Modern imaging of the infarct core and the ischemic penumbra in acute stroke patients: CT versus MRI

2009 ◽  
Vol 7 (4) ◽  
pp. 395-403 ◽  
Author(s):  
Carlos J Ledezma ◽  
Jochen B Fiebach ◽  
Max Wintermark
Keyword(s):  
Acute Stroke ◽  
Ischemic Penumbra ◽  
Stroke Patients ◽  
Infarct Core ◽  
Modern Imaging

Abstract WP83: Validation of a Relative Non-Contrast CT Map to Detect Early Ischemic Changes in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Margy E McCullough-Hicks ◽  
Soren Christensen ◽  
Aditya Srivatsan ◽  
Gregory W Albers ◽  
Maarten Lansberg
Keyword(s):  
Acute Stroke ◽  
Brain Regions ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Test Characteristics ◽  
Contrast Ct ◽  
Sensitivity Specificity ◽  
Early Infarction

Background: Discerning signs of early infarct on the non-contrast CT (NCCT) can be difficult. To facilitate interpretation of the NCCT we previously developed a technique to generate symmetry ratio maps of the NCCT (rNCCT maps) on which subtle (≥5%) differences in density between symmetric brain regions are enhanced. We sought to validate the rNCCT map against other measures of early infarction in a large cohort. Methods: rNCCT maps were generated for 146 ischemic stroke patients. We assessed how often a neurologist’s interpretation of the NCCT was changed when provided with the rNCCT map. The neurologist was blinded to CTP and DWI but was given the infarct hemisphere. In addition, using the 24-hour DWI as the gold standard, we assessed the sensitivity, specificity and volumetric accuracy of the rNCCT-defined infarct core and compared this to the test characteristics of CTP-defined infarct core (CBF<38% threshold). Results: Addition of rNCCT overlay map changed clinician’s initial read 64.4% of the time (95% CI 56-72%); the rNCCT identified new areas of ischemia not appreciated on blinded review 86.2% of the time (95% CI 78-92%) and in 35.1% helped rule out early ischemia where the reader was unsure of its presence (95% CI 26-45%). In the 53 patients with reperfusion and follow-up MRI, specificity of rNCCT for final lesion volume was 99.5% for rNCCT [98.5-99.8%] vs. 99.8% [IQR 98.8-99.9%] for CTP (P=0.08). Sensitivity for rNCCT was 19.9% [7.1-28.1%] vs. 17.5% [4.7-32.2%] for CTP (P=0.56). Conclusions: This study validates the rNCCT map for detection of early ischemic changes. It is more quantitative and objective than a clinician’s read of the NCCT alone. The sensitivity and specificity for detecting early ischemic changes on rNCCT were comparable to those achieved with CTP. This indicates that the rNCCT could be a valuable tool in the evaluation of acute stroke patients.

EVIDENCE OF AN ISCHEMIC PENUMBRA IN COLLATERALLY PERFUSED BRAIN TISSUE. A rCBF STUDY OF ACUTE STROKE PATIENTS:

2009 ◽  
Vol 65 (S90) ◽  
pp. 154-155
Author(s):  
T. Skyhoj Olsen ◽  
B. Larsen ◽  
M. Herning ◽  
E. Bech Skriver ◽  
N. A. Lassen
Keyword(s):  
Acute Stroke ◽  
Brain Tissue ◽  
Ischemic Penumbra ◽  
Stroke Patients

scholarly journals Altered Resting-State fMRI Signals in Acute Stroke Patients with Ischemic Penumbra

PLoS ONE ◽  
2014 ◽  
Vol 9 (8) ◽  
pp. e105117 ◽  
Author(s):  
Yuan-Hsiung Tsai ◽  
Rui Yuan ◽  
Yen-Chu Huang ◽  
Hsu-Huei Weng ◽  
Mei-Yu Yeh ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Resting State ◽  
Resting State Fmri ◽  
Ischemic Penumbra ◽  
Stroke Patients

White Matter Thresholds for Ischemic Penumbra and Infarct Core in Patients with Acute Stroke: CT Perfusion Study

Radiology ◽  
2008 ◽  
Vol 247 (3) ◽  
pp. 818-825 ◽  
Author(s):  
Blake D. Murphy ◽  
Allan J. Fox ◽  
Donald H. Lee ◽  
Demetrios J. Sahlas ◽  
Sandra E. Black ◽  
...  
Keyword(s):  
White Matter ◽  
Acute Stroke ◽  
Ct Perfusion ◽  
Ischemic Penumbra ◽  
Infarct Core ◽  
Perfusion Study

Abstract 2697: Fully-automated Identification of Acute Stroke Lesion Volumes with CT Perfusion

