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Dong M, Chen C, Chen W, An K. A CT texture-based nomogram for predicting futile reperfusion in patients with intraparenchymal hyperdensity after endovascular thrombectomy for acute anterior circulation large vessel occlusion. Front Neurol 2024; 15:1327585. [PMID: 38708002 PMCID: PMC11066250 DOI: 10.3389/fneur.2024.1327585] [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: 10/25/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Post-thrombectomy intraparenchymal hyperdensity (PTIH) in patients with acute anterior circulation large vessel occlusion is a common CT sign associated with a higher incidence of futile reperfusion (FR). We aimed to develop a nomogram to predict FR specifically in patients with PTIH. Methods We retrospectively collected information on patients with acute ischemic stroke who underwent endovascular thrombectomy (EVT) at two stroke centers. A total of 398 patients with PTIH were included to develop and validate the nomogram, including 214 patients in the development cohort, 92 patients in the internal validation cohort and 92 patients in the external validation cohort. The nomogram was developed according to the independent predictors obtained from multivariate logistic regression analysis, including clinical factors and CT texture features extracted from hyperdense areas on CT images within half an hour after EVT. The performance of the nomogram was evaluated with integrated discrimination improvement (IDI), category-free net reclassification improvement (NRI), the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, and decision curve analyses for discrimination, calibration ability, and clinical net benefits, respectively. Results Our nomogram was constructed based on three clinical factors (age, NIHSS score and ASPECT score) and two CT texture features (entropy and kurtosis), with AUC-ROC of 0.900, 0.897, and 0.870 in the development, internal validation, and external validation cohorts, respectively. NRI and IDI further validated the superior predictive ability of the nomogram compared to the clinical model. The calibration plot revealed good consistency between the predicted and the actual outcome. The decision curve indicated good positive net benefit and clinical validity of the nomogram. Conclusion The nomogram enables clinicians to accurately predict FR specifically in patients with PTIH within half an hour after EVT and helps to formulate more appropriate treatment plans in the early post-EVT period.
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Affiliation(s)
- Meijuan Dong
- Department of Endocrinology, The Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University, Huai'an, China
| | - Chun Chen
- Department of Neurology, Xuzhou Medical University Affiliated Hospital of Huai’an, Huai'an, China
| | - Wei Chen
- Department of Radiology, The Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University, Huai'an, China
| | - Kun An
- Department of Neurology, The Affiliated Huaian No.1 People′s Hospital of Nanjing Medical University, Huai'an, China
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Samaniego EA, Boltze J, Lyden PD, Hill MD, Campbell BCV, Silva GS, Sheth KN, Fisher M, Hillis AE, Nguyen TN, Carone D, Favilla CG, Deljkich E, Albers GW, Heit JJ, Lansberg MG. Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke. Stroke 2023; 54:3190-3201. [PMID: 37942645 PMCID: PMC10841844 DOI: 10.1161/strokeaha.123.044985] [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] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STAIR XII (12th Stroke Treatment Academy Industry Roundtable) included a workshop to discuss the priorities for advancements in neuroimaging in the diagnostic workup of acute ischemic stroke. The workshop brought together representatives from academia, industry, and government. The participants identified 10 critical areas of priority for the advancement of acute stroke imaging. These include enhancing imaging capabilities at primary and comprehensive stroke centers, refining the analysis and characterization of clots, establishing imaging criteria that can predict the response to reperfusion, optimizing the Thrombolysis in Cerebral Infarction scale, predicting first-pass reperfusion outcomes, improving imaging techniques post-reperfusion therapy, detecting early ischemia on noncontrast computed tomography, enhancing cone beam computed tomography, advancing mobile stroke units, and leveraging high-resolution vessel wall imaging to gain deeper insights into pathology. Imaging in acute ischemic stroke treatment has advanced significantly, but important challenges remain that need to be addressed. A combined effort from academic investigators, industry, and regulators is needed to improve imaging technologies and, ultimately, patient outcomes.
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Affiliation(s)
- Edgar A. Samaniego
- Department of Neurology, Radiology and Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
| | - Johannes Boltze
- School of Life Sciences, The University of Warwick, Coventry, United Kingdom
| | - Patrick D. Lyden
- Zilkha Neurogenetic Institute of the Keck School of Medicine at USC, Los Angeles, California, United States
| | - Michael D. Hill
- Department of Clinical Neuroscience & Hotchkiss Brain Institute, University of Calgary & Foothills Medical Centre, Calgary, Canada
| | - Bruce CV Campbell
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Kevin N Sheth
- Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, United States
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Argye E. Hillis
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United Stated
| | - Thanh N. Nguyen
- Department of Neurology, Boston Medical Center, Massachusetts, United States
| | - Davide Carone
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Christopher G. Favilla
- Department of Neurology, University of Pennsylvania Philadelphia, Pennsylvania, Unites States
| | | | - Gregory W. Albers
- Department of Neurology, Stanford University, Stanford, California, United States
| | - Jeremy J. Heit
- Department of Radiology and Neurosurgery, Stanford University, Stanford, California, United States
| | - Maarten G Lansberg
- Department of Neurology, Stanford University, Stanford, California, United States
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3
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Yang F, Zeng Y, Zhu F, Hu X. Prognostic value of contrast staining on dual-energy CT after endovascular therapy in acute ischemic stroke: a meta-analysis. BMC Neurol 2023; 23:326. [PMID: 37700234 PMCID: PMC10496411 DOI: 10.1186/s12883-023-03370-9] [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: 05/27/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Contrast staining (CS) on dual-energy CT (DECT) is common after endovascular therapy (EVT) in acute ischemic stroke (AIS). We performed a meta-analysis to investigate the prognostic significance of CS detected by DECT after EVT in AIS. METHOD MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science and Scopus databases were searched from inception to July 2023 for publications on the prognostic significance of CS on DECT after EVT in patients with AIS. Prognostic outcomes were hemorrhage transformation (HT) and poor functional outcome (modified Rankin Scale [mRS] Score of 3-6 at the 90-day follow-up). Data are presented as odds ratios (OR) and 95% confidence intervals (CI). RESULTS Eleven studies including 1123 cases of AIS were included. Pooled results indicated a higher risk of HT in patients with CS than in those without CS (OR = 2.22; 95% CI 1.41-3.51, P = 0.001; I2 = 45.4%). No association between CS and symptomatic HT was observed (OR = 2.10; 95% CI 0.64-6.95, P = 0.223; I2 = 67.3%). Moreover, there was also higher odds of poor functional outcome in patients with CS than in those without CS (OR = 2.76; 95% CI 1.53-4.97, P = 0.001; I2 = 44.9%). CONCLUSIONS The presence of contrast staining on DECT after EVT is associated with a higher risk of hemorrhage transformation and poor functional outcome. However, further high-quality studies with standardized processes are required to confirm these results.
