scholarly journals Prediction of Malignant Middle Cerebral Artery Infarction Using Computed Tomography-Based Intracranial Volume Reserve Measurements

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3403-3409 ◽  
Author(s):  
Jens Minnerup ◽  
Heike Wersching ◽  
E. Bernd Ringelstein ◽  
Walter Heindel ◽  
Thomas Niederstadt ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Predictive Value ◽  
Perfusion Ct ◽  
Lesion Volume ◽  
Intracranial Volume ◽  
Ischemic Lesion ◽  
Predictive Values ◽  
Malignant Infarction ◽  
Malignant Mca Infarction

Background and Purpose— Early decompressive surgery in patients with malignant middle cerebral artery (MCA) infarction improves outcome. Elevation of intracranial pressure depends on both the space occupying brain edema and the intracranial volume reserve (cerebrospinal fluid [CSF]). However, CSF volume was not investigated as a predictor of malignant infarction so far. We hypothesize that assessment of CSF volume in addition to admission infarct size improves early prediction of malignant MCA infarction. Methods— Stroke patients with carotid-T or MCA main stem occlusion and ischemic lesion (reduced cerebral blood volume [CBV]) on perfusion CT were considered for the analysis. The end point malignant MCA infarction was defined by clinical signs of herniation. Volumes of CSF and CBV lesion were determined on admission. Receiver-operator characteristics analysis was used to calculate predictive values for radiological and clinical measurements. Results— Of 52 patients included, 26 (50%) developed malignant MCA infarction. Age, a decreased level of consciousness on admission, CBV lesion volume, CSF volume, and the ratio of CBV lesion volume to CSF volume were significantly different between malignant and nonmalignant groups. The best predictor of a malignant course was the ratio of CBV lesion volume to CSF volume with a cut-off value of 0.92 (96.2% sensitivity, 96.2% specificity, 96.2% positive predictive value, and 96.2% negative predictive value). Conclusions— Based on admission native CT and perfusion CT measurements, the ratio of ischemic lesion volume to CSF volume predicts the development of malignant MCA infarction with higher accuracy than other known predictors, including ischemic lesion volume or clinical characteristics.

Relationship between Ischemic Lesion Volume and Functional Status in the 2nd Week after Middle Cerebral Artery Stroke

2005 ◽  
Vol 19 (2) ◽  
pp. 133-138 ◽  
Author(s):  
S. K. Schiemanck ◽  
M. W.M. Post ◽  
Th. D. Witkamp ◽  
L. J. Kappelle ◽  
A. J.H. Prevo
Keyword(s):  
Middle Cerebral Artery ◽  
Functional Status ◽  
Cerebral Artery ◽  
Right Hemisphere ◽  
Small Lesion ◽  
Lesion Volume ◽  
Modified Rankin Scale ◽  
Ischemic Lesion ◽  
Middle Cerebral Artery Stroke ◽  
The Relationship

Objective. To examine the relationship between the volume of the middle cerebral artery stroke lesion and functional status in the subacute phase of stroke. Methods. Infarctvolumes of 94 patients with a 1st middle cerebral artery stroke assessed on conventional MRI scans obtained in the 2nd week poststroke were related to a clinical measure of stroke severity (National Institutes of Health Stroke Scale [NIHSS]) and to functional status: motor impairment (Motricity Index [MI]) and limitation in activities (Barthel Index [BI] and modified Rankin Scale). Separate correlations were computed for patients with large (>30 ml) and small (30 ml) lesions, and to investigate the influence of lesion location on the relationship between volume and functional status, correlations were computed for patients with left and right hemisphere lesions and for patients with cortical and subcortical lesions. Results. Lesion volume correlated strongly with NIHSS scores (R = 0.61) and moderately with the patient’s functional status (MI [R between -0.42 and - 0.49], BI [R = -0.43], and Modified Rankin Scale [R = 0.45]). Right hemisphere lesions and cortical lesions had a stronger correlation with functional status. In patients with small lesion volumes (0-30 ml), no relationship between lesion volumes and functional status was seen at all. Conclusions. Lesion volume is moderately to strongly related to the functional status in the 2nd week poststroke.

scholarly journals Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

2010 ◽  
Vol 30 (10) ◽  
pp. 1712-1720 ◽  
Author(s):  
Max Nedelmann ◽  
Nouha Ritschel ◽  
Simone Doenges ◽  
Alexander C Langheinrich ◽  
Till Acker ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Outcome Evaluation ◽  
Tissue Type ◽  
Lesion Volume ◽  
Contrast Enhanced Ultrasound ◽  
Edema Formation ◽  
Ischemic Lesion ◽  
Beneficial Effects ◽  
Contrast Enhanced

