV and AUC of 0.84 (sensitivity/specificity: 93%/67%) for Vol-ATD 2-6sec . We defined a perfusion collateral index (PCI) calculated from Vol-ATD 2-6sec x its rCBV, that remained an independent predictor of good collaterals with improved diagnostic accuracy over each measure alone resulting in nominal AUC of 1 (sensitivity/specificity: 100%/100%). Conclusions: Multiparametric CT perfusion can be used to assess the status of collaterals in patients with AIS. Perfusion collateral index (PCI) defined as Vol-ATD 2-6sec x rCBV is a new perfusion index with a nominal diagnostic accuracy of 100% compared to baseline CTA to predict status of collaterals in our small cohort. Our results need to be validated in a larger prospective cohort.

scholarly journals MR Perfusion to Determine the Status of Collaterals in Patients with Acute Ischemic Stroke: A Look Beyond Time Maps

2017 ◽  
Vol 39 (2) ◽  
pp. 219-225 ◽  
Author(s):  
K. Nael ◽  
A. Doshi ◽  
R. De Leacy ◽  
J. Puig ◽  
M. Castellanos ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mr Perfusion ◽  
The Status

scholarly journals The impact of native leptomeningeal collateralization on rapid blood flow recruitment following ischemic stroke

2020 ◽  
Vol 40 (11) ◽  
pp. 2165-2178
Author(s):  
Atsushi Kanoke ◽  
Yosuke Akamatsu ◽  
Yasuo Nishijima ◽  
Eric To ◽  
Chih C Lee ◽  
...  
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Independent Predictor ◽  
Mouse Strains ◽  
Collateral Flow ◽  
Stroke Outcome ◽  
Slight Improvement ◽  
Cortical Stroke ◽  
The Impact ◽  
Cortical Perfusion

The leptomeningeal collateral status is an independent predictor of stroke outcome. By means of optical coherent tomography angiography to compare two mouse strains with different extent of native leptomeningeal collateralization, we determined the spatiotemporal dynamics of collateral flow and downstream hemodynamics following ischemic stroke. A robust recruitment of leptomeningeal collateral flow was detected immediately after middle cerebral artery (MCA) occlusion in C57BL/6 mice, with continued expansion over the course of seven days. In contrast, little collateral recruitment was seen in Balb/C mice during- and one day after MCAO, which coincided with a greater infarct size and worse functional outcome compared to C57BL/6, despite a slight improvement of cortical perfusion seven days after MCAO. Both strains of mice experienced a reduction of blood flow in the penetrating arterioles (PA) by more than 90% 30-min after dMCAO, although the decrease of PA flow was greater and the recovery was less in the Balb/C mice. Further, Balb/C mice also displayed a prolonged greater heterogeneity of capillary transit time after dMCAO in the MCA territory compared to C57BL/6 mice. Our data suggest that the extent of native leptomeningeal collaterals affects downstream hemodynamics with a long lasting impact in the microvascular bed after cortical stroke.

Clausal Density Between Ages 4 and 9 Years for the Edmonton Narrative Norms Instrument: Reference Data and Psychometric Properties

2020 ◽  
pp. 1-15
Author(s):  
Ling-Yu Guo ◽  
Phyllis Schneider ◽  
William Harrison
Keyword(s):  
Diagnostic Accuracy ◽  
Psychometric Properties ◽  
Language Impairment ◽  
Reference Data ◽  
Reliability And Validity ◽  
Correlation Coefficients ◽  
Criterion Validity ◽  
Likelihood Ratios ◽  
Generation Task ◽  
Sensitivity Specificity

Purpose This study provided reference data and examined psychometric properties for clausal density (CD; i.e., number of clauses per utterance) in children between ages 4 and 9 years from the database of the Edmonton Narrative Norms Instrument (ENNI). Method Participants in the ENNI database included 300 children with typical language (TL) and 77 children with language impairment (LI) between the ages of 4;0 (years;months) and 9;11. Narrative samples were collected using a story generation task, in which children were asked to tell stories based on six picture sequences. CD was computed from the narrative samples. The split-half reliability, concurrent criterion validity, and diagnostic accuracy were evaluated for CD by age. Results CD scores increased significantly between ages 4 and 9 years in children with TL and those with LI. Children with TL produced higher CD scores than those with LI at each age level. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of CD scores were all significant at each age level, with the magnitude ranging from small to large. The diagnostic accuracy of CD scores, as revealed by sensitivity, specificity, and likelihood ratios, was poor. Conclusions The finding on diagnostic accuracy did not support the use of CD for identifying children with LI between ages 4 and 9 years. However, given the attested reliability and validity for CD, reference data of CD from the ENNI database can be used for evaluating children's difficulties with complex syntax and monitoring their change over time. Supplemental Material https://doi.org/10.23641/asha.13172129