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Affiliation(s)
- Fan Yang
- Department of Radiology, Chengdu First People's Hospital, Chengdu, Sichuan, 610041, China
| | - Yi Zeng
- Department of Radiology, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, 610041, China
| | - Fei Zhu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoyan Hu
- Department of Radiology, Chengdu First People's Hospital, Chengdu, Sichuan, 610041, China.
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4
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Yang SJ, Lu YH, Huang YC, Chan L, Ting WY. Immediate CT change after thrombectomy predicting symptomatic hemorrhagic transformation. J Chin Med Assoc 2023; 86:854-858. [PMID: 37418338 DOI: 10.1097/jcma.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND The prognostic value of contrast accumulation from noncontrast brain computed tomography (CT) conducted immediately after intra mechanical thrombectomy (MT) in patients with acute ischemic stroke to predict symptomatic hemorrhage was studied. METHODS Patients with acute ischemic stroke treated using MT between February 2015 and April 2019 were included. Contrast accumulation was defined as a high attenuation area observed on noncontrast brain CT conducted immediately after thrombectomy treatment, and the patients were categorized into (1) symptomatic hemorrhage, (2) asymptomatic hemorrhage, and (3) no hemorrhage according to the presence of hemorrhagic transformation and their clinical conditions. The pattern and extent of contrast accumulation were compared between patients with and without symptomatic hemorrhage. The maximal Hounsfield unit (HU) of cortical involvement in contrast accumulation was evaluated by calculating the sensitivity, specificity, odds ratio, and area under the receiver operating characteristic (ROC) curve. RESULTS In total, 101 patients with anterior circulation acute ischemic stroke were treated by endovascular intervention. Nine patients developed symptomatic hemorrhage and 17 developed asymptomatic hemorrhage. Contrast accumulation was associated with all types of hemorrhagic transformation ( p < 0.01), and cortical involvement pattern was more frequently associated with symptomatic hemorrhage ( p < 0.01). The area under the ROC curve was 0.887. The sensitivity and specificity for HU > 100 in cortical involvement predicting symptomatic hemorrhage after endovascular treatment were 77.8% and 95.7%, respectively, with an odds ratio of 77.0 (95% CI, 11.94-496.50; p < 0.01). CONCLUSION Cortical involvement of contrast accumulation with a maximal HU > 100 predicts symptomatic hemorrhage after endovascular reperfusion treatment.
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Affiliation(s)
- Shang-Jung Yang
- Department of Radiology, En Chu Kong Hospital, New Taipei City, Taiwan, ROC
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yi-Chen Huang
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Lung Chan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Wei-Yi Ting
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, ROC
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5
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Zidan M, Ghaei S, Bode FJ, Weller JM, Krueger N, Lehnen NC, Petzold GC, Radbruch A, Dorn F, Paech D. Clinical significance and prevalence of subarachnoid hyperdensities on flat detector CT after mechanical thrombectomy: does it really matter? J Neurointerv Surg 2023:jnis-2023-020661. [PMID: 37648432 DOI: 10.1136/jnis-2023-020661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Subarachnoid hyperdensities after mechanical thrombectomy (MT) are a common finding. However, it is often regarded as clinically insignificant. OBJECTIVE With this single-center investigation, to identify the prevalence of subarachnoid hyperdensities following MT, associated predictors, and the impact on the clinical outcome of the patients. METHODS 383 patients from the stroke registry were analyzed for the presence of subarachnoid hyperdensities on flat detector CT (FDCT) directly after the completion of MT, and on follow-up dual-energy CT, then classified according to a visual grading scale. 178 patients were included with anterior circulation occlusions. Regression analysis was performed to identify significant predictors, and Kruskal-Wallis analysis and Χ2 test were performed to test the variables among the different groups. The primary outcome was the modified Rankin Scale (mRS) score at 90 days and was analyzed with the Wilcoxon-Mann-Whitney rank-sum test. RESULTS The prevalence of subarachnoid hyperdensities on FDCT was (66/178, 37.1%) with patients experiencing a significant unfavorable outcome (P=0.035). Significantly fewer patients with subarachnoid hyperdensities achieved a mRS score of ≤3 at 90 days 25/66 (37.9%) vs 60/112 (53.6%), P=0.043). In addition, mortality was significantly higher in the subarachnoid hyperdensities group (34.8% vs 19.6%, P=0.024). Distal occlusions and a higher number of device passes were significantly associated with subarachnoid hyperdensities (P=0.026) and (P=0.001), respectively. Patients who received intravenous tissue plasminogen activator had significantly fewer subarachnoid hyperdensities (P=0.029). CONCLUSIONS Postinterventional subarachnoid hyperdensities are a frequent finding after MT and are associated with neurological decline and worse functional outcome. They are more common with distal occlusions and multiple device passes.