In monitoring of recanalization and in sonothrombolysis, contrast-enhanced ultrasound (CEUS) is applied in extended time protocols. As extended use may increase the probability of unwanted effects, careful safety evaluation is required. We investigated the safety profile and beneficial effects of CEUS in a reperfusion model. Wistar rats were subjected to filament occlusion of the right middle cerebral artery (MCA). Reperfusion was established after 90 minutes, followed by recombinant tissue-type plasminogen activator (rt-PA) treatment and randomization to additional CEUS (contrast agent: SonoVue; 60 minutes). Blinded outcome evaluation consisted of magnetic resonance imaging (MRI), neurologic assessment, and histology and, in separate experiments, quantitative 3D nano-computed tomography (CT) angiography (900 nm3 voxel size). Nano-CT revealed severely compromised microcirculation in untreated animals after MCA reperfusion. The rt-PA partially improved hemispheric perfusion. Impairment was completely reversed in animals receiving rt-PA and CEUS. This combination was more effective than treatment with either CEUS without rt-PA or rt-PA and ultrasound or ultrasound alone. In MRI experiments, CEUS and rt-PA treatment resulted in a significantly reduced ischemic lesion volume and edema formation. No unwanted effects were detected on MRI, histology, and intracranial temperature assessment. This study shows that CEUS and rt-PA is safe in the situation of reperfusion and displays beneficial effects on the level of the microvasculature.

Abstract W P47: Developing an Acute Lesion Atlas from Patients with Middle Cerebral Artery Stroke

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Abhijith Annasamudram ◽  
David Esterquest ◽  
Bianca Maria Marin ◽  
Melissa McSweeney ◽  
Kelly Brandstatt ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Ischemic Lesion ◽  
Technical Problems ◽  
Acute Lesion ◽  
Acute Infarct

Background and purpose: Chronic lesion locations are associated with neurologic outcomes. However, voxel-based acute infarct maps have not been used to predict long-term deficits and outcomes. The combination of ischemic lesion volume and location may aid in acute outcome prediction models. We evaluated the feasibility of voxel-based lesion mapping in acute ischemic stroke patients. Methods: In a retrospective study of patients with suspected middle cerebral artery (MCA) territory strokes, we identified acute infarcts on the diffusion-weight imaging (DWI; b=1000) sequences and confirmed them on the apparent diffusion coefficient (ADC) sequences using a semi-qualitative approach. Only patients with all three sequences available were included in the study. We then manually created a lesion map for each patient. Lesions were overlaid on T1-weighted images and transformed to standardized stereotactic space. We overlaid the volumetric lesion masks from all patients to create a composite acute lesion atlas. Results: Among 164 patients, 5 (3.1%) patients had no clear acute lesion and 9 (5.5%) had technical problems with normalization or overlaying, leaving 150 (91.5%) patients for analysis (mean age 66.1 years; 52.0% male; 66.7% white; median NIHSS scale 4). A composite acute lesion atlas was developed (Figure) with regions of high overlap easily visible, suggesting high statistical power for acute lesion-outcome prediction modeling. Conclusion: Acute ischemic lesions can be reliably mapped and used to create aggregated infarct atlases. The considerable overlapping regions in stroke patients might provide sufficient power to detect highly correlated lesion-outcome relationships. The proposed technique may provide a time-sensitive method for identifying acute infarct location, predicting the course of recovery, and selecting patients for early interventions.

scholarly journals The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

2021 ◽  
Author(s):  
Kilian Fröhlich ◽  
Gabriela Siedler ◽  
Svenja Stoll ◽  
Kosmas Macha ◽  
Thomas M. Kinfe ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Posterior Circulation ◽  
Neurological Deficits ◽  
Stroke Severity ◽  
Lesion Volume ◽  
Middle Cerebral Artery Territory ◽  
Cerebral Lesion

Abstract Purpose Endovascular therapy (EVT) of large-vessel occlusion in acute ischemic stroke (AIS) may be performed in general anesthesia (GA) or conscious sedation (CS). We intended to determine the contribution of ischemic cerebral lesion sites on the physician’s decision between GA and CS using voxel-based lesion symptom mapping (VLSM). Methods In a prospective local database, we sought patients with documented AIS and EVT. Age, stroke severity, lesion volume, vigilance, and aphasia scores were compared between EVT patients with GA and CS. The ischemic lesions were analyzed on CT or MRI scans and transformed into stereotaxic space. We determined the lesion overlap and assessed whether GA or CS is associated with specific cerebral lesion sites using the voxel-wise Liebermeister test. Results One hundred seventy-nine patients with AIS and EVT were included in the analysis. The VLSM analysis yielded associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas. Stroke severity and lesion volume were significantly higher in the GA group. The prevalence of aphasia and aphasia severity was significantly higher and parameters of vigilance lower in the GA group. Conclusions The VLSM analysis showed associations between GA and ischemic lesions in the left hemispheric middle cerebral artery territory and posterior circulation areas including the thalamus that are known to cause neurologic deficits, such as aphasia or compromised vigilance, in AIS-patients with EVT. Our data suggest that higher disability, clinical impairment due to neurological deficits like aphasia, or reduced alertness of affected patients may influence the physician’s decision on using GA in EVT.

scholarly journals MRI Mouse Brain Data of Ischemic Lesion after Transient Middle Cerebral Artery Occlusion

2017 ◽  
Vol 11 ◽  
Author(s):  
Inge A. Mulder ◽  
Artem Khmelinskii ◽  
Oleh Dzyubachyk ◽  
Sebastiaan de Jong ◽  
Marieke J. H. Wermer ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Mouse Brain ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Ischemic Lesion ◽  
Brain Data ◽  
Cerebral Artery Occlusion

