Diffusion-weighted imaging lesion growth occurs despite recanalization in acute ischemic stroke: Implications for future treatment trials

2018 ◽  
Vol 14 (3) ◽  
pp. 257-264 ◽  
Author(s):  
Rani G Sah ◽  
Christopher D d’Esterre ◽  
Michael D Hill ◽  
Moiz Hafeez ◽  
Sana Tariq ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Effect Size ◽  
Diffusion Weighted Imaging ◽  
Arterial Occlusion ◽  
National Institutes Of Health ◽  
Stroke Therapy ◽  
Diffusion Weighted ◽  
Lesion Growth

Background A proportion of patients presenting with acute small ischemic strokes have poor functional outcomes, even following rapid recanalization treatment. Aims Infarct growth may occur even after successful recanalization and could represent an appropriate endpoint for future stroke therapy trials. Methods Magnetic resonance diffusion-weighted imaging lesion volumes were obtained at 5 h (initial posttreatment) and 24 h (follow-up) after acute stroke treatment for n = 33 in ischemic stroke patients. Sample sizes per arm (90% power, 30% effect size) for diffusion-weighted imaging lesion growth between initial and 24 h, early change in the National Institutes of Health Stroke Scale between pre- and 24 h, National Institutes of Health Stroke Scale at 24 h, and diffusion-weighted imaging lesion volume at 24 h were estimated to power a placebo-controlled stroke therapy trial. Results For patients with poor recanalization (modified thrombolysis in cerebral infarction <2 a; modified arterial occlusion lesion = 0–2) (n = 11), the median diffusion-weighted imaging lesion growth was 8.1 (interquartile range: 4.5, 22.4) ml and with good recanalization (modified thrombolysis in cerebral infarction =2 b or 3; modified arterial occlusion lesion = 3) (n = 22), the median diffusion-weighted imaging lesion growth was 10.0 (interquartile range: 6.0, 28.2) ml ( P = 0.749). When considering a 30% effect size, the sample size required per arm to achieve significance in an acute stroke study would be: (1) N = 49 for the diffusion-weighted imaging lesion growth between initial posttreatment and follow-up time points, (2) N = 65 for the change in the National Institutes of Health Stroke Scale between admission and 24 h, (3) N = 259 for the National Institutes of Health Stroke Scale at 24 h, and (4) N = 256 for diffusion-weighted imaging volume at 24 h. Conclusion Despite best efforts to recanalize the ischemic brain, early diffusion-weighted imaging lesion growth still occurs. Treatment trials in stroke should consider early diffusion-weighted imaging lesion growth as a surrogate outcome measure to significantly reduce sample sizes.

Diffusion imaging of cerebral diaschisis in childhood arterial ischemic stroke

2016 ◽  
Vol 11 (9) ◽  
pp. 1028-1035 ◽  
Author(s):  
Adam Kirton ◽  
Elizabeth Williams ◽  
Michael Dowling ◽  
Sarah Mah ◽  
Jacquie Hodge ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Diffusion Weighted Imaging ◽  
Infarct Volume ◽  
Resonance Imaging ◽  
Arterial Ischemic Stroke ◽  
Diffusion Weighted ◽  
Motor Outcome

Background Diffusion-weighted imaging magnetic resonance imaging may detect changes in brain structures remote but connected to stroke consistent with neuropathological descriptions of diaschisis. Early diffusion-weighted imaging demonstrates restriction in corticospinal pathways after arterial ischemic stroke of all ages that correlates with motor outcome. Aim/hypothesis We hypothesized that cerebral diaschisis is measurable in childhood arterial ischemic stroke and explored associations with outcome. Methods This sub-study of the validation of the Pediatric NIH Stroke Scale study prospectively enrolled children with acute arterial ischemic stroke and both acute and early follow-up (5–14 days) diffusion-weighted imaging. Inclusion criteria were (1) unilateral middle cerebral artery arterial ischemic stroke, (2) acute and subacute diffusion-weighted imaging ( b = 1000), and (3) 12 month neurological follow-up (Pediatric Stroke Outcome Measure). A validated method using ImageJ software quantified diffusion-weighted imaging diaschisis in anatomically connected structures. Diaschisis measures were corrected for infarct volume, compared to age, imaging timing, and outcomes (Chi square/Fisher, Mann–Whitney test). Results Nineteen children (53% male, median 8.1 years) had magnetic resonance imaging at medians of 21 and 168 h post-stroke onset. Diaschisis was common and evolved over time, observed in one (5%) on acute but eight (42%) by follow-up diffusion-weighted imaging. Thalamic and callosal diaschisis were most common (5, 26%). Estimates of perilesional diaschisis varied (54 ± 18% of infarct volume). Children with diaschisis tended to be younger (7.02 ± 5.4 vs. 11.82 ± 4.3 years, p = 0.08). Total diaschisis score was associated with poor cognitive outcomes ( p = 0.03). Corticospinal tract diaschisis was associated with motor outcome ( p = 0.004). Method reliability was excellent. Conclusions Diffusion-weighted imaging diaschisis occurs in childhood arterial ischemic stroke. Mistaking diaschisis for new areas of infarction carries important clinical implications. Improved recognition and study are required to establish clinical relevance.