Aortic arch calcification is strongly associated with coronary artery calcification

VASA ◽  
2015 ◽  
Vol 44 (2) ◽  
pp. 106-114 ◽  
Author(s):  
Adem Adar ◽  
Hakan Erkan ◽  
Tayyar Gokdeniz ◽  
Aysegul Karadeniz ◽  
Ismail G. Cavusoglu ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Aortic Arch ◽  
Chest Radiography ◽  
Coronary Artery Calcification ◽  
Independent Predictor ◽  
Study Group ◽  
Discriminative Performance ◽  
Sensitivity Specificity ◽  
Aortic Arch Calcification

Background: We aimed to investigate the association between aortic arch and coronary artery calcification (CAC). We postulated that low‐ and high‐risk CAC scores could be predicted with the evaluation of standard chest radiography for aortic arch calcification (AAC). Patients and methods: Consecutive patients who were referred for a multidetector computerized tomography (MDCT) examination were enrolled prospectively. All patients were scanned using a commercially available 64‐slice MDCT scanner for the evaluation of CAC score. A four‐point grading scale (0, 1, 2 and 3) was used to evaluate AAC on the standard posterior‐anterior chest radiography images. Results: The study group consisted of 248 patients. Median age of the study group was 52 (IQR: 10) years, and 165 (67 %) were male. AAC grades (r = 0.676, p < 0.0001) and age (r = 0.518, p < 0.0001) were significantly and positively correlated with CAC score. Presence of AAC was independently associated with the presence of CAC (OR: 11.20, 95 % CI 4.25 to 29.52). An AAC grade of ≥ 2 was the strongest independent predictor of a high‐risk CAC score (OR: 27.42, 95 % CI 6.09 to 123.52). Receiver operating characteristics curve analysis yielded a strong predictive ability of AAC grades for a CAC score of ≥ 100 (AUC = 0.892, P < 0.0001), and ≥ 400 (AUC = 0.894, P < 0.0001). Absence of AAC had a sensitivity, specificity and accuracy of 90 %, 84 % and 89 %, respectively, for a CAC score of < 100. An AAC grade of ≥ 2 predicted a CAC score of ≥400 with a sensitivity, specificity and accuracy of 68 %, 98 % and 95 %, respectively. Conclusions: AAC is a strong and independent predictor of CAC. The discriminative performance of AAC is high in detecting patients with low‐ and high‐risk CAC scores.

Noninvasive Evaluation of Coronary Artery Bypass Grafts with 16-Slice Multidetector Computed Tomography

2012 ◽  
Vol 15 (1) ◽  
pp. 12 ◽  
Author(s):  
Levent Sahiner ◽  
Ali Oto ◽  
Kudret Aytemir ◽  
Tuncay Hazirolan ◽  
Musturay Karcaaltincaba ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Multidetector Computed Tomography ◽  
Coronary Artery Bypass ◽  
Predictive Value ◽  
Artery Bypass ◽  
Time Interval ◽  
Mdct Angiography ◽  
Sensitivity Specificity

