1
|
Jiang J, Sheng K, Li M, Zhao H, Guan B, Dai L, Li Y. A dual-energy computed tomography-based radiomics nomogram for predicting time since stroke onset: a multicenter study. Eur Radiol 2024:10.1007/s00330-024-10802-8. [PMID: 38834786 DOI: 10.1007/s00330-024-10802-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/25/2024] [Accepted: 04/06/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES We aimed to develop and validate a radiomics nomogram based on dual-energy computed tomography (DECT) images and clinical features to classify the time since stroke (TSS), which could facilitate stroke decision-making. MATERIALS AND METHODS This retrospective three-center study consecutively included 488 stroke patients who underwent DECT between August 2016 and August 2022. The eligible patients were divided into training, test, and validation cohorts according to the center. The patients were classified into two groups based on an estimated TSS threshold of ≤ 4.5 h. Virtual images optimized the visibility of early ischemic lesions with more CT attenuation. A total of 535 radiomics features were extracted from polyenergetic, iodine concentration, virtual monoenergetic, and non-contrast images reconstructed using DECT. Demographic factors were assessed to build a clinical model. A radiomics nomogram was a tool that the Rad score and clinical factors to classify the TSS using multivariate logistic regression analysis. Predictive performance was evaluated using receiver operating characteristic (ROC) analysis, and decision curve analysis (DCA) was used to compare the clinical utility and benefits of different models. RESULTS Twelve features were used to build the radiomics model. The nomogram incorporating both clinical and radiomics features showed favorable predictive value for TSS. In the validation cohort, the nomogram showed a higher AUC than the radiomics-only and clinical-only models (AUC: 0.936 vs 0.905 vs 0.824). DCA demonstrated the clinical utility of the radiomics nomogram model. CONCLUSIONS The DECT-based radiomics nomogram provides a promising approach to predicting the TSS of patients. CLINICAL RELEVANCE STATEMENT The findings support the potential clinical use of DECT-based radiomics nomograms for predicting the TSS. KEY POINTS Accurately determining the TSS onset is crucial in deciding a treatment approach. The radiomics-clinical nomogram showed the best performance for predicting the TSS. Using the developed model to identify patients at different times since stroke can facilitate individualized management.
Collapse
Affiliation(s)
- Jingxuan Jiang
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Kai Sheng
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minda Li
- Department of Radiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Huilin Zhao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Baohui Guan
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lisong Dai
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Li
- Institute of Diagnostic and Interventional Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
2
|
Rebchuk AD, Hill MD, Goyal M, Demchuk A, Coutts SB, Asdaghi N, Dowlatshahi D, Holodinsky JK, Fainardi E, Shankar J, Najm M, Rubiera M, Khaw AV, Qiu W, Menon BK, Field TS. Exploring sex differences for acute ischemic stroke clinical, imaging and thrombus characteristics in the INTERRSeCT study. J Cereb Blood Flow Metab 2023; 43:1803-1809. [PMID: 37459107 PMCID: PMC10581233 DOI: 10.1177/0271678x231189908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 10/17/2023]
Abstract
Women, especially following menopause, are known to have worse outcomes following acute ischemic stroke. One primary postulated biological mechanism for worse outcomes in older women is a reduction in the vasculoprotective effects of estrogen. Using the INTERRseCT cohort, a multicentre international observational cohort studying recanalization in acute ischemic stroke, we explored the effects of sex, and modifying effects of age, on neuroradiological predictors of recanalization including robustness of leptomeningeal collaterals, thrombus burden and thrombus permeability. Ordinal regression analyses were used to examine the relationship between sex and each of the neuroradiological markers. Further, we explored both multiplicative and additive interactions between age and sex. All patients (n = 575) from INTERRseCT were included. Mean age was 70.2 years (SD: 13.1) and 48.5% were women. In the unadjusted model, female sex was associated with better collaterals (OR 1.37, 95% CIs: 1.01-1.85), however this relationship was not significant after adjusting for age and relevant comorbidities. There were no significant interactions between age and sex. In a large prospective international cohort, we found no association between sex and radiological predictors of recanalization including leptomeningeal collaterals, thrombus permeability and thrombus burden.
