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Guo Z, Feng J, Lu W, Yin Y, Yang G, Zhou J. Cross-modality cerebrovascular segmentation based on pseudo-label generation via paired data. Comput Med Imaging Graph 2024; 115:102393. [PMID: 38704993 DOI: 10.1016/j.compmedimag.2024.102393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
Accurate segmentation of cerebrovascular structures from Computed Tomography Angiography (CTA), Magnetic Resonance Angiography (MRA), and Digital Subtraction Angiography (DSA) is crucial for clinical diagnosis of cranial vascular diseases. Recent advancements in deep Convolution Neural Network (CNN) have significantly improved the segmentation process. However, training segmentation networks for all modalities requires extensive data labeling for each modality, which is often expensive and time-consuming. To circumvent this limitation, we introduce an approach to train cross-modality cerebrovascular segmentation network based on paired data from source and target domains. Our approach involves training a universal vessel segmentation network with manually labeled source domain data, which automatically produces initial labels for target domain training images. We improve the initial labels of target domain training images by fusing paired images, which are then used to refine the target domain segmentation network. A series of experimental arrangements is presented to assess the efficacy of our method in various practical application scenarios. The experiments conducted on an MRA-CTA dataset and a DSA-CTA dataset demonstrate that the proposed method is effective for cross-modality cerebrovascular segmentation and achieves state-of-the-art performance.
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Affiliation(s)
- Zhanqiang Guo
- Department of Automation, BNRist, Tsinghua University, Beijing, China
| | - Jianjiang Feng
- Department of Automation, BNRist, Tsinghua University, Beijing, China.
| | - Wangsheng Lu
- UnionStrong (Beijing) Technology Co.Ltd, Beijing, China
| | - Yin Yin
- UnionStrong (Beijing) Technology Co.Ltd, Beijing, China
| | | | - Jie Zhou
- Department of Automation, BNRist, Tsinghua University, Beijing, China
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David E, Martinelli O, Pacini P, Di Serafino M, Huang P, Dolcetti V, Del Gaudio G, Barr RG, Renda M, Lucarelli GT, Di Marzo L, Clevert DA, Solito C, Di Bella C, Cantisani V. New Technologies in the Assessment of Carotid Stenosis: Beyond the Color-Doppler Ultrasound-High Frame Rate Vector-Flow and 3D Arterial Analysis Ultrasound. Diagnostics (Basel) 2023; 13:diagnostics13081478. [PMID: 37189578 DOI: 10.3390/diagnostics13081478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Atherosclerotic plaque in the carotid artery is the main cause of ischemic stroke, with a high incidence rate among people over 65 years. A timely and precise diagnosis can help to prevent the ischemic event and decide patient management, such as follow up, medical, or surgical treatment. Presently, diagnostic imaging techniques available include color-Doppler ultrasound, as a first evaluation technique, computed tomography angiography, which, however, uses ionizing radiation, magnetic resonance angiography, still not in widespread use, and cerebral angiography, which is an invasively procedure reserved for therapeutically purposes. Contrast-enhanced ultrasound is carving out an important and emerging role which can significantly improve the diagnostic accuracy of an ultrasound. Modern ultrasound technologies, still not universally utilized, are opening new horizons in the arterial pathologies research field. In this paper, the technical development of various carotid artery stenosis diagnostic imaging modalities and their impact on clinical efficacy is thoroughly reviewed.
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Affiliation(s)
- Emanuele David
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital "Policlinico G. Rodolico", University of Catania, 95123 Catania, Italy
- Radiology Unit, Papardo-Hospital, 98158 Messina, Italy
| | - Ombretta Martinelli
- Department of Surgery "Paride Stefanini", Vascular and Endovascular Surgery Division, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, 80131 Naples, Italy
| | - Pintong Huang
- Department of Ultrasound in Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 242332, China
| | - Vincenzo Dolcetti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Richard G Barr
- Department of Radiology, Northeastern Ohio Medical University, Rootstown, OH 44272, USA
- Southwoods Imaging, Youngstown, OH 44512, USA
| | - Maurizio Renda
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Giuseppe T Lucarelli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Luca Di Marzo
- Department of Surgery "Paride Stefanini", Vascular and Endovascular Surgery Division, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Dirk A Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich, Grosshadern Campus, 81377 Munich, Germany
| | - Carmen Solito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Chiara Di Bella
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
| | - Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy
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3
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Simaan N, Jubeh T, Wiegler KB, Sharabi-Nov A, Honig A, Shahien R. Comparison of Doppler Ultrasound and Computerized Tomographic Angiography in Evaluation of Cervical Arteries Stenosis in Stroke Patients, a Retrospective Single-Center Study. Diagnostics (Basel) 2023; 13:diagnostics13030459. [PMID: 36766564 PMCID: PMC9914439 DOI: 10.3390/diagnostics13030459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
There are different diagnostic modalities to investigate atherosclerosis cervical artery disease in suspected stroke patients. We aimed to test the concordance of findings of the two most widely used diagnostic modalities in stroke patients: duplex ultrasound (DUS) and computerized tomographic angiography (CTA). A total of 100 stroke patients were retrospectively included in the study, all of them had DUS followed by CTA. Discrepancies of DUS compared to the CTA results in both the internal carotid and vertebral arteries were found in 44% of the patients. The patients with significant differences in diagnostic results were characterized by older age. Evaluation of the degree of carotid artery stenosis revealed vast differences in patients with 50-69% stenosis found by DUS, in which 45.5% of them had a different percentage of stenosis found by CTA. In studying the degree of stenosis of the vertebral artery, only 47.1% of the patients with more than 50% stenosis found by DUS had the same results with CTA, while the remaining revealed normal or less than 50% stenosis by CTA. The current study emphasizes that CTA is more accurate than DUS in the evaluation of stenosis of the cervical arteries including both the internal carotid and vertebral arteries.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel
- Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Tamer Jubeh
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel
| | | | - Adi Sharabi-Nov
- Research Wing, Ziv Medical Center, Safed 1311001, Israel
- Statistics Department, Tel-Hai Academic College, Qiryat Shemona 1220800, Israel
| | - Asaf Honig
- Departments of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 9112102, Israel
| | - Radi Shahien
- Department of Neurology, Ziv Medical Center, Safed 1311001, Israel
- Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
- Correspondence:
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McCall JR, Santibanez F, Belgharbi H, Pinton GF, Dayton PA. Non-invasive transcranial volumetric ultrasound localization microscopy of the rat brain with continuous, high volume-rate acquisition. Theranostics 2023; 13:1235-1246. [PMID: 36923540 PMCID: PMC10008741 DOI: 10.7150/thno.79189] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/24/2022] [Indexed: 02/15/2023] Open
Abstract
Rationale: Structure and function of the microvasculature provides critical information about disease state, can be used to identify local regions of pathology, and has been shown to be an indicator of response to therapy. Improved methods of assessing the microvasculature with non-invasive imaging modalities such as ultrasound will have an impact in biomedical theranostics. Ultrasound localization microscopy (ULM) is a new technology which allows processing of ultrasound data for visualization of microvasculature at a resolution better than allowed by acoustic diffraction with traditional ultrasound systems. Previous application of this modality in brain imaging has required the use of invasive procedures, such as a craniotomy, skull-thinning, or scalp removal, all of which are not feasible for the purpose of longitudinal studies. Methods: The impact of ultrasound localization microscopy is expanded using a 1024 channel matrix array ultrasonic transducer, four synchronized programmable ultrasound systems with customized high-performance hardware and software, and high-performance GPUs for processing. The potential of the imaging hardware and processing approaches are demonstrated in-vivo. Results: Our unique implementation allows asynchronous acquisition and data transfer for uninterrupted data collection at an ultra-high fixed frame rate. Using these methods, the vasculature was imaged using 100,000 volumes continuously at a volume acquisition rate of 500 volumes per second. With ULM, we achieved a resolution of 31 µm, which is a resolution improvement on conventional ultrasound imaging by nearly a factor of ten, in 3-D. This was accomplished while imaging through the intact skull with no scalp removal, which demonstrates the utility of this method for longitudinal studies. Conclusions: The results demonstrate new capabilities to rapidly image and analyze complex vascular networks in 3-D volume space for structural and functional imaging in disease assessment, targeted therapeutic delivery, monitoring response to therapy, and other theranostic applications.
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Affiliation(s)
- Jacob R McCall
- The Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University.,Electrical and Computer Engineering, NC State University
| | - Francisco Santibanez
- The Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University
| | - Hatim Belgharbi
- The Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University
| | - Gianmarco F Pinton
- The Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University
| | - Paul A Dayton
- The Joint Department of Biomedical Engineering, UNC Chapel Hill and NC State University
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Socio-Economic Disparities in Access to Diagnostic Neuroimaging Services in the United Kingdom: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010633. [PMID: 34682379 PMCID: PMC8535632 DOI: 10.3390/ijerph182010633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022]
Abstract
Socio-economic factors affecting health care can lead to delays in diagnosis of neurological conditions, consequentially affecting treatment and morbidity rates. This inequality in health care can leave patients from lower socio-economic backgrounds more vulnerable to a poorer quality of care from health care providers in the United Kingdom (U.K.). Aims: In this systematic review, we assess the impact of socio-economic status on the use of diagnostic neuroimaging in the U.K., measured by the timeliness, accessibility and appropriate use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography, electroencephalography (EEG) and single-photon emission computed tomography (SPECT). We specifically evaluate the non-surgical use of neuroimaging techniques as this relies on the judgment of primary care-givers (e.g., doctors and radiologists), where health disparities are most common. This study includes the analysis of diagnostic imaging used for dementia, minor head injury, stroke, cancer, epilepsy, chronic inflammatory demyelinating polyneuropathy and Parkinson’s disease. With this study, we aim to assess the health inequalities at disease diagnosis. Methods: Using Medline (via Ovid), PubMed and Web of Science databases as sources of information, we critically appraise existing studies on neuroimaging use in the U.K. health care system, published between January 2010 and February 2021. Findings: A total of 18 studies were included in this research, revealing that there was an increase in patients of Black and Asian communities diagnosed with dementia and at an earlier age. There was little evidence to suggest that a lack of access to diagnostic imaging is associated with socio-economic status. However, there are data to suggest that people of a lower socio-economic background require more specialist services with diagnostic neuroimaging tools. In addition, there is evidence to suggest that diagnostic neuroimaging techniques could be utilised more effectively by health care workers to prevent unnecessary delays in diagnosis for patients in lower socio-economic areas.
