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Lu SS. Multiphase MR angiography collateral map in brain stroke: may we shift the time from an absolute to the relative for therapy decisions? Eur Radiol 2024; 34:1409-1410. [PMID: 37814106 DOI: 10.1007/s00330-023-10275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/02/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Shan-Shan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Yi JS, Ki HJ, Jeon YS, Park JJ, Lee TJ, Kwak JT, Lee SB, Lee HJ, Kim IS, Kim JH, Lee JS, Roh HG, Kim HJ. The collateral map: prediction of lesion growth and penumbra after acute anterior circulation ischemic stroke. Eur Radiol 2024; 34:1411-1421. [PMID: 37646808 PMCID: PMC10873223 DOI: 10.1007/s00330-023-10084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES This study evaluated the collateral map's ability to predict lesion growth and penumbra after acute anterior circulation ischemic strokes. METHODS This was a retrospective analysis of selected data from a prospectively collected database. The lesion growth ratio was the ratio of the follow-up lesion volume to the baseline lesion volume on diffusion-weighted imaging (DWI). The time-to-maximum (Tmax)/DWI ratio was the ratio of the baseline Tmax > 6 s volume to the baseline lesion volume. The collateral ratio was the ratio of the hypoperfused lesion volume of the phase_FU (phase with the hypoperfused lesions most approximate to the follow-up DWI lesion) to the hypoperfused lesion volume of the phase_baseline of the collateral map. Multiple logistic regression analyses were conducted to identify independent predictors of lesion growth. The concordance correlation coefficients of Tmax/DWI ratio and collateral ratio for lesion growth ratio were analyzed. RESULTS Fifty-two patients, including twenty-six males (mean age, 74 years), were included. Intermediate (OR, 1234.5; p < 0.001) and poor collateral perfusion grades (OR, 664.7; p = 0.006) were independently associated with lesion growth. Phase_FUs were immediately preceded phases of the phase_baselines in intermediate or poor collateral perfusion grades. The concordance correlation coefficients of the Tmax/DWI ratio and collateral ratio for the lesion growth ratio were 0.28 (95% CI, 0.17-0.38) and 0.88 (95% CI, 0.82-0.92), respectively. CONCLUSION Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. Further studies are needed to generalize the findings of this study. CLINICAL RELEVANCE STATEMENT Precise prediction of lesion growth and penumbra can be possible using collateral maps, allowing for personalized application of recanalization treatments. KEY POINTS • Cell viability in cerebral ischemia due to proximal arterial steno-occlusion mainly depends on the collateral circulation. • The collateral map shows salvageable brain extent, which can survive by recanalization treatments after acute anterior circulation ischemic stroke. • Precise estimation of salvageable brain makes it possible to make patient-specific treatment decision.
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Affiliation(s)
- Jin Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Hee Jong Ki
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yoo Sung Jeon
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Taek-Jun Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jin Tae Kwak
- School of Electrical Engineering, Korea University, Seoul, Republic of Korea
| | - Sang Bong Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Hyung Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - In Seong Kim
- Siemens Healthineers Ltd., Seoul, Republic of Korea
| | - Joo Hyun Kim
- Philips Healthcare Korea, Seoul, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-Ro, Kwangjin-Gu, Seoul, 05030, Republic of Korea.
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea.
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Jeon YS, Kim HJ, Roh HG, Lee TJ, Park JJ, Lee SB, Lee HJ, Kwak JT, Lee JS, Ki HJ. Impact of Collateral Circulation on Futile Endovascular Thrombectomy in Acute Anterior Circulation Ischemic Stroke. J Korean Neurosurg Soc 2024; 67:31-41. [PMID: 37536707 PMCID: PMC10788550 DOI: 10.3340/jkns.2023.0139] [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: 07/01/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Collateral circulation is associated with the differential treatment effect of endovascular thrombectomy (EVT) in acute ischemic stroke. We aimed to verify the ability of the collateral map to predict futile EVT in patients with acute anterior circulation ischemic stroke. METHODS This secondary analysis of a prospective observational study included data from participants underwent EVT for acute ischemic stroke due to occlusion of the internal carotid artery and/or the middle cerebral artery within 8 hours of symptom onset. Multiple logistic regression analyses were conducted to identify independent predictors of futile recanalization (modified Rankin scale score at 90 days of 4-6 despite of successful reperfusion). RESULTS In a total of 214 participants, older age (odds ratio [OR], 2.40; 95% confidence interval [CI], 1.56 to 3.67; p<0.001), higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (OR, 1.12; 95% CI, 1.04 to 1.21; p=0.004), very poor collateral perfusion grade (OR, 35.09; 95% CI, 3.50 to 351.33; p=0.002), longer door-to-puncture time (OR, 1.08; 95% CI, 1.02 to 1.14; p=0.009), and failed reperfusion (OR, 3.73; 95% CI, 1.30 to 10.76; p=0.015) were associated with unfavorable functional outcomes. In 184 participants who achieved successful reperfusion, older age (OR, 2.30; 95% CI, 1.44 to 3.67; p<0.001), higher baseline NIHSS scores (OR, 1.12; 95% CI, 1.03 to 1.22; p=0.006), very poor collateral perfusion grade (OR, 4.96; 95% CI, 1.42 to 17.37; p=0.012), and longer door-to-reperfusion time (OR, 1.09; 95% CI, 1.03 to 1.15; p=0.003) were associated with unfavorable functional outcomes. CONCLUSION The assessment of collateral perfusion status using the collateral map can predict futile EVT, which may help select ineligible patients for EVT, thereby potentially reducing the rate of futile EVT.