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Affiliation(s)
- Mousa Zidan
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Shiwa Ghaei
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Felix J Bode
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Nadine Krueger
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Gabor C Petzold
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
- Department of Neuroradiology, LMU Klinikum der Universität München Medizinische Klinik und Poliklinik IV, Munchen, Bayern, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
- Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
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6
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Inoa V, Dornbos D, DiNitto J, Martineau D, Sullivan J, Angel J, Nolan VG, Arthur AS, Hoit D, Nickele C, Goyal N, Elijovich L. Flat-panel detector CT to assess intracranial hemorrhage immediately following mechanical thrombectomy. J Neuroimaging 2023; 33:368-374. [PMID: 36916873 DOI: 10.1111/jon.13098] [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: 10/21/2022] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND AND PURPOSE The risk of symptomatic intracranial hemorrhage (ICH) approaches 5% despite mechanical thrombectomy (MT) efficacy for ischemic stroke secondary to large vessel occlusion. Flat-panel detector CT (FDCT) imaging with Syngo Dyna CT imaging (Siemens Medical Solutions, Malvern, PA) can be used immediately following MT to detect ICH. PURPOSE To evaluate the accuracy and reliability of FDCT imaging with Dyna CT compared to conventional post-MT CT and MRI. METHODS Head FDCT (20 second, 70 kV) was performed immediately following MT on 26 consecutive patients; postprocedural CT or MRI was obtained ∼24 hours later. Two blinded, independent neuroradiologists evaluated all imaging, identifying ICH, stroke, and presence of subarachnoid contrast. Cohen's κ statistic was used to assess interrater agreement for each imaging outcome and compared the FDCT to conventional imaging. RESULTS FDCT for ICH demonstrated a strong degree of interrater reliability (κ = 0.896; 95% confidence interval [CI], 0.734-1.057). Negligible reliability was seen for ischemia determination on immediate post-MT FDCT (κ = 0.149; 95% CI, -0.243 to 0.541). ICH evaluation between FDCT and post-MT conventional CT revealed modest interrater reliability (κ = 0.432; 95% CI, -0.100 to 0.965), which did not reach statistical significance. There was no substantive reliability in the evaluation of ICH between FDCT and post-MT MRI (κ = 0.118, 95% CI, -0.345 to 0.580). CONCLUSION FDCT, such as Dyna CT, immediately post-MT is a promising tool that can expedite the detection of ICH with a high degree of reliability, although the detection of ischemic parenchymal changes is limited.
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Affiliation(s)
- Violiza Inoa
- Semmes-Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - David Dornbos
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, USA
| | - Julie DiNitto
- Siemens Medical Solutions, Malvern, Pennsylvania, USA
| | - David Martineau
- Department of Radiology, MidSouth Imaging, Memphis, Tennessee, USA.,Department of Radiology, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Joseph Sullivan
- Department of Radiology, MidSouth Imaging, Memphis, Tennessee, USA.,Department of Radiology, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Jacqueline Angel
- Department of Radiology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Radiology, Methodist University Hospital, Memphis, Tennessee, USA
| | - Vikki G Nolan
- Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis School of Public Health, Memphis, Tennessee, USA
| | - Adam S Arthur
- Semmes-Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Daniel Hoit
- Semmes-Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christopher Nickele
- Semmes-Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Nitin Goyal
- Semmes-Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Lucas Elijovich
- Semmes-Murphey Clinic, Memphis, Tennessee, USA.,Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
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7
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Ma Y, Wang J, Zhang H, Li H, Wang F, Lv P, Ye J. A CT-based radiomics nomogram for classification of intraparenchymal hyperdense areas in patients with acute ischemic stroke following mechanical thrombectomy treatment. Front Neurosci 2023; 16:1061745. [PMID: 36703995 PMCID: PMC9871784 DOI: 10.3389/fnins.2022.1061745] [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: 10/05/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives To develop and validate a radiomic-based model for differentiating hemorrhage from iodinated contrast extravasation of intraparenchymal hyperdense areas (HDA) following mechanical thrombectomy treatment in acute ischemic stroke. Methods A total of 100 and four patients with intraparenchymal HDA on initial post-operative CT were included in this study. The patients who met criteria were divided into a primary and a validation cohort. A training cohort was constructed using Synthetic Minority Oversampling Technique on the primary cohort to achieve group balance. Thereafter, a radiomics score was calculated and the radiomic model was constructed. Clinical factors were assessed to build clinical model. Combined with the Rad-score and independent clinical factors, a combined model was constructed. Different models were assessed using the area under the receiver operator characteristic curves. The combined model was visualized as nomogram, and assessed with calibration and clinical usefulness. Results Cardiogenic diseases, intraoperative tirofiban administration and preoperative national institute of health stroke scale were selected as independent predictors to construct the clinical model with area under curve (AUC) of 0.756 and 0.693 in the training and validation cohort, respectively. Our data demonstrated that the radiomic model showed good discrimination in the training (AUC, 0.955) and validation cohort (AUC, 0.869). The combined nomogram model showed optimal discrimination in the training (AUC, 0.972) and validation cohort (AUC, 0.926). Decision curve analysis demonstrated the combined model had a higher overall net benefit in differentiating hemorrhage from iodinated contrast extravasation in terms of clinical usefulness. Conclusions The nomogram shows favorable efficacy for differentiating hemorrhage from iodinated contrast extravasation, which might provide an individualized tool for precision therapy.