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Matus Straka ◽  
Gregory W Albers ◽  
Maarten G Lansberg ◽  
Stephanie M Kemp ◽  
Michael P Marks ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Automated Image Analysis ◽  
Great Promise ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Infarct Core ◽  
Median Volume ◽  
Stroke Lesion ◽  
Volume Difference

Purpose: Mismatch between volumes of infarct core and critically hypoperfused tissue (CHT) may be used to identify acute stroke patients who could benefit from reperfusion therapies. We present a fully-automated, operator-free approach for identifying the core and CHT lesion volumes with CT perfusion (CTP). Methods: 31 scans of 25 acute stroke patients who underwent CTP followed by MRI (range: 23-120 min) were analyzed. CTP was obtained as a one or two 2cm slabs. MRI included DWI and PWI. Reference stroke lesion metrics were MRI-based: core via DWI (ADC<615x10 -6 mm 2 /s), and CHT via PWI (Tmax>6s). CTP and PWI scans were processed with an automated image analysis program (RAPID) with delay-independent deconvolution. MRI maps were coregistered to CTP. Contralaterally-relative CBV CT and CBF CT ( cr CBF CT , cr CBF CT ) maps were computed by putting into ratio the original and corresponding laterally-mirrored and smoothed rCBV CT and rCBF CT maps (obtained by vertical flip and coregistration of the anatomic images, see Fig). Stroke core in CTP was delineated by thresholding cr CBV CT and cr CBF CT , and CHT by thresholding Tmax CT . Optimal thresholds were obtained by ROC analysis and minimization of lesion volume differences between CT and MRI. Results: For identification of stroke core in CTP, cr CBF CT performed better than cr CBV CT . Optimal threshold was cr CBF CT < 0.30 with sensitivity 60% (CI 95% 57-63%) and specificity 88%, (CI 95% 87-89%); median volume difference between CBF CT and DWI lesions was 0 ml (IQR: -6ml to 6 ml); correlation of volumes was r 2 =0.72 ( p <0.0001). For identification of CHT, reference MRI lesions (Tmax MR >6s) were most accurately identified by Tmax CT >6s with sensitivity 72% (CI 95% 70-74%), specificity 97% (CI 95% 96-97%); median volume difference between Tmax CT and Tmax MR was -3ml (IQR: -10ml to 0ml); correlation of CHT volumes r 2 =0.89 (p<0.0001). Conclusions: The processing methods and CTP thresholds presented in this study show a great promise for fully-automated outlining of stroke lesions using CTP. Such a technique could be of great value for CTP-based patient selection in clinical trials and clinical practice.

scholarly journals Avoiding “Pseudo-Reversibility” of CT-CBV Infarct Core Lesions in Acute Stroke Patients After Thrombolytic Therapy

Stroke ◽  
2009 ◽  
Vol 40 (8) ◽  
pp. 2875-2878 ◽  
Author(s):  
Pamela W. Schaefer ◽  
Kit Mui ◽  
Shahmir Kamalian ◽  
Raul G. Nogueira ◽  
R. Gilberto Gonzalez ◽  
...  
Keyword(s):  
Thrombolytic Therapy ◽  
Acute Stroke ◽  
Stroke Patients ◽  
Infarct Core

Endovascular treatment beyond 24 hours from the onset of acute ischemic stroke: the Italian Registry of Endovascular Thrombectomy in Acute Stroke (IRETAS)

2021 ◽  
pp. neurintsurg-2021-018045
Author(s):  
Ilaria Casetta ◽  
Enrico Fainardi ◽  
Giovanni Pracucci ◽  
Valentina Saia ◽  
Stefano Vallone ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Case Fatality ◽  
Functional Independence ◽  
Primary Outcome Measure ◽  
Stroke Patients ◽  
Infarct Core ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracranial Hemorrhage ◽  
Contrast Ct

BackgroundClinical trials and observational studies have demonstrated the benefit of thrombectomy up to 16 or 24 hours after the patient was last known to be well. This study aimed to evaluate the outcome of stroke patients treated beyond 24 hours from onset.MethodsWe analyzed the outcome of 34 stroke patients (mean age 70.7±12.3 years; median National Institutes of Health Stroke Scale (NIHSS) score 13) treated with endovascular thrombectomy beyond 24 hours from onset who were recruited in the Italian Registry of Endovascular Thrombectomy in Acute Stroke. Selection criteria for patients were: pre-stroke modified Rankin scale (mRS) score of ≤2, non-contrast CT Alberta Stroke Program Early CT score of ≥6, good collaterals on single phase CT angiography (CTA) or multiphase CTA, and CT perfusion mismatch with an infarct core size ≤50% of the total hypoperfusion extent or involving less than one-third of the extent of the middle cerebral artery territory evaluated by visual inspection. The primary outcome measure was functional independence assessed by the mRS at 90 days after onset. Safety outcomes were 90 day mortality and the occurrence of symptomatic intracranial hemorrhage (sICH).ResultsSuccessful recanalization (Thrombolysis in Cerebral Infarction score of 2b or 3) was present in 76.5% of patients. Three month functional independence (mRS score 0–2) was observed in 41.1% of patients. The case fatality rate was 26.5%. and the incidence of sICH was 8.8%.ConclusionsThese findings suggest that, in a real world setting, very late endovascular therapy is feasible in appropriately selected patients.