Diffusion-Weighted Imaging in Neonatal Cerebral Infarction: Clinical Utility and Follow-Up

2000 ◽  
Vol 15 (9) ◽  
pp. 592-602 ◽  
Author(s):  
Kalpathy S. Krishnamoorthy ◽  
Teesta B. Soman ◽  
Masanori Takeoka ◽  
Pamela W. Schaefer
Keyword(s):  
Cerebral Infarction ◽  
Diffusion Weighted Imaging ◽  
Clinical Utility ◽  
Diffusion Weighted

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Diffusion-weighted imaging for the follow-up of patients after matrix-associated autologous chondrocyte transplantation

2010 ◽  
Vol 73 (3) ◽  
pp. 622-628 ◽  
Author(s):  
Klaus M. Friedrich ◽  
Tallal C. Mamisch ◽  
Christina Plank ◽  
Georg Langs ◽  
Stefan Marlovits ◽  
...  
Keyword(s):  
Diffusion Weighted Imaging ◽  
Autologous Chondrocyte Transplantation ◽  
Chondrocyte Transplantation ◽  
Diffusion Weighted ◽  
Autologous Chondrocyte

Role of Diffusion Weighted Imaging in Differentiating Benign from Pathological Vertebral Compression

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Faten Mohammed Mahmoud Kamel ◽  
Hazem Ibrahim Abdel Rahman ◽  
Amany Sayed Khaleel Ahmed Elkhayat
Keyword(s):  
Vertebral Fractures ◽  
Diffusion Weighted Imaging ◽  
Laboratory Evaluation ◽  
Vertebral Collapse ◽  
Adc Value ◽  
Conventional Mri ◽  
Diffusion Weighted ◽  
Significant Difference

Abstract Background Vertebral collapse is a common problem due to benign conditions (trauma, infection, osteoporosis) or malignant process. And although the spine is the most common site of bone metastases (39% of bony metastases in patients with primary neoplasms) benign vertebral fractures due to osteopenia occur in one third of cancer patients, making it essential to determine whether the cause of vertebral collapse is benign or malignant. Aim of the Work To establish the role of DWI in differentiating benign from pathologic vertebral fractures using ADC values in comparison with histopathology report /laboratory evaluation and clinical follow-up. Patients and Methods A cross sectional study is approved by the ethics review board of Ain Shams University Hospital (Al Demerdash). All patients provided informed consent for the MR imaging examinations and for inclusion of their data in this analysis. From April 2020 to october 2020, 25 cases with previous imaging with vertebral compression underwent conventional MRI study on the affected region. Diffusion weighted imaging and ADC was added. Results We performed DWI using maximum b-values 600, and quantitative analysis, named apparent diffusion coefficient (ADC). We correlated the ADC number to histopathology, laboratory finding and clinical follow up. In our study there was significant difference (p &lt; 0.04) between DWI of the benign and malignant groups. Also the ADC value showed significant difference &lt;0.001. The mean ADCs of benign VCFs were higher significantly than those of pathological fractures. Conclusion DWI with ADC value was helpful when added to conventional MRI to differentiate benign from pathological (malignant) vertebral compression. It should be a routine sequence in patients with vertebral compression fractures for accurate diagnosis and successful management also can decrease no of biopsies.

scholarly journals Incidence of New Diffusion-Weighted Imaging Lesions Outside the Area of Initial Hypoperfusion Within 1 Week After Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 2654-2658 ◽  
Author(s):  
Tatiana Usnich ◽  
Fredrik N. Albach ◽  
Peter Brunecker ◽  
Jochen B. Fiebach ◽  
Christian H. Nolte
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted

The adjunctive value of diffusion weighted imaging in diagnosis and follow up of uterovaginal diffuse B-cell lymphoma: A case report and literature review.