Collapse
Affiliation(s)
- Alexander D Rebchuk
- Division of Neurosurgery, University of British Columbia, Vancouver, BC, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Mayank Goyal
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Andrew Demchuk
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Shelagh B Coutts
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Negar Asdaghi
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dar Dowlatshahi
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine (Neurology), University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jessalyn K Holodinsky
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Enrico Fainardi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
| | - Mohamed Najm
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marta Rubiera
- Neurology Department, Hospital Vall d’Hebron, Barcelona, Spain
| | - Alexander V Khaw
- Department of Clinical Neurosciences, University of Western Ontario, London, ON, Canada
| | - Wu Qiu
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Bijoy K Menon
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Vancouver Stroke Program, Vancouver, BC, Canada
| |
Collapse
|
3
|
Dolotova DD, Blagosklonova ER, Muslimov RS, Ramazanov GR, Zagryazkina TA, Stepanov VN, Gavrilov AV. Inter-Rater Reliability of Collateral Status Assessment Based on CT Angiography: A Retrospective Study of Middle Cerebral Artery Ischaemic Stroke. J Clin Med 2023; 12:5470. [PMID: 37685536 PMCID: PMC10487547 DOI: 10.3390/jcm12175470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023] Open
Abstract
The importance of assessing the collateral status (CS) in patients with ischaemic stroke (IS) has repeatedly been emphasised in clinical guidelines. Various publications offer qualitative or semiquantitative scales with gradations corresponding to the different extents of the collaterals, visualised mostly on the basis of CTA images. However, information on their inter-rater reliability is limited. Therefore, the aim of this study is to investigate the inter-rater reliability of the scales for collateral assessment. CTA images of 158 patients in the acute period of IS were used in the study. The assessment of CS was performed by two experts using three methodologies: the modified Tan scale, the Miteff scale, and the Rosenthal scale. Cohen's kappa, weighted kappa and Krippendorff's alpha were used as reliability measures. For the modified Tan scale and the Miteff and Rosenthal scales, the weighted kappa values were 0.72, 0.49 and 0.59, respectively. Although the best measure of consistency was found for the modified Tan scale, no statistically significant differences were revealed among the scales. The impact of the CS on the degree of neurological deficit at discharge was shown for the modified Tan and Rosenthal scales. In conclusion, the analysis showed a moderate inter-rater reliability of the three scales, but was not able to distinguish the best one among them.
Collapse
Affiliation(s)
- Daria D. Dolotova
- Department of Bioinformatics, Department of Pediatric Surgery, Pirogov Russian National Research Medical University, Russian Ministry of Health, 117997 Moscow, Russia
- Research Department, Gammamed-Soft, Ltd., 127473 Moscow, Russia
| | | | - Rustam Sh. Muslimov
- Department of Radiology, Scientific Department of Emergency Neurology and Rehabilitation Treatment, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, 129090 Moscow, Russia
| | - Ganipa R. Ramazanov
- Department of Radiology, Scientific Department of Emergency Neurology and Rehabilitation Treatment, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, 129090 Moscow, Russia
| | | | - Valentin N. Stepanov
- Department of Radiology, Scientific Department of Emergency Neurology and Rehabilitation Treatment, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, 129090 Moscow, Russia
| | - Andrey V. Gavrilov
- Research Department, Gammamed-Soft, Ltd., 127473 Moscow, Russia
- Scobeltsyn Nuclear Physics Research Institute, Lomonosov Moscow State University, 119991 Moscow, Russia
| |
Collapse
|
4
|