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Affiliation(s)
- Yoo Sung Jeon
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Taek-Jun Lee
- Department of Neurology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Sang Bong Lee
- Department of Neurology, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hyung Jin Lee
- Department of Neurosurgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jin Tae Kwak
- School of Electrical Engineering, Korea University, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jong Ki
- Department of Neurosurgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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You SH, Cho Y, Kim B, Yang KS, Kim I, Kim BK, Pak A, Park SE. Deep Learning-Based Synthetic TOF-MRA Generation Using Time-Resolved MRA in Fast Stroke Imaging. AJNR Am J Neuroradiol 2023; 44:1391-1398. [PMID: 38049991 PMCID: PMC10714844 DOI: 10.3174/ajnr.a8063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/17/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND PURPOSE Time-resolved MRA enables collateral evaluation in acute ischemic stroke with large-vessel occlusion; however, a low SNR and spatial resolution impede the diagnosis of vascular occlusion. We developed a CycleGAN-based deep learning model to generate high-resolution synthetic TOF-MRA images using time-resolved MRA and evaluated its image quality and clinical efficacy. MATERIALS AND METHODS This retrospective, single-center study included 397 patients who underwent both TOF- and time-resolved MRA between April 2021 and January 2022. Patients were divided into 2 groups for model development and image-quality validation. Image quality was evaluated qualitatively and quantitatively with 3 sequences. A multireader diagnostic optimality evaluation was performed by 16 radiologists. For clinical validation, we evaluated 123 patients who underwent fast stroke MR imaging to assess acute ischemic stroke. The diagnostic confidence level and decision time for large-vessel occlusion were also evaluated. RESULTS Median values of overall image quality, noise, sharpness, venous contamination, and SNR for M1, M2, the basilar artery, and posterior cerebral artery are better with synthetic TOF than with time-resolved MRA. However, with respect to real TOF, synthetic TOF presents worse median values of overall image quality, sharpness, vascular conspicuity, and SNR for M3, the basilar artery, and the posterior cerebral artery. During the multireader evaluation, radiologists could not discriminate synthetic TOF images from TOF images. During clinical validation, both readers demonstrated increases in diagnostic confidence levels and decreases in decision time. CONCLUSIONS A CycleGAN-based deep learning model was developed to generate synthetic TOF from time-resolved MRA. Synthetic TOF can potentially assist in the detection of large-vessel occlusion in stroke centers using time-resolved MRA.