2021 ◽  
Vol 17 ◽  
Author(s):  
Gehad A. Saleh ◽  
Reham Alghandour ◽  
Eman Y Rashad ◽  
Ahmed M Tawfik ◽  
Ali H. Elmokadem
Keyword(s):  
Case Report ◽  
B Cell ◽  
Diffusion Weighted Imaging ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Diagnostic Methods ◽  
Pelvic Mri ◽  
Diffusion Weighted ◽  
Large B Cell

Background: Lymphoma of the female gynecologic tract is extremely rare. Typically, lymphoma is managed non surgically unlike other non-lymphomatous malignant tumors raising the importance to differentiate between both entities. Case report: We describe the magnetic resonance imaging (MRI) features of a case of uterovaginal diffuse large B-cell lymphoma in a 50-year-old postmenopausal woman emphasizing Diffusion-Weighted Imaging (DWI) as a diagnostic and follow up tool. We reviewed the literature regarding the diagnostic methods for female genital lymphoma. Forty-five cases including our patient were reviewed with age range from 22 to 85 years. Vaginal bleeding was the most common presentation. The diagnosis was established by Papanicolaou smear, cervical biopsy (25/45), endometrial biopsy (6/45), vaginal biopsy (2/45), pelvic mass biopsy (2/45), iliac LN biopsy (1/45) and surgical diagnosis (8/45). Diffuse large B-cell lymphomas (DLBCL) constitute the vast majority of the cases (82%). The uterine cervix was involved at diagnosis in the majority of these cases (68%) while uterine body (42%) and vagina (28%) were less involved. Pelvic lymphadenopathy was found in 15 cases while extra genital lymphomatous infiltration in 13 cases. Sonographic findings were nonspecific while CT provided excellent data about extra-genital involvement. Thirteen cases underwent pelvic MRI that displayed superior detection of disease extension and parametric involvement. Diffusion restriction was reported only in one case without quantitative analysis of ADC map. Conclusion: MRI shows unique features that help to differentiate uterovaginal lymphoma from the much more common carcinomas and discriminate post-operative changes from tumor recurrence. It exhibits a marked restricted diffusion pattern with lower ADC values than carcinomas and post-operative changes.

Reversible diffusion-weighted imaging lesions in acute ischemic stroke

Neurology ◽  
2020 ◽  
Vol 94 (13) ◽  
pp. 571-587 ◽  
Author(s):  
Nandakumar Nagaraja ◽  
John R. Forder ◽  
Steven Warach ◽  
Jośe G. Merino
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Diffusion Weighted Imaging ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Nihss Score ◽  
Diffusion Weighted ◽  
Ischemic Tissue ◽  
Fluid Attenuated Inversion Recovery

ObjectivesTo systematically review the literature for reversible diffusion-weighted imaging (DWIR) lesions and to describe its prevalence, predictors, and clinical significance.MethodsStudies were included if the first DWI MRI was performed within 24 hours of stroke onset and follow-up DWI or fluid-attenuated inversion recovery (FLAIR)/T2 was performed within 7 or 90 days, respectively, to measure DWIR. We abstracted clinical, imaging, and outcomes data.ResultsTwenty-three studies met the study criteria. The prevalence of DWIR was 26.5% in DWI-based studies and 6% in FLAIR/T2-based studies. DWIR was associated with recanalization or reperfusion of the ischemic tissue with or without the use of tissue plasminogen activator (t-PA) or endovascular therapy, earlier treatment with t-PA, shorter time to endovascular therapy after MRI, and absent or less severe perfusion deficit within the DWI lesion. DWIR was associated with early neurologic improvement in 5 of 6 studies (defined as improvement in the NIH Stroke Scale (NIHSS) score by 4 or 8 points from baseline or NIHSS score 0 to 2 at 24 hours after treatment or at discharge or median NIHSS score at 7 days) and long-term outcome in 6 of 7 studies (defined as NIHSS score ≤1, improvement in the NIHSS score ≥8 points, or modified Rankin Scale score up to ≤2 at 30 or 90 days) likely due to reperfusion.ConclusionsDWIR is seen in up to a quarter of patients with acute ischemic stroke, and it is associated with good clinical outcome following reperfusion. Our findings highlight the pitfalls of DWI to define ischemic core in the early hours of stroke.

scholarly journals European Multicenter Study of ET-COVID-19

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 31-39
Author(s):  
Federico Cagnazzo ◽  
Michel Piotin ◽  
Simon Escalard ◽  
Benjamin Maier ◽  
Marc Ribo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebral Infarction ◽  
Lymphocyte Count ◽  
Interquartile Range ◽  
National Institutes Of Health ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Neurological Improvement ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. Methods: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. Secondary outcomes: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0–1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. Results: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59–79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11–21) and 8 (interquartile range, 7–9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3–87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20–39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8–29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7–12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21–5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22–5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43–12.91] per SD-log increase in LDH). Conclusions: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient’s profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04406090.

Sign in / Sign up

Export Citation Format

Share Document