scholarly journals Structured reporting of brain MRI following mechanical thrombectomy in acute ischemic stroke patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sebastian Mönch ◽  
Tiberiu Andrisan ◽  
Kathleen Bernkopf ◽  
Benno Ikenberg ◽  
Benjamin Friedrich ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Stroke Patients ◽  
Report Quality

Abstract Background To compare the quality of free-text reports (FTR) and structured reports (SR) of brain magnetic resonance imaging (MRI) examinations in patients following mechanical thrombectomy for acute stroke treatment. Methods A template for SR of brain MRI examinations based on decision trees was designed and developed in house and applied to twenty patients with acute ischemic stroke in addition to FTR. Two experienced stroke neurologists independently evaluated the quality of FTR and SR regarding clarity, content, presence of key features, information extraction, and overall report quality. The statistical analysis for the differences between FTR and SR was performed using the Mann–Whitney U-test or the Chi-squared test. Results Clarity (p < 0.001), comprehensibility (p < 0.001), inclusion of relevant findings (p = 0.016), structure (p = 0.005), and satisfaction with the content of the report for immediate patient management (p < 0.001) were evaluated significantly superior for the SR by both neurologist raters. One rater additionally found the explanation of the patient’s clinical symptoms (p = 0.003), completeness (p < 0.009) and length (p < 0.001) of SR to be significantly superior compared to FTR and stated that there remained no open questions, requiring further consultation of the radiologist (p < 0.001). Both neurologists preferred SR over FTR. Conclusions The use of SR for brain magnetic resonance imaging may increase the report quality and satisfaction of the referring physicians in acute ischemic stroke patients following mechanical thrombectomy. Trial registration Retrospectively registered.

scholarly journals Patients With Acute Ischemic Stroke Who Receive Brain Magnetic Resonance Imaging Demonstrate Favorable In‐Hospital Outcomes

2020 ◽  
Vol 9 (20) ◽  
Author(s):  
Hwan Lee ◽  
Yifeng Yang ◽  
Baoqiong Liu ◽  
Simon A. Castro ◽  
Tiantian Shi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Control Group ◽  
Inpatient Mortality ◽  
Resonance Imaging

Background Use of inpatient brain magnetic resonance imaging (MRI) in patients with acute ischemic stroke is highly institution dependent and has been associated with increased length and cost of hospital stay. We examined whether inpatient brain MRI in patients with acute ischemic stroke is associated with improved clinical outcomes to justify its resource requirements. Methods and Results The National Inpatient Sample database was queried retrospectively to find 94 003 patients who were admitted for acute ischemic stroke and then received inpatient brain MRI between 2012 and 2014. Multivariable regression analysis was performed with respect to a control group to assess for differences in the rates of inpatient mortality and complications, as well as the length and cost of hospital stay based on brain MRI use. Inpatient brain MRI was independently associated with lower rates of inpatient mortality (1.67% versus 3.09%; adjusted odds ratio [OR], 0.60; 95% CI, 0.53–0.68; P <0.001), gastrostomy (2.28% versus 2.89%; adjusted OR, 0.82; 95% CI, 0.73–0.93; P <0.001), and mechanical ventilation (1.97% versus 2.82%; adjusted OR, 0.68; 95% CI, 0.60–0.77; P <0.001). Brain MRI was independently associated with ≈0.32 days (8%) and $1131 (11%) increase in the total length ( P <0.001) and cost ( P <0.001) of hospital stay, respectively. Conclusions Inpatient brain MRI in patients with acute ischemic stroke is associated with substantial decrease in the rates of inpatient mortality and complications, at the expense of marginally increased length and cost of hospitalization.

scholarly journals Pseudo-colour with K-means Clustering Algorithm for Acute Ischemic Stroke Lesion Segmentation in Brain MRI