Sperti M, Arba F, Acerbi A, Busto G, Fainardi E, Sarti C. Determinants of cerebral collateral circulation in acute ischemic stroke due to large vessel occlusion. Front Neurol 2023; 14:1181001. [PMID: 37265461 PMCID: PMC10230086 DOI: 10.3389/fneur.2023.1181001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Cerebral collateral circulation has a central role in ischemic stroke pathophysiology, and it is considered to correlate with infarct size, the success of reperfusion therapies, and clinical outcomes. Our aim was to study the factors influencing the development of collaterals in patients with acute ischemic stroke eligible for endovascular treatment. Materials and methods We enrolled patients with acute ischemic stroke and large vessel occlusion of anterior circulation potentially eligible for endovascular treatment. Included patients performed multiphase CT angiography to assess collaterals that were graded by the Menon Grading Score. We investigated the associations between clinical factors and collaterals and tested independent associations with logistic (good vs. poor collaterals) and ordinal (collateral grade grouped, Menon 0-2, 3, 4-5) regression analysis adjusting for age, sex, stroke severity, and onset to CT time (OCTT). Results We included 520 patients, the mean age was 75 (±13.6) years, 215 (41%) were men, and the median (IQR) NIHSS was 17 (11-22). Good collaterals were present in 323 (62%) patients and were associated with lower NIHSS (median 16 vs. 18; p < 0.001) and left hemisphere involvement (60% vs. 45%; p < 0.001), whereas previous stroke/TIA was more frequent in patients with poor collaterals (17 vs. 26%; p = 0.014). These results were confirmed in both logistic and ordinal regression analyses where good collaterals were associated with lower NIHSS (OR = 0.94; 95% CI = 0.91-0.96; cOR = 0.95; 95% CI = 0.92-0.97, respectively) and left hemisphere stroke (OR = 2.24; 95% CI = 1.52-3.28; cOR = 2.11; 95% CI = 1.46-3.05, respectively), while previous stroke/TIA was associated with poor collaterals (OR = 0.57; 95% CI = 0.36-0.90; cOR = 0.61; 95% CI = 0.40-0.94, respectively). Vascular risk factors, demographics, and pre-stroke treatments did not influence the collateral score. Discussion The results of our study suggest that risk factors and demographics do not influence the development of collateral circles, except for a negative relation with previous ischemic events. We confirm an already reported observation of a possible protective effect of collaterals on tissue damage assuming NIHSS as its surrogate. The association between left hemispheric stroke and better collaterals deserves to be further explored. Further efforts are needed to identify the factors that favor the development of collaterals.
Collapse
Affiliation(s)
- Martina Sperti
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Francesco Arba
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Amedeo Acerbi
- Department of Neurofarba, University of Florence, Florence, Italy
| | - Giorgio Busto
- Neuroradiology, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology, Careggi University Hospital, Florence, Italy
| | - Cristina Sarti
- Department of Neurofarba, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
| |
Collapse
|
5
|
Uniken Venema SM, Dankbaar JW, van der Lugt A, Dippel DWJ, van der Worp HB. Cerebral Collateral Circulation in the Era of Reperfusion Therapies for Acute Ischemic Stroke. Stroke 2022; 53:3222-3234. [PMID: 35938420 DOI: 10.1161/strokeaha.121.037869] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical outcomes of patients with acute ischemic stroke depend in part on the extent of their collateral circulation. A good collateral circulation has also been associated with greater benefit of intravenous thrombolysis and endovascular treatment. Treatment decisions for these reperfusion therapies are increasingly guided by a combination of clinical and imaging parameters, particularly in later time windows. Computed tomography and magnetic resonance imaging enable a rapid assessment of both the collateral extent and cerebral perfusion. Yet, the role of the collateral circulation in clinical decision-making is currently limited and may be underappreciated due to the use of rather coarse and rater-dependent grading methods. In this review, we discuss determinants of the collateral circulation in patients with acute ischemic stroke, report on commonly used and emerging neuroimaging techniques for assessing the collateral circulation, and discuss the therapeutic and prognostic implications of the collateral circulation in relation to reperfusion therapies for acute ischemic stroke.
Collapse
Affiliation(s)
- Simone M Uniken Venema
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands. (S.M.U.V., H.B.v.d.W.)
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, the Netherlands. (J.W.D.)
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center Rotterdam, the Netherlands. (A.v.d.L.)
| | - Diederik W J Dippel
- Department of Neurology, Erasmus Medical Center Rotterdam, the Netherlands. (D.W.J.D.)
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands. (S.M.U.V., H.B.v.d.W.)
| |
Collapse
|