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Affiliation(s)
- Sung-Hye You
- From the Department of Radiology, (S.-H.Y., B.K., B.K.K., A.P., S.E.P.), Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yongwon Cho
- Biomedical Research Center (Y.C.), Korea University College of Medicine, Seoul, Korea
| | - Byungjun Kim
- From the Department of Radiology, (S.-H.Y., B.K., B.K.K., A.P., S.E.P.), Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Sook Yang
- Department of Biostatistics (K.-S.Y.), Korea University College of Medicine, Seoul, Korea
| | | | - Bo Kyu Kim
- From the Department of Radiology, (S.-H.Y., B.K., B.K.K., A.P., S.E.P.), Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Arim Pak
- From the Department of Radiology, (S.-H.Y., B.K., B.K.K., A.P., S.E.P.), Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sang Eun Park
- From the Department of Radiology, (S.-H.Y., B.K., B.K.K., A.P., S.E.P.), Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Lee TJ, Roh HG, Kim HJ, Jeon YS, Ki HJ, Park JJ, Lee HJ, Lee JS, Choi JW, Ryu SY, Jung YJ, Lee SB. Prognostic value of collateral perfusion estimation by arterial spin labeling for acute anterior circulation ischemic stroke. Neuroradiology 2023; 65:1695-1705. [PMID: 37837481 DOI: 10.1007/s00234-023-03233-7] [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: 06/12/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE This study aimed to verify the value of arterial spin labeling (ASL) collateral perfusion estimation for predicting functional outcomes in acute anterior circulation ischemic stroke. METHODS This secondary analysis of an ongoing prospective observational study included data from participants with acute ischemic stroke due to steno-occlusion of the internal carotid artery and/or the middle cerebral artery within 8 h of symptom onset. We compared the collateral map, which is a 5-phase collateral imaging derived from dynamic contrast-enhanced magnetic resonance angiography, and ASL to validate the ASL collateral perfusion estimation. Multiple logistic regression analyses were conducted to identify independent predictors of favorable functional outcomes. RESULTS One hundred forty-eight participants (68 ± 13 years, 96 men) were evaluated. The ASL collateral perfusion grade was positively correlated with the collateral perfusion grade of the collateral map (P < .001). Younger age (OR = 0.53, 95% CI = 0.36-0.78, P = .002), lower baseline NIHSS score (OR = 0.85, 95% CI = 0.78-0.92, P < .001), intermediate ASL collateral perfusion grade (OR = 4.02, 95% CI = 1.43-11.26, P = .008), good ASL collateral perfusion grade (OR = 26.37, 95% CI = 1.06-655.01, P = .046), and successful reperfusion (OR = 5.84, 95% CI = 2.08-16.42, P < .001) were independently associated with favorable functional outcomes. CONCLUSION ASL collateral perfusion estimation provides prognostic information, which can be helpful in guiding management decisions.
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Affiliation(s)
- Taek-Jun Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Yoo Sung Jeon
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hee Jong Ki
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seon Young Ryu
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea
| | - Sang Bong Lee
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-Ro, Jung-Gu, Daejeon, 34943, Republic of Korea.
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Tsui B, Chen IE, Nour M, Kihira S, Tavakkol E, Polson J, Zhang H, Qiao J, Bahr-Hosseini M, Arnold C, Tateshima S, Salamon N, Villablanca JP, Colby GP, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. Perfusion Collateral Index versus Hypoperfusion Intensity Ratio in Assessment of Collaterals in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2023; 44:1249-1255. [PMID: 37827719 PMCID: PMC10631520 DOI: 10.3174/ajnr.a8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/20/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND PURPOSE Perfusion-based collateral indices such as the perfusion collateral index and the hypoperfusion intensity ratio have shown promise in the assessment of collaterals in patients with acute ischemic stroke. We aimed to compare the diagnostic performance of the perfusion collateral index and the hypoperfusion intensity ratio in collateral assessment compared with angiographic collaterals and outcome measures, including final infarct volume, infarct growth, and functional independence. MATERIALS AND METHODS Consecutive patients with acute ischemic stroke with anterior circulation proximal arterial occlusion who underwent endovascular thrombectomy and had pre- and posttreatment MRI were included. Using pretreatment MR perfusion, we calculated the perfusion collateral index and the hypoperfusion intensity ratio for each patient. The angiographic collaterals obtained from DSA were dichotomized to sufficient (American Society of Interventional and Therapeutic Neuroradiology [ASITN] scale 3-4) versus insufficient (ASITN scale 0-2). The association of collateral status determined by the perfusion collateral index and the hypoperfusion intensity ratio was assessed against angiographic collaterals and outcome measures. RESULTS A total of 98 patients met the inclusion criteria. Perfusion collateral index values were significantly higher in patients with sufficient angiographic collaterals (P < .001), while there was no significant (P = .46) difference in hypoperfusion intensity ratio values. Among patients with good (mRS 0-2) versus poor (mRS 3-6) functional outcome, the perfusion collateral index of ≥ 62 was present in 72% versus 31% (P = .003), while the hypoperfusion intensity ratio of ≤0.4 was present in 69% versus 56% (P = .52). The perfusion collateral index and the hypoperfusion intensity ratio were both significantly predictive of final infarct volume, but only the perfusion collateral index was significantly (P = .03) associated with infarct growth. CONCLUSIONS Results show that the perfusion collateral index outperforms the hypoperfusion intensity ratio in the assessment of collateral status, infarct growth, and determination of functional outcomes.