Association of CT-Based Hypoperfusion Index With Ischemic Core Enlargement in Patients With Medium and Large Vessel Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012855
Author(s):  
Ali Z Nomani ◽  
Joseph Kamtchum Tatuene ◽  
Jeremy L Rempel ◽  
Thomas Jeerakathil ◽  
Ian Winship ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Reperfusion Therapy ◽  
Stroke Onset ◽  
Progression Rate ◽  
Stroke Patients ◽  
Infarct Core ◽  
Vessel Occlusion ◽  
Slow Progressors

Objective:The rate of infarct core progression in patients with acute ischemic stroke is variable and affects outcome of reperfusion therapy. We evaluated hypoperfusion index (HI) to estimate the initial rate of core progression in patients with medium-vessel-occlusion (MeVO) compared to large-vessel-occlusion (LVO) stroke and within a larger time frame since stroke onset.Methods:Core progression was assessed in 106 patients with acute stroke and CT perfusion. Using reperfusion trial core-time criteria, fast progressors had core>70-mL within 6-hours of stroke onset and slow progressors had core ≤70mL, mismatch ≥15mL and mismatch-to-core-ratio ≥1.8 within 6-24-hours. The relationship between HI and infarct core progression (core/time) was examined using receiver-operating-characteristics to determine optimal HI cut-off. The HI cut-off was then tested in overall cohort, compared between MeVO and LVO, and evaluated in patients up to 24-hours from stroke onset to differentiate fast from slow rate of core progression. HI threshold was assessed in a second independent cohort of 110 acute ischemic stroke patients.Results:In 106 patients with acute stroke, 6.6% were fast progressors, 27.4% were slow progressors, and 66% were not classified as fast or slow progressor by reperfusion trial core-time criteria. HI>0.5 was associated with fast progression and able to distinguish fast from slow progressors (AUC=0.94;95%CI=0.80-0.99). In MeVO patients (n=26) HI>0.5 had a core progression of 0.30-mL/min compared to 0.03-mL/min with HI≤0.5 (p<0.001). In LVO patients (n=80), HI>0.5 had a core progression of 0.26-mL/min compared to 0.02-mL/min with HI≤0.5 (p<0.001). In patients not classified as fast or slow progressor by reperfusion trial criteria, those with HI>0.5 had progression rate of 0.21-mL/min compared to 0.03-mL/min with HI≤0.5 (p<0.001). Validation in a second cohort of patients with acute ischemic stroke (n=110; MeVO n=42, LVO n=68) yielded similar results for HI>0.5 to distinguish fast and slow core progression with an AUC of 0.84(95%CI=0.72-0.97).Conclusions:HI can differentiate fast from slow core progression in MeVO and LVO patients within the first 24-hours of acute ischemic stroke. Consideration of core progression rate at time of stroke evaluation may have implications in the selection of MeVO and LVO stroke patients for reperfusion therapy that warrant further study.

The role of nursing in the rehabilitation of acute stroke patients: Toward a unified theoretical perspective

Pflege ◽  
1999 ◽  
Vol 12 (1) ◽  
pp. 21-27
Author(s):  
Marit Kirkevold
Keyword(s):  
Acute Stroke ◽  
Theoretical Perspective ◽  
Stroke Patients ◽  
Role Of Nursing ◽  
Rolle Der Pflegenden

Eine Übersicht der bestehenden Literatur weist auf Unsicherheiten bezüglich der spezifischen Rolle der Pflegenden in der Rehabilitation von Hirnschlagpatientinnen und -patienten hin. Es existieren zwei unterschiedliche Begrifflichkeiten für die Rolle der Pflegenden, keine davon bezieht sich auf spezifische Rehabilitationsziele oder Patientenergebnisse. Ein anfänglicher theoretischer Beitrag der Rolle der Pflege in der Genesung vom Hirnschlag wird als Struktur unterbreitet, um die therapeutischen Aspekte der Pflege im Koordinieren, Erhalten und Üben zu vereinen. Bestehende Literatur untermauert diesen Beitrag. Weitere Forschung ist jedoch notwendig, um den spezifischen Inhalt und Fokus der Pflege in der Genesung bei Hirnschlag zu entwickeln.

Sign in / Sign up

Export Citation Format

Share Document