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Affiliation(s)
- Yuan Ma
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, China,Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Jia Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China,Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hongying Zhang
- Clinical Medical College, Yangzhou University, Yangzhou, China,Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Hongmei Li
- Clinical Medical College, Yangzhou University, Yangzhou, China,Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Fu'an Wang
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, China,Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Penghua Lv
- Department of Interventional Radiology, Northern Jiangsu People's Hospital, Yangzhou, China,Clinical Medical College, Yangzhou University, Yangzhou, China,*Correspondence: Penghua Lv ✉
| | - Jing Ye
- Clinical Medical College, Yangzhou University, Yangzhou, China,Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, China,Jing Ye ✉
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8
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Chang GC, Ma DC, Li W, Qiu J, Sun XH, Zhao YG, Liu X, Zhao ZA, Liu L, Nguyen TN, Chen HS. Contrast enhancement by location and volume is associated with long-term outcome after thrombectomy in acute ischemic stroke. Sci Rep 2022; 12:16998. [PMID: 36216846 PMCID: PMC9551090 DOI: 10.1038/s41598-022-21276-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 09/26/2022] [Indexed: 12/29/2022] Open
Abstract
Contrast enhancement (CE) on brain non-contrast computed tomography (NCCT) is common after endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS), but its association with clinical outcomes is not well established. The current study aimed to investigate this relationship. We retrospectively reviewed consecutive patients with acute ischemic stroke who had hyperdensity on NCCT immediately after EVT for anterior circulation large vessel occlusion (LVO) from January 2016 to December 2019. We used ASPECTS combined with volume measurement by 3D reconstruction to estimate the extent and location of CE. Multivariable regression analysis was conducted to explore the risk factors associated with clinical outcome. In this study, 113 of 158 (71.52%) anterior circulation AIS-LVO patients had hyperdensity on brain NCCT. After strict inclusion and exclusion criteria, a total of 64 patients were enrolled in the final analysis. In logistic regression analysis, CE-ASPECTS, CE volume, CE at the caudate nucleus, M4 and M6 region were associated with 3-month poor functional outcome after adjusting for confounding factors. The conventional variable model was used for reference, including age, initial NIHSS, the procedure time, stent retriever passes, recanalization status and baseline ASPECTS, with AUC of 0.73. When combined with the above-named variables (conventional variables + CE-ASPECTS + CE volume + CE at caudate nucleus + CE at M4 region + CE at M6 region), the predictive power was significantly improved, with AUC of 0.87 (95% CI 0.78-0.95). The spatial location and volume of CE on NCCT obtained immediately after EVT were independent and strong predictors for poor outcome at 3-months in patients with AIS after excluding definite hemorrhage by 24-h follow up CT.
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Affiliation(s)
- Guo-Can Chang
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Dai-Chao Ma
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
- Department of Encephalopathy, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, People's Republic of China
| | - Wei Li
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Jin Qiu
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Xian-Hui Sun
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Yong-Gang Zhao
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Xin Liu
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Zi-Ai Zhao
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Liang Liu
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China
| | - Thanh N Nguyen
- Neurology, Radiology, Boston Medical Center, Boston, MA, USA
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shen Yang, People's Republic of China.
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9
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Chen L, Xu Z, Zhang C, Ji Y, Huang X, Yang W, Zhou Z, Wang S, Wang K, Luo B, Wang J. Post-ASPECTS based on hyperdensity in NCCT immediately after thrombectomy is an ultra-early predictor of hemorrhagic transformation and prognosis. Front Neurol 2022; 13:887277. [PMID: 36034273 PMCID: PMC9399794 DOI: 10.3389/fneur.2022.887277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeAlmost half of the patients exhibit futile recanalization after thrombectomy; however, the early postoperative predictors of futile recanalization remain unclear. We analyzed the relationship of post-thrombectomy ASPECTS (Post-ASPECTS) with 90-day prognosis and hemorrhagic transformation (HT).MethodsWe collected data from patients with acute ischemic stroke (AIS) with anterior-circulation large vessel occlusion (ACLVO) who were treated via thrombectomy within 10 h in 3 hospitals. Successful endovascular recanalization was achieved (modified thrombolysis in cerebral ischemia [mTICI] 2b/3). Non-contrast computed tomography (NCCT) examination was performed immediately (within 1 h) after thrombectomy. Post-ASPECTS were scored based on the brain parenchymal hyperdensity in NCCT according to the ASPECTS scoring method. HT was defined according to the ECASS II classification criteria. Linear correlation, logistic regression, and receiver operating characteristic curve analyses were used to determine the influencing factors and best predictive value of 90-day prognosis, 90-day death, and HT.ResultsA total of 231 patients were enrolled. The good prognosis rate, mortality rate, and HT rate were 57.1, 9.5, and 38.3%, respectively. The Post-ASPECTS affected poor prognosis, death, and HT. The best predictive value of Post-ASPECTS for poor prognosis, death, and HT was 7. The specificities of Post-ASPECTS for predicting HT, poor prognosis, and death were 87.6% (AUC, 0.811; P < 0.001), 87.1% (AUC, 0.768; P < 0.001), and 73.7% (AUC, 0.748; P < 0.001), with positive predictive values of 74.2, 75.7, and 21.4%, respectively.ConclusionPost-ASPECTS predicted 90-day prognosis, death, and HT with high specificity and high positive predictive value in patients with AIS with ACLVO. Post-ASPECTS may be an ultra-early predictor of prognosis after thrombectomy.