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Affiliation(s)
- Brian Tsui
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Iris E Chen
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - May Nour
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Shingo Kihira
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Elham Tavakkol
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jennifer Polson
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Haoyue Zhang
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Joe Qiao
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mersedeh Bahr-Hosseini
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Corey Arnold
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Department of Bioengineering (J.P., H.Z., C.A.), University of California, Los Angeles, Los Angeles, California
| | - Satoshi Tateshima
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Noriko Salamon
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - J Pablo Villablanca
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Geoffrey P Colby
- Department of Neurosurgery (G.P.C.), University of California, Los Angeles, Los Angeles, California
| | - Reza Jahan
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Gary Duckwiler
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jeffrey L Saver
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - David S Liebeskind
- Department of Neurology (M.N., M.B.-H., J.L.S., D.S.L.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Kambiz Nael
- From the Department of Radiological Sciences (B.T., I.E.C., M.N., S.K., E.T., J.Q., C.A., S.T., N.S., J.P.V., R.J., G.D., K.N.), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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7
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Consoli A, Pizzuto S, Sgreccia A, Di Maria F, Coskun O, Rodesch G, Lapergue B, Felblinger J, Chen B, Bracard S. Angiographic collateral venous phase: a novel landmark for leptomeningeal collaterals evaluation in acute ischemic stroke. J Neurointerv Surg 2023; 15:e323-e329. [PMID: 36539270 DOI: 10.1136/jnis-2022-019653] [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: 09/19/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Although recanalization rates constantly increase (>80%), a favorable clinical outcome is achieved in only 45-55% of patients undergoing mechanical thrombectomy (MT) for anterior circulation stroke. Collateral circulation seems to play a major role in determining this discrepancy. The aim of the study was to investigate a novel angiographic landmark assessing the collateral venous phase (CVP) compared with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) score, based on the arterial collateral assessment. METHODS Two hundred patients with anterior circulation stroke treated by MT between 2016 and 2021 were included. The ASITN/SIR score and the presence of CVP were blindly evaluated by expert neuroradiologists. Three subanalyses were performed comparing patients with good versus poor collaterals, CVP presence versus absence, and a composite analysis including both ASITN/SIR and CVP grading results. RESULTS Good collateral circulation (ASITN >2) was observed in 113 patients (56.5%) whereas CVP was present in 90 patients (45%) and mostly in patients with good collaterals. Favorable clinical and neuroradiological outcomes were more likely observed in patients with both good collaterals and the presence of CVP than in those with good collaterals and absence of CVP (modified Rankin Scale score 0-2: 77.3% vs 7.9%, p<0.0001; mortality: 9.3% vs 26.3%, p=0.02; 24-hour Alberta Stroke Program Early CT Score: 8 vs 6, p<0.0001), while ASITN/SIR score alone was not significantly associated with clinical outcomes. CONCLUSIONS The presence of CVP improves the angiographic assessment of collateral circulation. CVP could be proposed as a new imaging landmark to better understand the functionality of collaterals.