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Wang Z, Wang X, Wan JB, Xu F, Zhao N, Chen M. Optical Imaging in the Second Near Infrared Window for Vascular Bioimaging. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2021; 17:e2103780. [PMID: 34643028 DOI: 10.1002/smll.202103780] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/17/2021] [Indexed: 06/13/2023]
Abstract
Optical imaging in the second near infrared region (NIR-II, 1000-1700 nm) provides higher resolution and deeper penetration depth for accurate and real-time vascular anatomy, blood dynamics, and function information, effectively contributing to the early diagnosis and curative effect assessment of vascular anomalies. Currently, NIR-II optical imaging demonstrates encouraging results including long-term monitoring of vascular injury and regeneration, real-time feedback of blood perfusion, tracking of lymphatic metastases, and imaging-guided surgery. This review summarizes the latest progresses of NIR-II optical imaging for angiography including fluorescence imaging, photoacoustic (PA) imaging, and optical coherence tomography (OCT). The development of current NIR-II fluorescence, PA, and OCT probes (i.e., single-walled carbon nanotubes, quantum dots, rare earth doped nanoparticles, noble metal-based nanostructures, organic dye-based probes, and semiconductor polymer nanoparticles), highlighting probe optimization regarding high brightness, longwave emission, and biocompatibility through chemical modification or nanotechnology, is first introduced. The application of NIR-II probes in angiography based on the classification of peripheral vascular, cerebrovascular, tumor vessel, and cardiovascular, is then reviewed. Major challenges and opportunities in the NIR-II optical imaging for vascular imaging are finally discussed.
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Affiliation(s)
- Zi'an Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Xuan Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Jian-Bo Wan
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
| | - Fujian Xu
- Key Laboratory of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100000, China
| | - Nana Zhao
- Key Laboratory of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing, 100000, China
| | - Meiwan Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macau SAR, 999078, China
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7
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Gomez JR, Hobbs KS, Johnson LL, Vu QD, Bennett J, Tegeler C, Wolfe SQ, Sarwal A. The Clinical Contribution of Neurovascular Ultrasonography in Acute Ischemic Stroke. J Neuroimaging 2020; 30:867-874. [PMID: 32857913 DOI: 10.1111/jon.12771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Patients with acute ischemic stroke receive computed tomography angiogram (CTA) and digital subtraction angiogram (DSA) for clinical evaluation. Current guidelines lack in defining indications for transcranial Doppler (TCD) and/or carotid duplex ultrasonography (CUS) in acute stroke evaluation or follow-up cerebrovascular imaging after reperfusion. We investigated the clinical utility of performing additional TCD/CUS after reperfusion in guiding postacute care stroke management. METHODS Retrospective review of acute ischemic stroke patients admitted to a comprehensive stroke center with CTA head and neck and/or DSA followed by TCD/CUS. Cases were reviewed by two authors to determine if TCD/CUS provided additional diagnostic information to aid management. A nominal group process, using a third author, achieved consensus in cases of disagreements. RESULTS Only 25 of 198 patients had CTA or DSA followed by TCD/CUS. Ten (40%) cases showed new clinical information from CUS aiding management. Of those with TCD, 5 patients (22.7%) had findings that impacted management. These clinical scenarios included detection of mobile thrombus requiring anticoagulation; distinguishing carotid near-occlusion from occlusion; confirming hemodynamic significance of intra/extracranial stenosis helping emergent stenting/endarterectomy; detecting hyperperfusion on TCDs causing symptoms; and establishing chronicity of carotid stenosis based on collateral flow patterns, which deferred further intervention. DISCUSSION Our experience shows that TCD/CUS may offer additional diagnostic information assisting postacute care management in small subset of patients with acute ischemic stroke. Larger studies are needed to research the clinical impact and cost-effectiveness of additional imaging and inform clinical guidelines for selecting patients who will benefit from these additional studies.