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Affiliation(s)
- Lulu Chen
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Ziqi Xu
- Department of Neurology, Brain Medical Centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chen Zhang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yachen Ji
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Weimin Yang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, China
| | - Shuiping Wang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kai Wang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Benyan Luo
- Department of Neurology, Brain Medical Centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingye Wang
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Jingye Wang
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Chung Y, Bae Y, Hong CE, Won YS, Baek JH, Chung PW, Kim MS, Rho MH. Hyperattenuations on flat-panel computed tomography after successful recanalization of mechanical thrombectomy for anterior circulation occlusion. Quant Imaging Med Surg 2022; 12:1051-1062. [PMID: 35111604 DOI: 10.21037/qims-21-322] [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: 03/22/2021] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Abstract
Background To evaluate intraparenchymal hyperattenuation (IPH) on flat-panel computed tomography (FPCT) findings and their clinical usefulness for predicting prognosis after successful mechanical thrombectomy (MT) for acute occlusion of anterior circulation. Methods A retrospective review was conducted for 158 consecutive patients undergoing mechanical thrombectomy during the last six years. After excluding those with posterior circulation occlusion or incomplete recanalization and those without FPCT, 82 patients were finally included. Immediate post-procedural IPH on FPCT was categorized into four patterns (none, striatal, cortical, or combined pattern). Follow-up magnetic resonance images or CT scans after 48 hours from MT were analyzed according to FPCT findings. The existence of hemorrhagic transformation, intracerebral hemorrhage, and brain swelling was evaluated. Functional clinical outcomes were accessed with post-procedural 3-month modified Rankin scales (mRS). Results Of 82 patients, 34 patients were found to have IPH (16 with a striatal pattern, 8 with a cortical pattern, and 10 with a combined pattern). Hemorrhagic complication (P<0.001), brain swelling (P<0.001), and poor mRS scores (P=0.042) showed significant differences according to IPH patterns. Multivariate logistic regression analysis revealed that the presence of a striatal pattern (OR: 13.26, P<0.001), cortical pattern (OR: 11.61, P=0.009), and combined pattern (OR: 45.34, P<0.001) independently predicted hemorrhagic complications. The location of the occlusion (OR: 4.13, P=0.034), cortical pattern (OR: 5.94, P=0.039), and combined pattern (OR: 39.85, P=0.001) predicted brain swelling. Age (OR: 1.07, P=0.006) and the presence of a combined pattern (OR: 10.58, P=0.046) predicted poor clinical outcomes. Conclusions FPCT is a rapid and effective tool for a prompt follow-up just after MT to predict prognosis. Those with striatal patterns showed relatively good clinical outcomes despite significant hemorrhage. Cortical IPH patterns independently predicted a high rate of post-procedural hemorrhage or brain swelling. Combined pattern is a strong predictor for both radiologic and poor clinical outcomes.
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Affiliation(s)
- Yeongu Chung
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Youngoh Bae
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Eui Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yu Sam Won
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Ho Rho
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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11
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Chen X, Li Y, Zhou Y, Yang Y, Yang J, Pang P, Wang Y, Cheng J, Chen H, Guo Y. CT-based radiomics for differentiating intracranial contrast extravasation from intraparenchymal haemorrhage after mechanical thrombectomy. Eur Radiol 2022; 32:4771-4779. [PMID: 35113213 PMCID: PMC9213289 DOI: 10.1007/s00330-022-08541-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/27/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a nonenhanced CT-based radiomic signature for the differentiation of iodinated contrast extravasation from intraparenchymal haemorrhage (IPH) following mechanical thrombectomy. METHODS Patients diagnosed with acute ischaemic stroke who underwent mechanical thrombectomy in 4 institutions from December 2017 to June 2020 were included in this retrospective study. The study population was divided into a training cohort and a validation cohort. The nonenhanced CT images taken after mechanical thrombectomy were used to extract radiomic features. The maximum relevance minimum redundancy (mRMR) algorithm was used to eliminate confounding variables. Afterwards, least absolute shrinkage and selection operator (LASSO) logistic regression was used to generate the radiomic signature. The diagnostic performance of the radiomic signature was evaluated by the area under the curve (AUC), accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS A total of 166 intraparenchymal areas of hyperattenuation from 101 patients were used. The areas of hyperattenuation were randomly allocated to the training and validation cohorts at a ratio of 7:3. The AUC of the radiomic signature was 0.848 (95% confidence interval (CI) 0.780-0.917) in the training cohort and 0.826 (95% CI 0.705-0.948) in the validation cohort. The accuracy of the radiomic signature was 77.6%, with a sensitivity of 76.7%, a specificity of 78.9%, a PPV of 85.2%, and a NPV of 68.2% in the validation cohort. CONCLUSIONS The radiomic signature constructed based on initial post-operative nonenhanced CT after mechanical thrombectomy can effectively differentiate IPH from iodinated contrast extravasation. KEY POINTS • Radiomic features were extracted from intraparenchymal areas of hyperattenuation on initial post-operative CT scans after mechanical thrombectomy. • The nonenhanced CT-based radiomic signature can differentiate IPH from iodinated contrast extravasation early. • The radiomic signature may help prevent unnecessary rescanning after mechanical thrombectomy, especially in cases where contrast extravasation is highly suggestive.