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Affiliation(s)
- Arturo Consoli
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Hôpital Foch, Suresnes, France
- CIC, Innovation Technologique, Université de Lorraine, INSERM, Nancy, France
| | - Silvia Pizzuto
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Hôpital Foch, Suresnes, France
| | - Alessandro Sgreccia
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Hôpital Foch, Suresnes, France
| | - Federico Di Maria
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Hôpital Foch, Suresnes, France
| | - Oguzhan Coskun
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Hôpital Foch, Suresnes, France
| | - Georges Rodesch
- Department of Diagnostic and Interventional Neuroradiology, Versailles Saint-Quentin en Yvelines University, Hôpital Foch, Suresnes, France
| | - Bertrand Lapergue
- Department of Neurology, Versailles Saint-Quentin en Yvelines University, Hôpital Foch, Suresnes, France
| | - Jacques Felblinger
- CIC, Innovation Technologique, Université de Lorraine, INSERM, Nancy, France
- IADI, Université de Lorraine, INSERM, Nancy, France
| | - Bailiang Chen
- CIC, Innovation Technologique, Université de Lorraine, INSERM, Nancy, France
- IADI, Université de Lorraine, INSERM, Nancy, France
| | - Serge Bracard
- IADI, Université de Lorraine, INSERM, Nancy, France
- Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, Nancy University Hospital, Nancy Regional University Hospital Center, Nancy, France
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Kaewumporn U, Songsaeng D, Kunapinun A, Chaisinanunkul N. FLAIR vascular hyperintensity-DWI mismatch and DWI-FLAIR mismatch ASPECTS for prediction of good outcome after recanalization in anterior circulation stroke; multicenter observational study. Eur J Radiol 2023; 163:110837. [PMID: 37084592 DOI: 10.1016/j.ejrad.2023.110837] [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: 02/12/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION Acute ischemic stroke is a medical emergency caused by decreased blood flow to the brain, leading cause of long-term disability. Recanalization, one of the most concerning difficulties linked with intracranial arterial occlusion, has been used to reduce mortality in ischemic stroke treatment. The mismatch concepts MR PWI-DWI or DWI-FLAIR can help identify patients for thrombolysis. PURPOSE This paper introduces a novel method of predicting revascularization using the value of fluid-attenuated inversion recovery vascular hyperintensity FVH-DWI mismatch and DWI-FLAIR mismatch, which releases anterior circulation large vessel occlusion (LVO) after endovascular thrombectomy (EVT). Moreover, we present a new scoring system following anatomical region distributed for MCA territory called a DWI-FLAIR MISMATCH ASPECTS. RESULT Statistical analysis was performed to predict revascularization and functional outcome with 110 patients with anterior circulation LVO treated with EVT. We found that FVH-DWI mismatch was present in 71 patients (89.9 %) with complete revascularization and present in 8 patients (10.1 %) with no/partial revascularization, which had no significant difference (p = 0.12), and there was no significant difference between good functional outcome and poor functional outcome. Moreover, in 76 patients with DWI-FLAIR mismatch ASPECTS of > 6 point-group, present FVH-DWI mismatch in 57 patients (83.8 %) with complete revascularization had a significant difference as compared to 11 patients (16.2 %) with absent FVH-DWI mismatch (p < 0.05). The clinical outcome in complete revascularization is better than no/partial revascularization, and complete revascularization is independently associated with good functional outcomes (p < 0.05). CONCLUSION FVH-DWI mismatch paired with DWI-FLAIR mismatch ASPECTS > 6 points may be possible to predict revascularization in patients with anterior circulation LVO.
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Affiliation(s)
- Utarat Kaewumporn
- Division of Diagnostic Radiology, Department of Radiology Faculty of Medicine Siriraj Hospital University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand
| | - Dittapong Songsaeng
- Division of Diagnostic Radiology, Department of Radiology Faculty of Medicine Siriraj Hospital University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand.
| | - Alisa Kunapinun
- Division of Diagnostic Radiology, Department of Radiology Faculty of Medicine Siriraj Hospital University, 2 Prannok Road, Bangkok-Noi, Bangkok 10700, Thailand
| | - Napasri Chaisinanunkul
- Phyathai 1 Stroke Center, Phyathai 1 Hospital, 364/1, Phaya Thai Road, Ratchathewi, Bangkok 10400, Thailand
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9
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Abousrafa SE, Mair G. MRI for collateral assessment pre-thrombectomy and association with outcome: a systematic review and meta-analysis. Neuroradiology 2023; 65:1001-1014. [PMID: 36847834 PMCID: PMC10169893 DOI: 10.1007/s00234-023-03127-8] [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: 12/01/2022] [Accepted: 01/30/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Various neuroimaging methods exist to assess the collateral circulation in stroke patients but much of the evidence is based on computed tomography. Our aim was to review the evidence for using magnetic resonance imaging for collateral status evaluation pre-thrombectomy and assess the impact of these methods on functional independence. METHODS We systematically reviewed EMBASE and MEDLINE for studies that evaluated baseline collaterals using MRI pre-thrombectomy and conducted a meta-analysis to express the relationship between good collaterals (defined variably as the presence [good] vs absence [poor] or quality [ordinal scores binarized as good-moderate vs poor] of collaterals) and functional independence (modified Rankin score mRS≤2) at 90 days. Outcome data were presented as relative risk (RR, 95% confidence interval, 95%CI). We assessed for study heterogeneity, publication bias, and conducted subgroup analyses of different MRI methods and affected arterial territories. RESULTS From 497 studies identified, we included 24 (1957 patients) for the qualitative synthesis, and 6 (479 patients) for the metanalysis. Good pre-thrombectomy collaterals were significantly associated with favorable outcome at 90 days (RR=1.91, 95%CI=1.36-2.68], p= 0.0002) with no difference between MRI methods and affected arterial territory subgroups. There was no evidence of statistical heterogeneity (I2=25%) among studies but there was evidence of publication bias. CONCLUSION In stroke patients treated with thrombectomy, good pre-treatment collaterals assessed using MRI are associated with double the rate of functional independence. However, we found evidence that relevant MR methods are heterogenous and under-reported. Greater standardization and clinical validation of MRI for collateral evaluation pre-thrombectomy are required.