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Affiliation(s)
- Jonathan R Gomez
- Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, MD
| | - Kyle S Hobbs
- Neurocritical Care Section, Intermountain Medical Center, Salt Lake City, UT
| | - Leilani L Johnson
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Quang D Vu
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - John Bennett
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Charles Tegeler
- Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, NC
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC
| | - Aarti Sarwal
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
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8
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Kim DK, Verdoorn JT, Gunderson TM, Huston III J, Brinjikji W, Lanzino G, Lehman VT. Comparison of non-contrast vessel wall imaging and 3-D time-of-flight MRA for atherosclerotic stenosis and plaque characterization within intracranial arteries. J Neuroradiol 2020; 47:266-271. [DOI: 10.1016/j.neurad.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/07/2023]
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9
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Arnold SA, Platt SR, Gendron KP, West FD. Imaging Ischemic and Hemorrhagic Disease of the Brain in Dogs. Front Vet Sci 2020; 7:279. [PMID: 32528985 PMCID: PMC7266937 DOI: 10.3389/fvets.2020.00279] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/27/2020] [Indexed: 01/12/2023] Open
Abstract
Strokes, both ischemic and hemorrhagic, are the most common underlying cause of acute, non-progressive encephalopathy in dogs. In effect, substantial information detailing the underlying causes and predisposing factors, affected vessels, imaging features, and outcomes based on location and extent of injury is available. The features of canine strokes on both computed tomography (CT) and magnetic resonance imaging (MRI) have been described in numerous studies. This summary article serves as a compilation of these various descriptions. Drawing from the established and emerging stroke evaluation sequences used in the investigation of strokes in humans, this summary describes all theoretically available sequences. Particular detail is given to logistics of image acquisition, description of imaging findings, and each sequence's advantages and disadvantages. As the imaging features of both forms of strokes are highly representative of the underlying pathophysiologic stages in the hours to months following stroke onset, the descriptions of strokes at various stages are also discussed. It is unlikely that canine strokes can be diagnosed within the same rapid time frame as human strokes, and therefore the opportunity for thrombolytic intervention in ischemic strokes is unattainable. However, a thorough understanding of the appearance of strokes at various stages can aid the clinician when presented with a patient that has developed a stroke in the days or weeks prior to evaluation. Additionally, investigation into new imaging techniques may increase the sensitivity and specificity of stroke diagnosis, as well as provide new ways to monitor strokes over time.
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Affiliation(s)
- Susan A Arnold
- Department of Veterinary Clinical Sciences, University of Minnesota Twin Cities, St. Paul, MN, United States
| | - Simon R Platt
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Karine P Gendron
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
| | - Franklin D West
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, United States
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11
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Thompson EJ, Wildman-Tobriner B, Parente V. Case 1: Delayed Diagnosis in a 13-year-old with Persistent Neurologic Symptoms after a Carnival Ride. Pediatr Rev 2019; 40:359-361. [PMID: 31263044 DOI: 10.1542/pir.2017-0270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Huang X, Alakbarzade V, Khandanpour N, Pereira AC. Management of a wake-up stroke. Pract Neurol 2019; 19:326-331. [PMID: 30872357 DOI: 10.1136/practneurol-2018-002179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 01/01/2023]
Abstract
Current national guidelines advocate intravenous thrombolysis to treat patients with acute ischaemic stroke presenting within 4.5 hours from symptom onset, and thrombectomy for patients with anterior circulation ischaemic stroke from large vessel occlusion presenting within 6 hours from onset. However, a substantial group of patients presents with acute ischaemic stroke beyond these time windows or has an unknown time of onset. Recent studies are set to revolutionise treatment for these patients. Using MRI diffusion/FLAIR (fluid-attenuated inversion recovery) mismatch, it is possible to identify patients within 4.5 hours from onset and safely deliver thrombolysis. Using CT perfusion imaging, it is possible to identify subjects with a middle cerebral artery syndrome who have an extensive area of ischaemic brain but as yet have only a small area of infarction who may benefit from urgent thrombectomy in up to 24 hours. Here, we highlight the recent advances in late window stroke treatment and their potential contribution to clinical practice.
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Affiliation(s)
- Xuya Huang
- Department of Neurology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Vafa Alakbarzade
- Department of Neurology, St. George's University Hospitals NHS Foundation Trust, London, UK.,Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Nader Khandanpour
- Department of Neurology, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Anthony C Pereira
- Department of Neurology, St. George's University Hospitals NHS Foundation Trust, London, UK
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13
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Lakomkin N, Dhamoon M, Carroll K, Singh IP, Tuhrim S, Lee J, Fifi JT, Mocco J. Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature. J Neurointerv Surg 2018; 11:241-245. [PMID: 30415226 DOI: 10.1136/neurintsurg-2018-014239] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Accurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention. OBJECTIVE To perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis. METHODS A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper. RESULTS Sixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study. CONCLUSIONS Despite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.
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Affiliation(s)
- Nikita Lakomkin
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Mandip Dhamoon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kirsten Carroll
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Inder Paul Singh
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Stanley Tuhrim
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Joyce Lee
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Johanna T Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
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14
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Boujan T, Neuberger U, Pfaff J, Nagel S, Herweh C, Bendszus M, Möhlenbruch MA. Value of Contrast-Enhanced MRA versus Time-of-Flight MRA in Acute Ischemic Stroke MRI. AJNR Am J Neuroradiol 2018; 39:1710-1716. [PMID: 30115678 DOI: 10.3174/ajnr.a5771] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/17/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vessel imaging in acute ischemic stroke is essential to select patients with large-vessel occlusion for mechanical thrombectomy. Our aim was to compare the diagnostic accuracy of time-of-flight MR angiography and contrast-enhanced MR angiography for identification of vessel occlusion and collateral status in acute ischemic stroke. MATERIALS AND METHODS One hundred twenty-three patients with stroke with large-vessel occlusion before thrombectomy were included in this retrospective study. Before thrombectomy, 3T MR imaging, including conventional 3D TOF-MRA of the intracranial arteries and contrast-enhanced MRA of intra- and extracranial arteries, was performed. Both techniques were assessed independently by 2 neuroradiologists for location of the occlusion, imaging quality, and collateral status. Findings were compared, with subsequent DSA as the reference standard. RESULTS Both techniques had good interrater agreement of κ = 0.74 (95% CI, 0.66-0.83) for TOF-MRA and κ = 0.72 (95% CI, 0.63-0.80) for contrast-enhanced MRA. Occlusion localization differed significantly on TOF-MRA compared with DSA (P < .001), while no significant difference was observed between DSA and contrast-enhanced MRA (P = .75). Assessment of collaterals showed very good agreement between contrast-enhanced MRA and DSA (94.9% with P = .25), but only fair agreement between TOF-MRA and DSA (23.2% with P < .001). CONCLUSIONS Contrast-enhanced MRA offers better diagnostic accuracy than TOF-MRA in acute ischemic stroke. Contrast-enhanced MRA was superior in localizing vessel occlusion within a shorter acquisition time while providing a larger coverage, including extracranial vessels, and a more accurate assessment of collateral status. These results support inclusion of contrast-enhanced MRA in acute stroke MR imaging, perhaps making TOF-MRA superfluous.