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Affiliation(s)
- Xiaojun Chen
- Department of Radiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, 365 Renmin East Road, Jinhua, 321000, China
| | - Yuanzhe Li
- CT/MRI Department, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Yongjin Zhou
- Department of Radiology, Lishui Hospital of Zhejiang University, 289 Kuocang Road, Lishui, 323000, China
| | - Yan Yang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325000, China
| | - Jiansheng Yang
- Department of Neurology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, 88 Jiefang Road, Hangzhou, 325000, China
| | - Peipei Pang
- Department of Pharmaceuticals Diagnosis, GE Healthcare, 122 Shuguang Road, Hangzhou, 310000, China
| | - Yi Wang
- CT/MRI Department, The Second Affiliated Hospital, Fujian Medical University, 34 Zhongshan North Road, Quanzhou, 362000, China
| | - Jianmin Cheng
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xueyuan West Road, Wenzhou, 325000, China
| | - Haibo Chen
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, 310000, China.
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310000, China.
| | - Yifan Guo
- Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, 310000, China.
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310000, China.
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12
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A New Classification System for Postinterventional Cerebral Hyperdensity: The Influence on Hemorrhagic Transformation and Clinical Prognosis in Acute Stroke. Neural Plast 2021; 2021:6144304. [PMID: 34858495 PMCID: PMC8632469 DOI: 10.1155/2021/6144304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Postinterventional cerebral hyperdensity (PCHD) is commonly seen in acute ischemic patients after mechanical thrombectomy. We propose a new classification of PCHD to investigate its correlation with hemorrhagic transformation (HT). The clinical prognosis of PCHD was further studied. Methods Data from 189 acute stroke patients were analyzed retrospectively. According to the European Cooperative Acute Stroke Study criteria (ECASS), HT was classified as hemorrhagic infarction (HI-1 and HI-2) and parenchymal hematoma (pH-1 and pH-2). Referring to the classification of HT, PCHD was classified as PCHD-1, PCHD-2, PCHD-3, and PCHD-4. The prognosis included early neurological deterioration (END) and the modified Rankin Scale (mRS) score at 3 months. Results The incidence of HT was 14.8% (12/81) in the no-PCHD group and 77.8% (84/108) in the PCHD group. PCHD was highly correlated with HT (r = 0.751, p < 0.01). After stepwise regression analysis, PCHD and the National Institutes of Health Stroke Scale (NIHSS) score at admission were found to be independent factors for END (p < 0.001, p = 0.015, respectively). The area of curves (AUC) of PCHD, the NIHSS at admission, and the combined model were 0.810, 0.667, and 0.832, respectively. The optimal diagnostic cutoff of PCHD for END was PCHD > 2. PCHD, the NIHSS score at admission, and good vascular recanalization (VR) were independently associated with 3-month mRS (all p < 0.05). The AUC of PCHD, the NIHSS at admission, good VR, and the combined model were 0.779, 0.733, 0.565, and 0.867, respectively. And the best cutoff of PCHD for the mRS was PCHD > 1. Conclusion The relationship of PCHD and HT suggested PCHD was an early risk indicator for HT. The occurrence of PCHD-3 and PCHD-4 was a strong predictor for END. PCHD-1 is considered to be relatively benign in relation to the 3-month mRS.
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13
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Wang C, Zhu Q, Cui T, Wang L, Yang T, Hao Z, Wu S, Zheng H, Hu F, Wu B. Early Prediction of Malignant Edema After Successful Recanalization in Patients with Acute Ischemic Stroke. Neurocrit Care 2021; 36:822-830. [PMID: 34751418 DOI: 10.1007/s12028-021-01380-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postinterventional cerebral hyperdensities are common on non-contrast-enhanced computed tomography (CT) after endovascular thrombectomy in patients with acute ischemic stroke, which may reflect blood-brain barrier damage. The disruption of the blood-brain barrier may lead to malignant brain edema. The relationship between the extent of postinterventional cerebral hyperdensities and malignant brain edema is unclear. METHODS Patients with middle cerebral artery territory infarction and successful recanalization were consecutively enrolled. Postinterventional non-contrast-enhanced CT was performed to evaluate postinterventional cerebral hyperdensities within 24 h after endovascular thrombectomy. On the basis of the areas of the Alberta Stroke Program Early CT Score, we devised the Hyperdensity on CT Score to evaluate the extent of postinterventional cerebral hyperdensities. The primary outcome was malignant brain edema, defined as the development of clinical signs of herniation (including a decrease in consciousness and/or anisocoria), accompanied by imaging evidence of brain swelling. The component of postinterventional cerebral hyperdensities was divided into contrast staining and hemorrhage on the basis of persistency. RESULTS Three hundred sixty patients were included (50.6% male, mean age 67.9 years), of whom 247 (68.6%) developed postinterventional cerebral hyperdensities and 66 (18.3%) developed malignant brain edema. After adjustment for confounders, including the component of postinterventional cerebral hyperdensities, the extent of postinterventional cerebral hyperdensities assessed by the Hyperdensity on CT Score was significantly associated with malignant brain edema (odds ratio 1.46, 95% confidence interval 1.20-1.77, p < 0.001). A Hyperdensity on CT Score greater than 3 had a sensitivity of 0.73 and a specificity of 0.87 for predicting malignant brain edema. CONCLUSIONS The extent of postinterventional cerebral hyperdensities on postinterventional non-contrast-enhanced CT was associated with malignant brain edema. The Hyperdensity on CT Score could be used to predict malignant brain edema regardless of the component of postinterventional cerebral hyperdensities.