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Affiliation(s)
| | - Grant Mair
- Centre for Clinical Brain Sciences, Chancellor's Building, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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10
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Asaduddin M, Roh HG, Kim HJ, Kim EY, Park SH. Perfusion Maps Acquired From Dynamic Angiography MRI Using Deep Learning Approaches. J Magn Reson Imaging 2023; 57:456-469. [PMID: 35726646 DOI: 10.1002/jmri.28315] [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: 02/22/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND A typical stroke MRI protocol includes perfusion-weighted imaging (PWI) and MR angiography (MRA), requiring a second dose of contrast agent. A deep learning method to acquire both PWI and MRA with single dose can resolve this issue. PURPOSE To acquire both PWI and MRA simultaneously using deep learning approaches. STUDY TYPE Retrospective. SUBJECTS A total of 60 patients (30-73 years old, 31 females) with ischemic symptoms due to occlusion or ≥50% stenosis (measured relative to proximal artery diameter) of the internal carotid artery, middle cerebral artery, or anterior cerebral artery. The 51/1/8 patient data were used as training/validation/test. FIELD STRENGTH/SEQUENCE A 3 T, time-resolved angiography with stochastic trajectory (contrast-enhanced MRA) and echo planar imaging (dynamic susceptibility contrast MRI, DSC-MRI). ASSESSMENT We investigated eight different U-Net architectures with different encoder/decoder sizes and with/without an adversarial network to generate perfusion maps from contrast-enhanced MRA. Relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), mean transit time (MTT), and time-to-max (Tmax ) were mapped from DSC-MRI and used as ground truth to train the networks and to generate the perfusion maps from the contrast-enhanced MRA input. STATISTICAL TESTS Normalized root mean square error, structural similarity (SSIM), peak signal-to-noise ratio (pSNR), DICE, and FID scores were calculated between the perfusion maps from DSC-MRI and contrast-enhanced MRA. One-tailed t-test was performed to check the significance of the improvements between networks. P values < 0.05 were considered significant. RESULTS The four perfusion maps were successfully extracted using the deep learning networks. U-net with multiple decoders and enhanced encoders showed the best performance (pSNR 24.7 ± 3.2 and SSIM 0.89 ± 0.08 for rCBV). DICE score in hypo-perfused area showed strong agreement between the generated perfusion maps and the ground truth (highest DICE: 0.95 ± 0.04). DATA CONCLUSION With the proposed approach, dynamic angiography MRI may provide vessel architecture and perfusion-relevant parameters simultaneously from a single scan. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Muhammad Asaduddin
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Seoul, South Korea
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea
| | - Eung Yeop Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Sung-Hong Park
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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11
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Le HL, Roh HG, Kim HJ, Kwak JT. A 3D Multi-task Regression and Ordinal Regression Deep Neural Network for Collateral Imaging from Dynamic Susceptibility Contrast-Enhanced MR perfusion in Acute Ischemic Stroke. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107071. [PMID: 35994873 DOI: 10.1016/j.cmpb.2022.107071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Cerebral collaterals have been identified as one of the primary determinants for treatment options in acute ischemic stroke. Several works have been proposed, but these have not been adopted for a routine clinical usage due to their manual and heuristic nature as well as inconsistency and instability of the assessment. Herein, we present an advanced deep learning-based method that can automatically generate a multiphase collateral imaging (collateral map) derived from dynamic susceptibility contrast-enhanced MR perfusion (DSC-MRP) in an accurate and robust manner. METHODS We develop a 3D multi-task regression and ordinal regression deep neural network for generating collateral maps from DSC-MRP, which formulates the prediction of collateral maps as both a regression task and an ordinal regression task. For an ordinal regression task, we introduce a spacing-decreasing discretization (SDD) strategy to represent the intensity of the collateral status on a discrete, ordinal scale. We also devise loss functions to achieve effective and efficient multi-task learning. RESULTS We systematically evaluated the performance of the proposed network using DSC-MRP from 802 patients. On average, the proposed network achieved ≥0.900 squared correlation coefficient (R-Squared), ≥0.916 Tanimoto measure (TM), ≥0.0913 structural similarity index measure (SSIM), and ≤0.564 × 10-1 mean absolute error (MAE), outperforming eight competing models that have been recently developed in medical imaging and computer vision. We also found that the proposed network could provide an improved contrast between the low and high intensity regions in the collateral maps, which is a key to an accurate evaluation of the collateral status. CONCLUSIONS The experimental results demonstrate that the proposed network is able to generate collateral maps with high accuracy, facilitating a timely and prompt assessment of the collateral status in clinlcs. The future study will entail the optimization of the proposed network and its clinical evalution in a prospective manner.