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Affiliation(s)
- T Boujan
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - U Neuberger
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - J Pfaff
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - S Nagel
- Neurology (S.N.), University of Heidelberg Medical Center, Heidelberg, Germany
| | - C Herweh
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - M Bendszus
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
| | - M A Möhlenbruch
- From the Departments of Neuroradiology (T.B., U.N., J.P., C.H., M.B., M.M.)
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15
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Kaufhold L, Harloff A, Schumann C, Krafft AJ, Hennig J, Hennemuth A. Image-based assessment of uncertainty in quantification of carotid lumen. J Med Imaging (Bellingham) 2018; 5:034003. [PMID: 30840745 PMCID: PMC6152582 DOI: 10.1117/1.jmi.5.3.034003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/31/2018] [Indexed: 09/01/2023] Open
Abstract
Measurements of the vessel lumen diameter are often used to determine the degree of atherosclerotic disease in carotid arteries. However, quantification results vary with imaging technique and acquisition settings. We aim at providing a tool that quantifies the lumen diameter on different image datasets and gives an estimate of quantification uncertainties, so that they can be taken into consideration when evaluating and comparing measurements. For the segmentation of the vessel lumen, we present an algorithm using ray-casting techniques and partial volume correction. We furthermore propose a scheme for the analysis and exploration of the lumen diameter. Finally, we present a clinically relevant application scenario, in which we explore agreement between lumen diameter estimations in corresponding computed tomography angiography, contrast-enhanced magnetic resonance angiography, time-of-flight, and subtraction images of carotid vessels with severe carotid atherosclerotic plaques.
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Affiliation(s)
- Lilli Kaufhold
- Fraunhofer MEVIS, Bremen, Germany
- Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Andreas Harloff
- Medical Center—University of Freiburg, Department of Neurology and Neurophysiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Axel J. Krafft
- Medical Center—University of Freiburg, Department of Radiology—Medical Physics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Hennig
- Medical Center—University of Freiburg, Department of Radiology—Medical Physics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anja Hennemuth
- Fraunhofer MEVIS, Bremen, Germany
- Charité-Universitaetsmedizin Berlin, Berlin, Germany
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16
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Bhatti MS, Tang TB, Chen HC. Ocular Blood Flow in Rabbits under Deep Anesthesia: A Real-Time Measurement Technique and Its Application in Characterizing Retinal Ischemia. Sci Rep 2018; 8:5713. [PMID: 29632320 PMCID: PMC5890247 DOI: 10.1038/s41598-018-24141-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 03/28/2018] [Indexed: 12/28/2022] Open
Abstract
In this study, we reported a new technique based on laser speckle flowgraphy to record the ocular blood flow in rabbits under deep anesthesia, and proposed parameters to characterize retinal ischemia. We applied the proposed technique to study the correlation of blood flow between the eyes of normal non-anesthetized animals, and to characterize the occlusion of the internal carotid artery (ICA) and external carotid artery (ECA). We established a correlation in blood flow between the eyes of non-anesthetized animals, and derived two new parameters, namely, the laterality index and vascular perfusion estimate (VPE). Our experimental results from 16 eyes (of 13 New Zealand white rabbits) showed a reduction in ocular blood flow with a significant decrease in the VPE after the occlusion of the ECA (p < 0.001). A low/minimal effect on blood flow was observed with the occlusion of the ICA. In conclusion, we demonstrated a means for the real-time measurement of the ocular blood flow in rabbits under deep anesthesia by using laser speckle flowgraphy and the VPE as an indicator of successful occlusion. The proposed technique might be applicable in quantifying the efficacy of new drugs and interventions for the treatment of retinal ischemia.