Association of Infarct Volume Before Hemicraniectomy and Outcome After Malignant Infarction

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011987
Author(s):  
Dominik Lehrieder ◽  
Katharina Layer ◽  
Hans-Peter Müller ◽  
Viktoria Rücker ◽  
Jan Kassubek ◽  
...  
Keyword(s):  
Infarct Size ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Randomized Trials ◽  
Infarct Volume ◽  
Unfavorable Outcome ◽  
Inclusion Criteria ◽  
Younger Patients ◽  
Malignant Infarction ◽  
The Impact

ObjectiveTo determine the impact of infarct volume before hemicraniectomy in malignant middle cerebral artery infarction (MMI) as an independent predictor for patient selection and outcome prediction, we retrospectively analyzed data of 140 patients from a prospective multi-center study.MethodsPatients from the DESTINY-Registry that underwent hemicraniectomy after ischemic infarction of >50% of the middle cerebral artery territory were included. Functional outcome according to the modified Rankin Scale (mRS) was assessed at 12 months. Unfavorable outcome was defined as mRS 4-6. Infarct size was quantified semi-automatically from computed tomography or magnetic resonance imaging before hemicraniectomy. Subgroup analyses in patients fulfilling inclusion criteria of randomized trials in younger patients (age≤60y) were predefined.ResultsAmong 140 patients with complete datasets (34% female, mean (SD) age 54 (11) years), 105 (75%) had an unfavorable outcome (mRS > 3). Mean (SD) infarct volume was 238 (63) ml. Multivariable logistic regression identified age (OR 1.08 per 1 year increase; 95%-CI 1.02-1.13; p=0.004), infarct size (OR 1.27 per 10ml increase; 95%-CI 1.12-1.44; p<0.001) and NIHSS (OR 1.10; 95%-CI 1.01-1.20; p=0.030) before hemicraniectomy as independent predictors for unfavorable outcome. Findings were reproduced in patients fulfilling inclusion criteria of randomized trials in younger patients. Infarct volume thresholds for prediction of unfavorable outcome with high specificity (94% in overall cohort and 92% in younger patients) were more than 258 ml before hemicraniectomy.ConclusionOutcome in MMI strongly depends on age and infarct size before hemicraniectomy. Standardized volumetry may be helpful in the process of decision making concerning hemicraniectomy.

scholarly journals Prediction of secondary ischemic lesions with diffusion-weighted imaging after transient middle cerebral artery occlusion in rats

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 352-352
Author(s):  
Fuhai Li ◽  
Matthew D Silva ◽  
Xiangjun Meng ◽  
Christopher H Sotak ◽  
Marc Fisher
Keyword(s):  
Middle Cerebral Artery ◽  
Middle Cerebral Artery Occlusion ◽  
Cerebral Artery ◽  
Diffusion Weighted Imaging ◽  
Artery Occlusion ◽  
Lesion Volume ◽  
Diffusion Weighted ◽  
Adc Values ◽  
Cerebral Artery Occlusion ◽  
Initial Lesions

P75 Background and Purpose: Previous studies demonstrated that secondary ischemic lesions documented by diffusion-weighted imaging might be smaller than, larger than or similar to initial lesions that occur during ischemia. The purpose of this study was to investigate if the size of secondary lesions can be predicted. Methods: Twelve rats underwent 30 minutes of transient middle cerebral artery occlusion with the intraluminal suture method. Diffusion- and perfusion-weighted images were performed just before reperfusion, 90 minutes and 24 hours after reperfusion. The ischemic lesion size was calculated by tracing visual abnormalities on the apparent diffusion coefficient (ADC) maps. Cerebral blood flow index (CBF i ) ratio was calculated by dividing the ipsilateral CBF i by the contralateral CBF i . Based on difference between initial and secondary lesion volume, rats were assigned to reperfusion-benefit group (n=6) where secondary lesions were smaller than initial lesions (less than 85% of initial lesions) and reperfusion-nonbenefit group (n=6) where secondary lesions were similar to or larger than initial lesions (more than 85% of initial lesions). Results: At 90 minutes after reperfusion, the initial ischemic lesions almost disappeared in both groups. At 24 hours, secondary lesions were 54±11% (mean±SD) of the initial lesions in the reperfusion-benefit group and 100±14% of the initial lesions in the reperfusion-nonbenefit group (p<0.001). There was no difference in ADC values (47±2×10 -5 mm 2 /s vs 46±5×10 -5 mm 2 /s, p=0.7) and CBF i ratio (0.62±0.06 vs 0.67±0.04, p=0.2) between the two groups before reperfusion. However, the initial lesion volume was significantly smaller in the reperfusion-benefit group than in the reperfusion-nonbenefit group (125±54 mm 3 vs 195±36 mm 3 , p=0.037). Conclusions: Changes of ADC values and CBF before reperfusion are unable to predict if initial ischemic lesions will eventually shrink or not after reperfusion. Smaller size of initial lesions may suggest that secondary lesions will be smaller than initial lesions.

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