2021 ◽  
Vol 29 (2) ◽  
Author(s):  
Abang Mohd Arif Anaqi Abang Isa ◽  
Kuryati Kipli ◽  
Ahmad Tirmizi Jobli ◽  
Muhammad Hamdi Mahmood ◽  
Siti Kudnie Sahari ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Clustering Algorithm ◽  
Brain Mri ◽  
Segmentation Algorithm ◽  
Automated Segmentation ◽  
Resonance Imaging ◽  
Greyscale Image

Segmentation of an acute ischemic stroke from a single modality of a greyscale magnetic resonance imaging (MRI) is an essential and challenging task. Recently, there are several numbers of related works on the automatic segmentation of infarct lesion from the input image and give a high accuracy in extraction of infarct lesion. Still, limited works have been reported in isolating the penumbra tissues and infarct core separately. The segmentation of the penumbra tissues is necessary because that region has the potential to recover. This paper presented an automated segmentation algorithm on diffusion-weighted magnetic resonance imaging (DW-MRI) image utilizing pseudo-colour conversion and K-means clustering techniques. A greyscale image contains only intensity information and often misdiagnosed due to overlap intensity of an image. Colourization is the method of adding colours to greyscale images which allocate luminance or intensity for red, green, and blue channels. The greyscale image is converted to pseudo-colour is to intensify the visual perception and deliver more information. Then, the algorithm segments the region of interest (ROI) using K-means clustering. The result shows the potential of automated segmentation to differentiate between the healthy and lesion tissues with 90.08% in accuracy and 0.89 in dice coefficient. The development of an automated segmentation algorithm was successfully achieved by entirely depending on the computer with minimal interaction.

Reliability of fast magnetic resonance imaging for acute ischemic stroke patients using a 1.5-T scanner

2018 ◽  
Vol 29 (5) ◽  
pp. 2641-2650 ◽  
Author(s):  
Mi Sun Chung ◽  
Ji Ye Lee ◽  
Seung Chai Jung ◽  
Seunghee Baek ◽  
Woo Hyun Shim ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Resonance Imaging ◽  
Stroke Patients ◽  
Fast Magnetic Resonance Imaging

Extending the time window for intravenous thrombolysis in acute ischemic stroke using magnetic resonance imaging-based patient selection

2019 ◽  
Vol 14 (5) ◽  
pp. 483-490 ◽  
Author(s):  
Peter Ringleb ◽  
Martin Bendszus ◽  
Erich Bluhmki ◽  
Geoffrey Donnan ◽  
Christoph Eschenfelder ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Resonance Imaging ◽  
Stroke Patients ◽  
Symptomatic Intracranial Hemorrhage

Background Intravenous thrombolysis with alteplase within a time window up to 4.5 h is the only approved pharmacological treatment for acute ischemic stroke. We studied whether acute ischemic stroke patients with penumbral tissue identified on magnetic resonance imaging 4.5–9 h after symptom onset benefit from intravenous thrombolysis compared to placebo. Methods Acute ischemic stroke patients with salvageable brain tissue identified on a magnetic resonance imaging were randomly assigned to receive standard dose alteplase or placebo. The primary end point was disability at 90 days assessed by the modified Rankin scale, which has a range of 0–6 (with 0 indicating no symptoms at all and 6 indicating death). Safety end points included death, symptomatic intracranial hemorrhage, and other serious adverse events. Results The trial was stopped early for slow recruitment after the enrollment of 119 (61 alteplase, 58 placebo) of 264 patients planned. Median time to intravenous thrombolysis was 7 h 42 min. The primary endpoint showed no significant difference in the modified Rankin scale distribution at day 90 (odds ratio alteplase versus placebo, 1.20; 95% CI, 0.63–2.27, P = 0.58). One symptomatic intracranial hemorrhage occurred in the alteplase group. Mortality at 90 days did not differ significantly between the two groups (11.5 and 6.8%, respectively; P = 0.53). Conclusions Intravenous alteplase administered between 4.5 and 9 h after the onset of symptoms in patients with salvageable tissue did not result in a significant benefit over placebo. (Supported by Boehringer Ingelheim, Germany; ISRCTN 71616222).