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Affiliation(s)
- Mehwish Saba Bhatti
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical & Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak, Malaysia
| | - Tong Boon Tang
- Centre for Intelligent Signal and Imaging Research (CISIR), Department of Electrical & Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar, 32610, Perak, Malaysia.
| | - Hui Cheng Chen
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, 43400 UPM, Serdang, Malaysia
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17
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Pourier VEC, van Laarhoven CJHCM, Vergouwen MDI, Rinkel GJE, de Borst GJ. Prevalence of extracranial carotid artery aneurysms in patients with an intracranial aneurysm. PLoS One 2017; 12:e0187479. [PMID: 29131823 PMCID: PMC5683613 DOI: 10.1371/journal.pone.0187479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022] Open
Abstract
Background and purpose Aneurysms in various arterial beds have common risk- and genetic factors. Data on the correlation of extracranial carotid artery aneurysms (ECAA) with aneurysms in other vascular territories are lacking. We aimed to investigate the prevalence of ECAA in patients with an intracranial aneurysm (IA). Methods We used prospectively collected databases of consecutive patients registered at the University Medical Center Utrecht with an unruptured intracranial aneurysm (UIA) or aneurysmal Subarachnoid hemorrhage (SAH). The medical files of patients included in both databases were screened for availability of radiological reports, imaging of the brain and of the cervical carotid arteries. All available radiological images were then reviewed primarily for the presence of an ECAA and secondarily for an extradural/cavernous carotid or vertebral artery aneurysm. An ECAA was defined as a fusiform dilation ≥150% of the normal internal or common carotid artery or a saccular distention of any size. Results We screened 4465 patient records (SAH database n = 3416, UIA database n = 1049), of which 2931 had radiological images of the carotid arteries available. An ECAA was identified in 12/638 patients (1.9%; 95% CI 1.1–3.3) with completely imaged carotid arteries and in 15/2293 patients (0.7%; 95% CI 0.4–1.1) with partially depicted carotid arteries. Seven out of 27 patients had an additional extradural (cavernous or vertebral artery) aneurysm. Conclusions This comprehensive study suggests a prevalence for ECAA of approximately 2% of patients with an IA. The rarity of the disease makes screening unnecessary so far. Future registry studies should study the factors associated with IA and ECAA to estimate the prevalence of ECAA in these young patients more accurately.
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Affiliation(s)
- V. E. C. Pourier
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan Utrecht, The Netherlands
| | | | - M. D. I. Vergouwen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Heidelberglaan Utrecht, the Netherlands
| | - G. J. E. Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Heidelberglaan Utrecht, the Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Heidelberglaan Utrecht, The Netherlands
- * E-mail:
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18
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Jiang H, Zhang J, Wu J, Wei G, He Y, Gao X. Neutrophil-to-Lymphocyte Ratio Correlates with Severity of Extracranial Carotid Stenosis—A Study Using Digital Subtraction Angiography. J Stroke Cerebrovasc Dis 2017; 26:1182-1190. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/04/2016] [Accepted: 01/04/2017] [Indexed: 12/29/2022] Open
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19
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Barlinn K, Floegel T, Kitzler HH, Kepplinger J, Siepmann T, Pallesen LP, Bodechtel U, Reichmann H, Alexandrov AV, Puetz V. Multi-parametric ultrasound criteria for internal carotid artery disease-comparison with CT angiography. Neuroradiology 2016; 58:845-51. [PMID: 27230916 DOI: 10.1007/s00234-016-1706-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The German Society of Ultrasound in Medicine (known by its acronym DEGUM) recently proposed a novel multi-parametric ultrasound approach for comprehensive and accurate assessment of extracranial internal carotid artery (ICA) steno-occlusive disease. We determined the agreement between duplex ultrasonography (DUS) interpreted by the DEGUM criteria and CT angiography (CTA) for grading of extracranial ICA steno-occlusive disease. METHODS Consecutive patients with acute cerebral ischemia underwent DUS and CTA. Internal carotid artery stenosis was graded according to the DEGUM-recommended criteria for DUS. Independent readers manually performed North American Symptomatic Carotid Endarterectomy Trial-type measurements on axial CTA source images. Both modalities were compared using Spearman's correlation and Bland-Altman analyses. RESULTS A total of 303 acute cerebral ischemia patients (mean age, 72 ± 12 years; 58 % men; median baseline National Institutes of Health Stroke Scale score, 4 [interquartile range 7]) provided 593 DUS and CTA vessel pairs for comparison. There was a positive correlation between DUS and CTA (r s = 0.783, p < 0.001) with mean difference in degree of stenosis measurement of 3.57 %. Bland-Altman analysis further revealed widely varying differences (95 % limits of agreement -29.26 to 22.84) between the two modalities. CONCLUSION Although the novel DEGUM criteria showed overall good agreement between DUS and CTA across all stenosis ranges, potential for wide incongruence with CTA underscores the need for local laboratory validation to avoid false screening results.
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Affiliation(s)
- Kristian Barlinn
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Thomas Floegel
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.,Department of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Hagen H Kitzler
- Department of Neuroradiology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Jessica Kepplinger
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Lars-Peder Pallesen
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ulf Bodechtel
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Volker Puetz
- Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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20
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Borhani-Haghighi A, Emami M, Vasaksi AS, Shariat A, Banihashemi MA, Nikseresht A, Ashjazadeh N, Izadi S, Petramfar P, Poursadegh M, Jaberi AR, Emami S, Agheli H, Nemati R, Yaghoubi E, Abdi MH, Mohammadi M, Jafari P, Cruz-Flores S, Edgell R. Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors. JOURNAL OF VASCULAR AND INTERVENTIONAL NEUROLOGY 2015; 8:11-16. [PMID: 25825626 PMCID: PMC4367801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA). METHODS This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects. RESULTS A total of 3703 stroke patients were identified. Of them, 342 patients (62.3%, male) underwent DSA for LAD. The mean age at the time of angiography was 66.7±10.3 years. Extracranial and intracranial arteries were involved in 305 (89.2%) and 162 (47.4%), respectively. And 301 patients (88%) had anterior circulation and 128 patients (37.4%) had posterior circulation involvement. Diabetes mellitus but not age, sex, hypertension, hyperlipidemia, or smoking was significantly associated with intracranial involvement. (P = 0.002). CONCLUSION It can be concluded that the distribution of the large arterial atherosclerotic disease in Iran is similar to that seen in North America and Europe. Intracranial stenosis was more prevalent in diabetic patients.
