Abstract P337: RAPID-LVO for Automated Detection of Intracranial Large Vessel Occlusion in Ct Angiography of the Brain

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Seena Dehkharghani ◽  
Maarten G Lansberg ◽  
Chitra Venkatsubramanian ◽  
carlo W cereda ◽  
Fabricio O Lima ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Sensitivity And Specificity ◽  
Large Vessel ◽  
Receiver Operating Characteristics ◽  
Subspecialty Training ◽  
Emergency Setting ◽  
Large Vessel Occlusion ◽  
Operating Characteristics ◽  
Vessel Occlusion ◽  
Receiver Operating

Background: Identification of large vessel occlusion (LVO) is paramount in the urgent evaluation of acute ischemic stroke (AIS). Emergent interpretation of large and high-complexity data sets, however, may impose strains upon imaging and clinical workflows, motivating development of fast and accurate computer-aided approaches to facilitate LVO detection in the emergency setting. This study investigates the performance of a fully automated LVO detection platform in a mixed cohort of stroke subjects with and without LVO on head and neck CT angiography (CTA). Methods: CTA from two cerebrovascular trials were enriched with cases from eleven global sites. Imaging and clinical variables were balanced between populations including in LVO positivity and across demographic and imaging environments to the extent achievable. Independent and fully blinded review for intracranial ICA or MCA M1 LVO was performed by two subspecialty neuroradiologists. A novel, user-independent imaging analysis application ( RAPID-LVO , iSchemaview inc) was used to predict LVO presence, location, and overall performance relative to reader consensus. Any discordance between readers was adjudicated by a blinded tertiary reader with subspecialty training. Sensitivity, specificity, and receiver-operating characteristics were determined by an independent statistician. Performance thresholds were set a priori, including a lower bound of the 95% CI of sensitivity and specificity of ≥0.8 at mean times-to-notification <3.5 minutes. Results: 217 CTA (median age 65.5, 53% male, 109 LVO(+)) were included. Lower confidence limits of sensitivity and specificity exceeded 90% (sensitivity 0.963, 95% CI 0.909-0.986; specificity 0.981, 95% CI 0.935-0.995), surpassing pre-specified performance benchmarks. Subgroup analyses revealed no decrement in performance relative to subject age or sex, vendor systems, or location of the examination within or outside the United States. The area under the receiver operating characteristics curve was 0.99 (95% CI: 0.971-0.999) and average time-to-notification was 3.18 minutes. Conclusion: RAPID-LVO offers fast, highly accurate, and fully user-independent large vessel occlusion detection across all tested clinical and imaging environments.

scholarly journals Early detection of large‐vessel occlusion stroke after cardiac surgery using CT angiography leading to early recanalization with endovascular thrombectomy

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Kiyoshi Takemoto ◽  
Masaaki Sakuraya ◽  
Michitaka Nakamura ◽  
Hidetsugu Maekawa ◽  
Kazuo Yamanaka ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Early Detection ◽  
Ct Angiography ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Sensitivity and specificity of Sirius indices in diagnosis of keratoconus and suspect keratoconus

2021 ◽  
pp. 112067212110601
Author(s):  
Abdelrahman Salman ◽  
Taym Darwish ◽  
Ali Ali ◽  
Marwan Ghabra ◽  
Rafea Shaaban
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Accuracy ◽  
Corneal Thickness ◽  
Case Series ◽  
Area Under The Curve ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Symmetry Index ◽  
Case Series Study ◽  
Receiver Operating

Aim To estimate the sensitivity and specificity of topographic and tomographic corneal parameters as determined by Sirius (CSO, Florence, Italy) in discriminating keratoconus (KC) and suspect keratoconus from normal cornea. Method In this retrospective case-series study, keratoconus screening indices were measured using Sirius tomographer. Receiver operating characteristics (ROC) curves were used to determine the test's overall predictive accuracy (area under the curve) and to identify optimal cut-off points to maximize sensitivity and specificity in differentiating keratoconus and suspect keratoconus from normal corneas. Results Receiver operating characteristics (ROC) curve analyses showed high predictive accuracy for Symmetry Index back (SIb), Keratoconus Vertex front (KVf), Symmetry Index front (SIf), Keratoconus Vertex back (KVb), Apex Keratometry (Curve-Apex) and Minimum corneal Thickness (ThkMin) to distinguish keratoconus from normal (area under the curve > 0.9, all). Symmetry Index back was identified as the best diagnostic parameter for detecting suspect keratoconus with AUC of 0.86. Highest specificity to detect keratoconus and suspect keratoconus was seen for SIb, 99.87% and 84.66%, respectively. These values were associated with optimal cut-off points of 0.46 D for keratoconus and 0.12 D for suspect keratoconus. Conclusion Sirius parameters evaluated in the study were effective to differentiate keratoconus from normal corneas. However, Symmetry Index back was the index with the highest ability to detect suspect keratoconus.

scholarly journals qTICI: Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients

2020 ◽  
pp. 174749302090963
Author(s):  
Haryadi Prasetya ◽  
Lucas A Ramos ◽  
Thabiso Epema ◽  
Kilian M Treurniet ◽  
Bart J Emmer ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Digital Subtraction Angiography ◽  
Quantitative Measure ◽  
Receiver Operating Characteristics ◽  
Binary Logistic Regression Analysis ◽  
Digital Subtraction ◽  
Operating Characteristics ◽  
Vessel Occlusion ◽  
Receiver Operating Characteristics Curve ◽  
Receiver Operating

Background The Thrombolysis in Cerebral Infarction (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer-dependent, which may result in suboptimal prediction of patient outcome and inconsistent reperfusion grading. Aims We present a semi-automated quantitative reperfusion measure (quantified TICI (qTICI)) using image processing techniques based on the TICI methodology. Methods We included patients with an intracranial proximal large vessel occlusion with complete, good quality runs of anteroposterior and lateral digital subtraction angiography from the MR CLEAN Registry. For each vessel occlusion, we identified the target downstream territory and automatically segmented the reperfused area in the target downstream territory on final digital subtraction angiography. qTICI was defined as the percentage of reperfused area in target downstream territory. The value of qTICI and extended TICI (eTICI) in predicting favorable functional outcome (modified Rankin Scale 0–2) was compared using area under receiver operating characteristics curve and binary logistic regression analysis unadjusted and adjusted for known prognostic factors. Results In total, 408 patients with M1 or internal carotid artery occlusion were included. The median qTICI was 78 (interquartile range 58–88) and 215 patients (53%) had an eTICI of 2C or higher. qTICI was comparable to eTICI in predicting favorable outcome with area under receiver operating characteristics curve of 0.63 vs. 0.62 (P = 0.8) and 0.87 vs. 0.86 (P = 0.87), for the unadjusted and adjusted analysis, respectively. In the adjusted regression analyses, both qTICI and eTICI were independently associated with functional outcome. Conclusion qTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score.

A quantitative analysis of CT angiography, large vessel occlusion, and thrombectomy rates in acute ischaemic stroke

2019 ◽  
Vol 74 (9) ◽  
pp. 731.e21-731.e25 ◽  
Author(s):  
E. Griffin ◽  
D. Herlihy ◽  
R. Hayden ◽  
M. Murphy ◽  
J. Walsh ◽  
...  
Keyword(s):  
Quantitative Analysis ◽  
Ischaemic Stroke ◽  
Ct Angiography ◽  
Acute Ischaemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Abstract WP178: “CTA for All”: Emergency CT Angiography for All Stroke Patients Presenting Within 24 Hours of Onset Improves Outcome After Large Vessel Occlusion

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Stephan Mayer ◽  
Tanuwong Viarasilpa ◽  
Nicha Panyavachiraporn ◽  
Brent Griffith ◽  
Daniel Miller ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion

Revisiting the NIH Stroke Scale as a screening tool for proximal vessel occlusion: can advanced imaging be targeted in acute stroke?

2016 ◽  
Vol 8 (12) ◽  
pp. 1208-1210 ◽  
Author(s):  
Ryan D Moore ◽  
John C Jackson ◽  
Sheila L Venkatesh ◽  
Steven D Quarfordt ◽  
Blaise W Baxter
Keyword(s):  
Ct Angiography ◽  
Vascular Occlusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Advanced Imaging ◽  
Vessel Occlusion ◽  
Historical Cohort ◽  
Clinical Scoring ◽  
Contrast Ct ◽  
Proximal Occlusion

Background and purposeMost patients with stroke-like symptoms screened by advanced imaging for proximal occlusion will not have a thrombus accessible by neurointerventional techniques. Development of a sensitive clinical scoring system for rapidly identifying patients with an emergent large vessel occlusion could help target limited resources and reduce exposure to unnecessary imaging.MethodsThis historical cohort study included patients who underwent non-contrast CT and CT angiography in the emergency department for stroke-like symptoms. NIH Stroke Scale (NIHSS) criteria were extended to include resolved symptoms and dichotomized as present or absent. Combinations of NIHSS criteria were considered as tests for proximal occlusion.ResultsProximal cerebral vascular occlusion was present in 19.2% (100/522) of the population and, of these, 13% (13/100) had an NIHSS score of 0. The presence on examination or history of diminished consciousness with inability to answer questions, leg weakness, dysarthria, or gaze deviation had 96% sensitivity and 39% specificity for proximal occlusion. If implemented in this population, the use of CT angiography would have been decreased by 32.4% (169/522 patients) while missing 0.76% with proximal occlusions (4/522). Half of those missed (2/4) would have been identified as large vessel infarcts on non-contrast CT, while the remainder (2/4) were transient ischemic attacks associated with carotid stenosis.ConclusionsIn this cohort, specific NIHSS criteria were highly sensitive for emergent large vessel occlusion and, if validated, may allow for clinical screening prior to advanced imaging with CT angiography.

Detection of emergent large vessel occlusion stroke with CT angiography is high across all levels of radiology training and grayscale viewing methods

2020 ◽  
Vol 30 (8) ◽  
pp. 4447-4453 ◽  
Author(s):  
Chelsea A. Boyd ◽  
Mahesh V. Jayaraman ◽  
Grayson L. Baird ◽  
William S. Einhorn ◽  
Matthew T. Stib ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
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