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Affiliation(s)
- Changyi Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Departement of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiange Zhu
- The Second Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Ting Cui
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Wang
- Departement of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tang Yang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zilong Hao
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Simiao Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongbo Zheng
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fayun Hu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Bo Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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14
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Clinical Significance of Hyperdense Lesions on Non-enhanced Brain CT Obtained Immediately after Arterial Revascularization in Acute Ischemic Stroke Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1562502. [PMID: 34527073 PMCID: PMC8437617 DOI: 10.1155/2021/1562502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022]
Abstract
Purpose To analyze the characteristics of hyperdense lesions on brain CT conducted immediately after arterial revascularization (AR) in patients with acute ischemic stroke (AIS), track the outcome of those lesions and investigate their clinical significance. Materials and Methods 97 AIS patients were enrolled in our study. Among them, 52 patients showed hyperdense lesions and were divided into three categories: type I, type II and type III according to the morphologic characteristics of hyperdense lesions. All patients underwent several follow-up CT/MR examinations to visualize the outcomes of the lesions. Results Among the 52 patients, 22 showed contrast extravasation, 23 displayed contrast extravasation combined with hemorrhagic transformation (HT) and 7 confirmed symptomatic intracranial hemorrhage (SICH) in follow-up CT/MR. Among the without hyperdense lesions group, only 7 converted to hemorrhage, and no SICH occurred. All type I lesions showed contrast extravasation; 23 type II lesions turned to hemorrhage, 2 revealed SICH and 6 were pure contrast extravasation; all of the type III developed into SICH. Conclusion Hyperdense lesions on non-enhanced brain CT obtained immediately after arterial revascularization (AR) exhibited varying features. Type I indicated a pure contrast extravasation. Type II and type III hyperdense lesions suggested higher incidence of HT, the presence of type III lesions indicated an ominous outcome.
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15
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Application of Flat-Panel Volume Computed Tomography to Evaluate Cerebral Hemorrhage After Mechanical Thrombectomy of Acute Embolic Stroke of the Anterior Circulation. J Comput Assist Tomogr 2021; 45:919-925. [PMID: 34347702 DOI: 10.1097/rct.0000000000001203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate cerebral hemorrhage (CH) and contrast media leakage (CML or commonly synonymous with "contrast staining") differentiation on flat-panel volume computed tomography (FPVCT) after intra-arterial mechanical thrombectomy. METHODS We evaluated patients with hyperattenuation on FPVCT after intra-arterial mechanical thrombectomy between 2018 and 2021 by multiple parameters on CT angiography, FPVCT, CT, and/or magnetic resonance imaging. RESULTS The CH (n = 43) versus CML (n = 24) groups revealed: (1) regional anatomical characteristics (preserved and distorted): 7 of 43 (9.6%) and 36 of 43 (83.7%) versus 22 of 24 (91.7%) and 2 of 24 (8.3%, P < 0.001); (2) thrombus in proximal two-thirds versus distal one-thirds M1 segment of middle cerebral artery (preserved and distorted): 17 of 21 (81.0%) and 4 of 21 (19.0%) versus 5 of 11 (45.5%) and 6 of 11 (54.5%, P = 0.040); and (3) average density ratio: 1.83 ± 0.65 versus 1.35 ± 0.13 (P = 0.004). CONCLUSIONS Contrast media leakage can be differentiated from CH by preserved regional anatomical characteristics and relatively low average density ratio on FPVCT. Patients with CML who have embolism in proximal two thirds of M1 segment are more likely to develop hyperattenuation with preserved regional anatomy.
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16
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Ospel JM, Qiu W, Menon BK, Mayank A, Demchuk A, McTaggart R, Nogueira RG, Poppe AY, Jayaraman M, Buck B, Haussen D, Roy D, Joshi M, Zerna C, Almekhlafi M, Tymianski M, Hill MD, Goyal M. Radiologic Patterns of Intracranial Hemorrhage and Clinical Outcome after Endovascular Treatment in Acute Ischemic Stroke: Results from the ESCAPE-NA1 Trial. Radiology 2021; 300:402-409. [PMID: 34060942 DOI: 10.1148/radiol.2021204560] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Intracranial hemorrhage is a known complication after endovascular treatment in patients with acute ischemic stroke due to large vessel occlusion, but the association between radiologic hemorrhage severity and outcome is controversial. Purpose To investigate the prevalence and impact on outcome of intracranial hemorrhage and hemorrhage severity after endovascular stroke treatment. Materials and Methods The Efficacy and Safety of Nerinetide for the Treatment of Acute Ischemic Stroke (ESCAPE-NA1) trial enrolled participants with acute large vessel occlusion stroke who underwent endovascular treatment from March 1, 2017, to August 12, 2019. Evidence of any intracranial hemorrhage, hemorrhage multiplicity, and radiologic severity, according to the Heidelberg classification (hemorrhagic infarction type 1 [HI1], hemorrhagic infarction type 2 [HI2], parenchymal hematoma type 1 [PH1], and parenchymal hematoma type 2 [PH2]) was assessed at CT or MRI 24 hours after endovascular treatment. Good functional outcome, defined as a modified Rankin score of 0-2 at 90 days, was compared between participants with intracranial hemorrhage and those without intracranial hemorrhage at follow-up imaging and between hemorrhage subtypes. Poisson regression was performed to obtain adjusted effect size estimates for the presence of any intracranial hemorrhage and hemorrhage subtypes at good functional outcome. Results Of 1097 evaluated participants (mean age, 69 years ± 14 [standard deviation]; 551 men), any degree of intracranial hemorrhage was observed in 372 (34%). Good outcomes were less often achieved among participants with hemorrhage than among those without hemorrhage at follow-up imaging (164 of 372 participants [44%] vs 500 of 720 [69%], respectively; P < .01). After adjusting for baseline variables and infarct volume, intracranial hemorrhage was not associated with decreased chances of good outcome (adjusted risk ratio [RR] = 0.91 [95% CI: 0.82, 1.02], P = .10), but there was a graded relationship of radiologic hemorrhage severity and outcomes, whereby PH1 (RR = 0.77 [95% CI: 0.61, 0.97], P = .03) and PH2 (RR = 0.41 [95% CI: 0.21, 0.81], P = .01) were associated with decreased chances of good outcome. Conclusion Any degree of intracranial hemorrhage after endovascular treatment was seen in one-third of participants. A graded association existed between radiologic hemorrhage severity and outcome. Hemorrhagic infarction was not associated with outcome, whereas parenchymal hematoma was strongly associated with poor outcome, independent of infarct volume. © RSNA, 2021 Clinical trial registration no. NCT01778335 Online supplemental material is available for this article.