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Affiliation(s)
- Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Emami
- Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Abdolhamid Shariat
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Alireza Nikseresht
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Ashjazadeh
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sadegh Izadi
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Poursadegh
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rahimi Jaberi
- Departments of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajjad Emami
- Department of Neurology, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Hamid Agheli
- Neurologist, Shahidzadeh Hospital, Behbahan, Iran
| | - Reza Nemati
- Department of Neurology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ehsan Yaghoubi
- Department of Neurology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | | | | | - Peyman Jafari
- Departments of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Randal Edgell
- Departments of Neurology and Psychiatry , Saint Louis University, Saint Louis, USA
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Assessment of Arterial Collateralization and Its Relevance to Intra-arterial Therapy for Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2014; 23:399-407. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 03/12/2013] [Indexed: 11/16/2022] Open
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22
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Herzberg M, Boy S, Hölscher T, Ertl M, Zimmermann M, Ittner KP, Pemmerl J, Pels H, Bogdahn U, Schlachetzki F. Prehospital stroke diagnostics based on neurological examination and transcranial ultrasound. Crit Ultrasound J 2014; 6:3. [PMID: 24572006 PMCID: PMC3996057 DOI: 10.1186/2036-7902-6-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 02/07/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Transcranial color-coded sonography (TCCS) has proved to be a fast and reliable tool for the detection of middle cerebral artery (MCA) occlusions in a hospital setting. In this feasibility study on prehospital sonography, our aim was to investigate the accuracy of TCCS for neurovascular emergency diagnostics when performed in a prehospital setting using mobile ultrasound equipment as part of a neurological examination. METHODS Following a '911 stroke code' call, stroke neurologists experienced in TCCS rendezvoused with the paramedic team. In patients with suspected stroke, TCCS examination including ultrasound contrast agents was performed. Results were compared with neurovascular imaging (CTA, MRA) and the final discharge diagnosis from standard patient-centered stroke care. RESULTS We enrolled '232 stroke code' patients with follow-up data available in 102 patients with complete TCCS examination. A diagnosis of ischemic stroke was made in 73 cases; 29 patients were identified as 'stroke mimics'. MCA occlusion was diagnosed in ten patients, while internal carotid artery (ICA) occlusion/high-grade stenosis leading to reversal of anterior cerebral artery flow was diagnosed in four patients. The initial working diagnosis 'any stroke' showed a sensitivity of 94% and a specificity of 48%. 'Major MCA or ICA stroke' diagnosed by mobile ultrasound showed an overall sensitivity of 78% and specificity of 98%. CONCLUSIONS The study demonstrates the feasibility and high diagnostic accuracy of emergency transcranial ultrasound assessment combined with neurological examinations for major ischemic stroke. Future combination with telemedical support, point-of-care analysis of blood serum markers, and probability algorithms of prehospital stroke diagnosis including ultrasound may help to speed up stroke treatment.
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Affiliation(s)
- Moriz Herzberg
- Department of Neurology, University of Regensburg, Community District Hospital, Universitätsstr.84, Regensburg 93053, Germany
| | - Sandra Boy
- Department of Neurology, University of Regensburg, Community District Hospital, Universitätsstr.84, Regensburg 93053, Germany
| | - Thilo Hölscher
- Department of Radiology and Neuroscience, University of California San Diego, San Diego, CA, USA
| | - Michael Ertl
- Department of Neurology, University of Regensburg, Community District Hospital, Universitätsstr.84, Regensburg 93053, Germany
| | - Markus Zimmermann
- Department of Emergency Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Karl-Peter Ittner
- Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Hendrik Pels
- Department of Neurology, Krankenhaus der Barmherzigen Brüder Regensburg, Regensburg, Germany
| | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Community District Hospital, Universitätsstr.84, Regensburg 93053, Germany
| | - Felix Schlachetzki
- Department of Neurology, University of Regensburg, Community District Hospital, Universitätsstr.84, Regensburg 93053, Germany
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Liang JT, Huo LR, Bao YH, Wang ZY, Ling F. Cerebral vasculopathy in a Chinese family with neurofibromatosis type I mutation. Neurosci Bull 2013; 29:708-14. [PMID: 24218100 DOI: 10.1007/s12264-013-1388-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/22/2013] [Indexed: 01/03/2023] Open
Abstract
Neurofibromatosis type I (NF1) is a hereditary, autosomal dominant, neurocutaneous syndrome that is attributed to NF1 gene mutation. NF1 has been associated with scoliosis, macrocephaly, pseudoarthrosis, short stature, mental retardation, and malignancies. NF1-associated vasculopathy is an uncommon and easily-overlooked presentation. Examination of a Chinese family affected by NF1 combined with cerebral vessel stenosis and/or abnormality suggested a possible relationship between NF1 and vessel stenosis. To determine which NF1 gene mutation is associated with vascular lesions, particularly cerebral vessel stenosis, we examined one rare family with combined cerebral vessel lesions or maldevelopment. Vascular lesions were detected using transcranial Doppler sonography and digital subtraction angiography in family members. Next, denaturing high-performance liquid chromatography and sequencing were used to screen for NF1 gene mutations. The results revealed a nonsense mutation, c.541C>T, in the NF1 gene. This mutation truncated the NF1 protein by 2659 amino-acid residues at the C-terminus and co-segregated with all of the patients, but was not present in unaffected individuals in the family. Exceptionally, three novel mutations were identified in unaffected family members, but these did not affect the product of the NF1 gene. Thus the nonsense mutation, c.541C>T, located in the NF1 gene could constitute one genetic factor for cerebral vessel lesions.