Comparison of T2*GRE and DSC-PWI for hemorrhage detection in acute ischemic stroke patients: Pooled analysis of the EPITHET, DEFUSE 2, and SENSE 3 stroke studies

2019 ◽  
Vol 15 (2) ◽  
pp. 216-225
Author(s):  
Shalini A Amukotuwa ◽  
Nancy J Fischbein ◽  
Gregory W Albers ◽  
Stephen Davis ◽  
Geoffrey A Donnan ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Kappa Statistic ◽  
Hemorrhagic Transformation ◽  
Dynamic Susceptibility ◽  
Resonance Imaging ◽  
Stroke Patients

Aims The objective of this study was to compare the diagnostic performance of the baseline pre-contrast images of dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) with conventional T2*gradient recalled echo (GRE) imaging for detection of hemorrhage in acute ischemic stroke patients. Material and methods T2*GRE and DSC-PWI from 393 magnetic resonance imaging scans from 221 patients enrolled in three prospective stroke studies were independently evaluated by two readers blinded to clinical and other imaging data. Agreement between T2*GRE and DSC-PWI for the presence of hemorrhage, and acute hemorrhagic transformation, was assessed using the kappa statistic. Inter-reader agreement was also assessed using the kappa statistic. Results Agreement between the baseline images of DSC-PWI and T2*GRE regarding the presence of hemorrhage was almost perfect (kreader 1 : 0.90, 95% confidence interval 0.86–0.95 and kreader 2 : 0.91, 95% confidence interval 0.87–0.96). Agreement between the sequences was still higher for detection of acute hemorrhagic transformation (kreader 1 : 0.94, 95% confidence interval 0.91–0.98 and kreader 2 : 0.95, 95% confidence interval 0.92–0.98). Inter-reader agreement for detection of hemorrhage was also almost perfect for both T2*GRE (k: 0.95, 95% confidence interval 0.91–0.98) and DSC-PWI (k: 0.96, 95% confidence interval 0.93–0.99). Acute hemorrhagic transformation detected on T2*GRE was missed on DSC-PWI by one or both readers in 5/393 (1.3%) scans. Conclusion The almost perfect statistical agreement between DSC-PWI and conventional T2*GRE suggests that DSC-PWI is sufficient for hemorrhage screening prior to thrombolysis in stroke patients. T2*GRE can therefore be omitted when DSC-PWI is included, thereby shortening the acute ischemic stroke magnetic resonance imaging protocol and expediting treatment. Trial registration: ClinicalTrials.gov Identifier: NCT02586415.

scholarly journals Frequency, Determinants, and Outcomes of Emboli to Distal and New Territories Related to Mechanical Thrombectomy for Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Gregory J. Wong ◽  
Bryan Yoo ◽  
David Liebeskind ◽  
Humain Baharvahdat ◽  
Jeffrey Gornbein ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Odds Ratio ◽  
Resonance Imaging ◽  
Stroke Patients