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Affiliation(s)
- Hoang Long Le
- Department of Computer Science and Engineering, Sejong University, Seoul 05006, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Korea
| | - Jin Tae Kwak
- School of Electrical Engineering, Korea University, Seoul 02841, Korea.
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12
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Tsui B, Nour M, Chen I, Qiao JX, Salehi B, Yoo B, Colby GP, Salamon N, Villablanca P, Jahan R, Duckwiler G, Saver JL, Liebeskind DS, Nael K. MR Angiography in Assessment of Collaterals in Patients with Acute Ischemic Stroke: A Comparative Analysis with Digital Subtraction Angiography. Brain Sci 2022; 12:brainsci12091181. [PMID: 36138917 PMCID: PMC9497115 DOI: 10.3390/brainsci12091181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Collateral status has prognostic and treatment implications in acute ischemic stroke (AIS) patients. Unlike CTA, grading collaterals on MRA is not well studied. We aimed to evaluate the accuracy of assessing collaterals on pretreatment MRA in AIS patients against DSA. AIS patients with anterior circulation proximal arterial occlusion with baseline MRA and subsequent endovascular treatment were included. MRA collaterals were evaluated by two neuroradiologists independently using the Tan and Maas scoring systems. DSA collaterals were evaluated by using the American Society of Interventional and Therapeutic Neuroradiology grading system and were used as the reference for comparative analysis against MRA. A total of 104 patients met the inclusion criteria (59 female, age (mean ± SD): 70.8 ± 18.1). The inter-rater agreement (k) for collateral scoring was 0.49, 95% CI 0.37–0.61 for the Tan score and 0.44, 95% CI 0.26–0.62 for the Maas score. Total number (%) of sufficient vs. insufficient collaterals based on DSA was 49 (47%) and 55 (53%) respectively. Using the Tan score, 45% of patients with sufficient collaterals and 64% with insufficient collaterals were correctly identified in comparison to DSA, resulting in a poor agreement (0.09, 95% CI 0.1–0.28). Using the Maas score, only 4% of patients with sufficient collaterals and 93% with insufficient collaterals were correctly identified against DSA, resulting in poor agreement (0.03, 95% CI 0.06–0.13). Pretreatment MRA in AIS patients has limited concordance with DSA when grading collaterals using the Tan and Maas scoring systems.
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Affiliation(s)
- Brian Tsui
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Correspondence:
| | - May Nour
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Iris Chen
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Joe X. Qiao
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Banafsheh Salehi
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Bryan Yoo
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Geoffrey P. Colby
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Pablo Villablanca
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Reza Jahan
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Gary Duckwiler
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - David S. Liebeskind
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Kambiz Nael
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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13
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Kim HJ, Roh HG. Imaging in Acute Anterior Circulation Ischemic Stroke: Current and Future. Neurointervention 2022; 17:2-17. [PMID: 35114749 PMCID: PMC8891584 DOI: 10.5469/neuroint.2021.00465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Clinical trials on acute ischemic stroke have demonstrated the clinical effectiveness of revascularization treatments within an appropriate time window after stroke onset: intravenous thrombolysis (NINDS and ECASS-III) through the administration of tissue plasminogen activator within a 4.5-hour time window, endovascular thrombectomy (ESCAPE, REVASCAT, SWIFT-PRIME, MR CLEAN, EXTEND-IA) within a 6-hour time window, and extending the treatment time window up to 24 hours for endovascular thrombectomy (DAWN and DEFUSE 3). However, a substantial number of patients in these trials were ineligible for revascularization treatment, and treatments of some patients were considerably futile or sometimes dangerous in the clinical trials. Guidelines for the early management of patients with acute ischemic stroke have evolved to accept revascularization treatment as standard and include eligibility criteria for the treatment. Imaging has been crucial in selecting eligible patients for revascularization treatment in guidelines and clinical trials. Stroke specialists should know imaging criteria for revascularization treatment. Stroke imaging studies have demonstrated imaging roles in acute ischemic stroke management as follows: 1) exclusion of hemorrhage and stroke mimic disease, 2) assessment of salvageable brain, 3) localization of the site of vascular occlusion and thrombus, 4) estimation of collateral circulation, and 5) prediction of acute ischemic stroke expecting hemorrhagic transformation. Here, we review imaging methods and criteria to select eligible patients for revascularization treatment in acute anterior circulation stroke, focus on 2019 guidelines from the American Heart Association/American Stroke Association, and discuss the future direction of imaging-based patient selection to improve treatment effects.