<p><b>Background:</b> The aim of this study was to investigate the diagnostic accuracy of 16-slice multislice, multidetector computed tomography (MDCT) angiography for the evaluation of grafts in patients with coronary artery bypass grafting (CABG).</p><p><b>Methods:</b> Fifty-eight consecutive patients with CABG who underwent both MDCT and conventional invasive coronary angiography were included. The median time interval between the 2 procedures was 10 days (range, 1-32 days). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MDCT for the detection of occluded grafts were calculated. The accuracy of MDCT angiography for detecting significant stenoses in patent grafts and the evaluability of proximal and distal anastomoses were also investigated.</p><p><b>Results:</b> Optimal diagnostic images could not be obtained for only 3 (2%) of 153 grafts. Evaluation of the remaining 150 grafts revealed values for sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the MDCT angiography procedure for the diagnosis of occluded grafts of 87%, 97%, 94%, 93%, and 92%, respectively. All of the proximal anastomoses were optimally visualized. In 4 (8%) of 50 patent arterial grafts, however, the distal anastomotic region could not be evaluated because of motion and surgical-clip artifacts. The accuracy of MDCT angiography for the detection of significant stenotic lesions was relatively low (the sensitivity, specificity, PPV, and NPV were 67%, 98%, 50%, and 99%, respectively). The number of significant lesions was insufficient to reach a reliable conclusion, however.</p><p><b>Conclusion:</b> Our study showed that MDCT angiography with 16-slice systems has acceptable diagnostic performance for the evaluation of coronary artery bypass graft patency.</p>

The role of serum periostin in the diagnosis of asthma: A meta-analysis

2020 ◽  
Vol 41 (4) ◽  
pp. 240-247
Author(s):  
Lei Yang ◽  
Qingtao Zhao ◽  
Shuyu Wang
Keyword(s):  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
False Negative ◽  
Summary Receiver Operating Characteristic ◽  
True Negative ◽  
Negative Results ◽  
Noninvasive Biomarker ◽  
Sensitivity Specificity ◽  
Serum Periostin

Background: Serum periostin has been proposed as a noninvasive biomarker for asthma diagnosis and management. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. Methods: This meta-analysis aimed to evaluate the diagnostic accuracy of periostin level in the clinical determination of asthma. Several medical literature data bases were searched for relevant studies through December 1, 2019. The numbers of patients with true-positive, false-positive, false-negative, and true-negative results for the periostin level were extracted from each individual study. We assessed the risk of bias by using Quality Assessment of Diagnostic Accuracy Studies 2. We used the meta-analysis to produce summary estimates of accuracy. Results: In total, nine studies with 1757 subjects met the inclusion criteria. The pooled estimates of sensitivity, specificity, and diagnostic odds ratios for the detection of asthma were 0.58 (95% confidence interval [CI], 0.38‐0.76), 0.86 (95% CI, 0.74‐0.93), and 8.28 (95% CI, 3.67‐18.68), respectively. The area under the summary receiver operating characteristic curve was 0.82 (95% CI, 0.79‐0.85). And significant publication bias was found in this meta‐analysis (p = 0.39). Conclusion: Serum periostin may be used for the diagnosis of asthma, with moderate diagnostic accuracy.

VALUE OF ST-SEGMENT ELEVATION IN LEAD AVR IN PREDICTING LEFT MAIN AND OR 3-VESSEL DISEASE IN PATIENTS WITH ACUTE CORONARY SYNDROMES

2017 ◽  
pp. 59-63
Author(s):  
Thanh Hung Dieu ◽  
Anh Vu Nguyen
Keyword(s):  
Predictive Value ◽  
Acute Coronary Syndromes ◽  
Independent Predictor ◽  
Left Main ◽  
St Segment Elevation ◽  
Vessel Disease ◽  
St Segment ◽  
Coronary Syndromes ◽  
Lead Avr ◽  
Sensitivity Specificity

Objects: We assessed the ability of ST-segment elevation in lead aVR to predict left main and/or 3-vessel disease (LM/3VD) in patients with acute coronary syndromes (ACS). Meterial and Method: 410 patients with ACS, who underwent coronary angiography, were evaluated. Results: 131 (31.9%) patients have been LM/3VD. ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD with sensitivity, specificity, positive predictive value PPV) and negative predictive value (NPV) 74.0%, 78.1%, 61.4% and 86.5%, respectively (p<0.001). ST segment elevation > 0.05 mV in leads aVR with ST segment depression in leads V4-V6 have related LM/3VD with sensitivity, specificity, PPV and NPV 44.3%, 92.8%, 74.4% and 75.2%, respectively (p<0.001). ST segment elevation > 0.1 mV in leads aVR have related LM/3VD with sensitivity, specificity, PPV and NPV 51.9%, 87.1%, 65.1% and 79.4%, respectively (p<0.001). Conclusions: ST segment elevation > 0.05 mV in leads aVR have been an independent predictor LM/3VD in patients with ACS. Key words: Acute coronary syndromes, ST-segment elevation, aVR

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