Background and Purpose: Clot fragmentation and distal embolization during endovascular thrombectomy for acute ischemic stroke may produce emboli downstream of the target occlusion or in previously uninvolved territories. Susceptibility-weighted magnetic resonance imaging can identify both emboli to distal territories (EDT) and new territories (ENT) as new susceptibility vessel signs (SVS). Diffusion-weighted imaging (DWI) can identify infarcts in new territories (INT). Methods: We studied consecutive acute ischemic stroke patients undergoing magnetic resonance imaging before and after thrombectomy. Frequency, predictors, and outcomes of EDT and ENT detected on gradient-recalled echo imaging (EDT-SVS and ENT-SVS) and INT detected on DWI (INT-DWI) were analyzed. Results: Among 50 thrombectomy-treated acute ischemic stroke patients meeting study criteria, mean age was 70 (±16) years, 44% were women, and presenting National Institutes of Health Stroke Scale score 15 (interquartile range, 8–19). Overall, 21 of 50 (42%) patients showed periprocedural embolic events, including 10 of 50 (20%) with new EDT-SVS, 10 of 50 (20%) with INT-DWI, and 1 of 50 (2%) with both. No patient showed ENT-SVS. On multivariate analysis, model-selected predictors of EDT-SVS were lower initial diastolic blood pressure (odds ratio, 1.09 [95% CI, 1.02–1.16]), alteplase pretreatment (odds ratio, 5.54 [95% CI, 0.94–32.49]), and atrial fibrillation (odds ratio, 7.38 [95% CI, 1.02–53.32]). Classification tree analysis identified pretreatment target occlusion SVS as an additional predictor. On univariate analysis, INT-DWI was less common with internal carotid artery (5%), intermediate with middle cerebral artery (25%), and highest with vertebrobasilar (57%) target occlusions ( P =0.02). EDT-SVS was not associated with imaging/functional outcomes, but INT-DWI was associated with reduced radiological hemorrhagic transformation (0% versus 54%; P <0.01). Conclusions: Among acute ischemic stroke patients treated with thrombectomy, imaging evidence of distal emboli, including EDT-SVS beyond the target occlusion and INT-DWI in novel territories, occur in about 2 in every 5 cases. Predictors of EDT-SVS are pretreatment intravenous fibrinolysis, potentially disrupting thrombus structural integrity; atrial fibrillation, possibly reflecting larger target thrombus burden; lower diastolic blood pressure, suggestive of impaired embolic washout; and pretreatment target occlusion SVS sign, indicating erythrocyte-rich, friable target thrombus.

scholarly journals Cardiac Magnetic Resonance Imaging in Patients with Acute Ischemic Stroke and Elevated Troponin: A TRoponin ELevation in Acute Ischemic Stroke (TRELAS) Sub-Study

2019 ◽  
Vol 9 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Karl Georg Haeusler ◽  
Christoph Jensen ◽  
Jan F. Scheitz ◽  
Thomas Krause ◽  
Christian Wollboldt ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Acute Ischemic Stroke ◽  
Elevated Troponin ◽  
Resonance Imaging ◽  
Stroke Patients ◽  
Troponin Elevation ◽  
Artery Disease

Background: Elevated high-sensitive cardiac troponin (hs-cTn) can be found in more than 50% of the patients with acute ischemic stroke. The observational TRoponin ELevation in Acute ischemic Stroke (TRELAS) study revealed that about 25% of all stroke patients with elevated troponin had a coronary angiography-detected culprit lesion affording immediate intervention, and about 50% of all patients did not have any obstructive coronary artery disease. Given the risk of procedure-related complications, the identification of stroke patients in urgent need of invasive coronary angiography is desirable. Methods: TRELAS patients were prospectively enrolled into this sub-study. In addition to conventional coronary angiography, a cardiac magnetic resonance imaging (MRI) at 3T was performed during the in-hospital stay after acute ischemic stroke to compare the diagnostic value of both imaging modalities. Results:Nine stroke patients (median age 73 years [range 58–87]; four females; median NIH Stroke Severity score on admission 4 [range 0–6] with elevated hs-cTnT [median 74 ng/L, interquartile range 41–247] on admission) completed cardiac MRI and underwent coronary angiography. The absence of MRI-detected wall motion abnormalities and/or late gadolinium enhancement in 5 stroke patients corresponded with the exclusion of culprit lesions or significant coronary artery disease by coronary angiography. Four patients had abnormal MRI findings, whereof 2 showed evidence of myocardial infarction and in whom coronary angiography demonstrated a >70% stenosis of a coronary artery. Conclusions: The TRELAS sub-study indicates that noninvasive cardiac MRI may provide helpful information to identify stroke patients with or without acute coronary syndrome. Our findings might help to select stroke patients in urgent need of coronary angiography.

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