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Affiliation(s)
- Hyun Jeong Kim
- Department of Radiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
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Collateral estimation by susceptibility-weighted imaging and prediction of functional outcomes after acute anterior circulation ischemic stroke. Sci Rep 2021; 11:21370. [PMID: 34725373 PMCID: PMC8560757 DOI: 10.1038/s41598-021-00775-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/14/2021] [Indexed: 12/14/2022] Open
Abstract
To determine the value of susceptibility-weighted imaging (SWI) for collateral estimation and for predicting functional outcomes after acute ischemic stroke. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, SWI collateral grade, mode of treatment, and successful reperfusion were evaluated by multiple logistic regression analyses. A total of 152 participants were evaluated. A younger age (adjusted odds ratio (aOR), 0.42; 95% confidence interval (CI) 0.34 to 0.77; P < 0.001), a lower baseline NIHSS score (aOR 0.90; 95% CI 0.82 to 0.98; P = 0.02), a smaller baseline DWI lesion volume (aOR 0.83; 95% CI 0.73 to 0.96; P = 0.01), an intermediate collateral grade (aOR 9.49; 95% CI 1.36 to 66.38; P = 0.02), a good collateral grade (aOR 6.22; 95% CI 1.16 to 33.24; P = 0.03), and successful reperfusion (aOR 5.84; 95% CI 2.08 to 16.42; P = 0.001) were independently associated with a favorable functional outcome. There was a linear association between the SWI collateral grades and functional outcome (P = 0.008). Collateral estimation using the prominent vessel sign on SWI is clinically reliable, as it has prognostic value.
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15
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Collateral and permeability imaging derived from dynamic contrast material-enhanced MR angiography in prediction of PH 2 hemorrhagic transformation after acute ischemic stroke: a pilot study. Neuroradiology 2021; 63:1471-1479. [PMID: 33533948 DOI: 10.1007/s00234-021-02655-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the role of collateral and permeability imaging derived from dynamic contrast material-enhanced magnetic resonance angiography to predict PH 2 hemorrhagic transformation in acute ischemic stroke. METHODS The secondary analysis of a published data from participants with acute ischemic stroke. The multiphase collateral map and permeability imaging were generated by using dynamic signals from dynamic contrast material-enhanced magnetic resonance angiography obtained at admission. To identify independent predictors of PH 2 hemorrhagic transformation, age, sex, risk factors, baseline National Institutes of Health Stoke Scale (NIHSS) score, baseline DWI lesion volume, collateral-perfusion status, mode of treatment, and successful early reperfusion were evaluated with multiple logistic regression analyses and the significance of permeability imaging in prediction of PH 2 hemorrhagic transformation was evaluated by subgroup analysis. RESULTS In 115 participants, including 70 males (mean (SD) age, 69 (12) years), PH 2 hemorrhagic transformation occurred in 6 participants with very poor collateral-perfusion status (MAC 0). MAC 0 (OR, 0.06; 95% CI, 0.01, 0.74; P = .03) was independently associated with PH 2 hemorrhagic transformation. In 22 participants with MAC 0, the permeable signal on Kep permeability imaging was the only significant characteristic associated with PH 2 hemorrhagic transformation (P = .009). The specificity of Kep permeability imaging was 93.8% (95% confidence interval: 69.8, 99.8) in predicting PH 2 hemorrhagic transformation. CONCLUSION Individual-based prediction of PH 2 hemorrhagic transformation in patients with acute ischemic stroke may be possible with multiphase collateral map and permeability imaging derived from dynamic contrast material-enhanced magnetic resonance angiography.
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