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Affiliation(s)
- Jian-Tao Liang
- Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, 100053, China
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Pacheco FT, Rocha AJD, Littig IA, Júnior ACMM, Gagliardi RJ. Multiparametric multidetector computed tomography scanning on suspicion of hyperacute ischemic stroke: validating a standardized protocol. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:349-56. [PMID: 23828536 DOI: 10.1590/0004-282x20130037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 11/29/2012] [Indexed: 11/22/2022]
Abstract
Multidetector computed tomography (MDCT) scanning has enabled the early diagnosis of hyperacute brain ischemia. We aimed at validating a standardized protocol to read and report MDCT techniques in a series of adult patients. The inter-observer agreement among the trained examiners was tested, and their results were compared with a standard reading. No false positives were observed, and an almost perfect agreement (Kappa>0.81) was documented when the CT angiography (CTA) and cerebral perfusion CT (CPCT) map data were added to the noncontrast CT (NCCT) analysis. The inter-observer agreement was higher for highly trained readers, corroborating the need for specific training to interpret these modern techniques. The authors recommend adding CTA and CPCT to the NCCT analysis in order to clarify the global analysis of structural and hemodynamic brain abnormalities. Our structured report is suitable as a script for the reproducible analysis of the MDCT of patients on suspicion of ischemic stroke.
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Affiliation(s)
- Felipe Torres Pacheco
- Division of Neuroradiology, Santa Casa de Misericórdia de São Paulo, São PauloSP, Brazil
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25
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Kepplinger J, Dzialowski I, Barlinn K, Puetz V, Wojciechowski C, Schneider H, Gahn G, Back T, Schackert G, Reichmann H, von Kummer R, Bodechtel U. Emergency Transfer of Acute Stroke Patients within the East Saxony Telemedicine Stroke Network: A Descriptive Analysis. Int J Stroke 2013; 9:160-5. [DOI: 10.1111/ijs.12032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Telemedicine may facilitate the selection of stroke patients who require emergency transfer to a comprehensive stroke center to receive additional therapies other than intravenous tissue plasminogen activator. Aims and/or hypothesis We sought to analyze frequency, patient characteristics, and specific therapies among emergently transferred patients within the telemedical Stroke East Saxony Network. Methods We reviewed consecutive patients who were transferred emergently from remote spoke sites to hub sites. Certified stroke neurologists performed teleconsultations 24/7, with access to high-speed videoconferencing and transfer of brain images. Emergent transfers were initiated when considered necessary by the stroke neurologist. Results In 2009 and 2010, we conducted 1413 teleconsultations and subsequently recommended transfer in 339 (24%) patients [mean age 64 ± 14 years, 54% males, median National Institutes of Health Stroke Scale score 5 (interquartile range, IQR 12). The mean teleconsultation-to-arrival time was 1·7 ± 0·8 h (median 1·6 h). Sixty-eight (20%) transferred patients had a nonstroke diagnosis. The remaining 271 (80%) patients had stroke diagnoses [ischemic stroke, 114 (34%); transient ischemic attack, 8 (2%); and intracranial haemorrhage, 149 (44%)]. Forty (35%) ischemic stroke patients received tissue plasminogen activator at spoke sites (‘drip and ship’). Of the 240 stroke patients emergently transferred to the main hub site, 119 (49·6%) received at least one specific stroke therapy. Conclusion A remarkable number of stroke patients can be transferred within a telemedical network to enable the delivery of specific stroke therapies that require advanced multispecialty expertise. Whether associated logistic efforts and costs have an impact on patients' clinical outcomes needs to be evaluated.
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Affiliation(s)
- Jessica Kepplinger
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Imanuel Dzialowski
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Volker Puetz
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Claudia Wojciechowski
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Hauke Schneider
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Georg Gahn
- Department of Neurology, Community Hospital Karlsruhe, Karlsruhe, Germany
| | - Tobias Back
- Department of Neurology, Saxon Hospital Arnsdorf, Arnsdorf, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Ruediger von Kummer
- Department of Neuroradiology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
| | - Ulf Bodechtel
- Department of Neurology, Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
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