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Affiliation(s)
- Johanna M Ospel
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Wu Qiu
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Bijoy K Menon
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Arnuv Mayank
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Andrew Demchuk
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Ryan McTaggart
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Raul G Nogueira
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Alexandre Y Poppe
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Mahesh Jayaraman
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Brian Buck
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Diogo Haussen
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Daniel Roy
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Manish Joshi
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Charlotte Zerna
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Mohammed Almekhlafi
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Michael Tymianski
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Michael D Hill
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
| | - Mayank Goyal
- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
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- From the Department of Clinical Neurosciences and Diagnostic Imaging, University of Calgary Cumming School of Medicine, 29th St NW, 1079 A, Calgary, AB, Canada T2N 2T9 (J.M.O., W.Q., B.K.M., A.M., A.D., C.Z., M.A., M.D.H., M.G.); Department of Radiology, University Hospital of Basel, Basel, Switzerland (J.M.O.); Department of Radiology, University of Calgary, Calgary, Canada (B.K.M., A.D., M. Joshi, M.A., M.D.H., M.G.); Department of Interventional Radiology, Warren Alpert Medical School of Brown University, Providence, RI (R.M., M. Jayaraman); Department of Neurology, Emory University School of Medicine, Atlanta, Ga (R.G.N., D.H.); Department of Neurology (D.R.) and Neurosciences (A.Y.P.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Medicine, University of Alberta Hospital, Edmonton, Canada (B.B.); and NoNo, Toronto, Canada (M.T.)
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Jiang Q, Hou J, Ge J, Huang Z, Wang H, Guo Z, Cao Y, You S, Xiao G. Clinical Significance of Hyperdense Area after Endovascular Therapy in Patients with Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2021; 50:500-509. [PMID: 34044398 DOI: 10.1159/000515410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/22/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to investigate the clinical significance of hyperdense area after thrombectomy in patients with acute ischemic stroke (AIS). METHODS We searched Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and other Non-Indexed, Cochrane Library Clinical Controlled Trials and Embase from inception to September 2020 and collected the cohort and case-control studies about the clinical significance of hyperdense area on different types of computed tomography (CT) after thrombectomy in patients with AIS. Outcomes were poor functional outcome (modified Rankin Scale [mRS] Score 3-6 at discharge or 90-day), mortality and subtypes of hemorrhage according to the European Cooperative Acute Stroke Study (ECASS). RESULTS 1,999 patients from 16 studies were included in this meta-analysis. Pooled results indicated higher risk of symptomatic intracerebral hemorrhage (odds ratio [OR] = 3.02; 95% confidence interval [CI] 1.84-4.95; p < 0.0001, I2 = 0%) in patients with hyperdense area, and the subtype of parenchymal hematoma as well. There was also higher odds of poor functional outcome based on the mRS 3-6 at discharge or 90-day (OR = 1.92; 95% CI 1.35-2.73; p = 0.0003, I2 = 31%) and mortality (OR = 2.06; 95% CI 1.41-3.02; p = 0.0002, I2 = 0%) in patients with hyperdense area after thrombectomy compared with those without hyperdense area. CONCLUSIONS Our results indicated that the presence of hyperdense area on CT after thrombectomy was associated with high risk of symptomatic intracerebral hemorrhage, poor functional outcome, as well as mortality in patients with AIS. However, further studies were needed to confirm these results. The meta-analysis was conducted in adherence with the PRISMA Statement and was registered at the International Prospective Register of Systematic Reviews (CRD42020164165). To the best of our knowledge, this study is the first meta-analysis investigating the effect of hyperdense area after endovascular therapy in patients with AIS.
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Affiliation(s)
- Qianmei Jiang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie Hou
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jian Ge
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhichao Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Huaishun Wang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhiliang Guo
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Guodong Xiao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
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18
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Zhu W, Hua X, Liu Z, Zhang X, Li S, Jing C. Relationship between chronic hyperglycemia and contrast extravasation in revascularization of symptomatic intracranial atherosclerotic stenosis: A retrospective single-center study. J Clin Neurosci 2021; 89:311-318. [PMID: 34119286 DOI: 10.1016/j.jocn.2021.05.025] [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: 02/23/2021] [Revised: 04/25/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Contrast extravasation is one of the most common perioperative complications in symptomatic intracranial atherosclerotic stenosis (ICAS) patients after percutaneous transluminal angioplasty and/or stenting (PTAS). This study aimed to investigate the correlations between the relevant serum biochemical indicators of carbohydrate metabolism and the occurrence of contrast extravasation. METHODS Patients' demographic characteristics, vascular risk factors and laboratory examination data were collected. Blood routine test, blood biochemical examination and hormone level test within 1 week before surgery were measured in all enrolled subjects. Patients underwent non-contrast CT scans immediately after the endovascular procedure. Follow-up non-contrast CT scans were performed in the next 24 h and repeated as per clinical condition. RESULTS 104 patients who have undergone effective PTAS were involved in this study. 18 patients have identified as contrast extravasation and there was no obvious abnormality in another 86 cases. There were significant differences in the pre-operative HbA1c, fasting blood sugar and cortisol levels in the subjects regardless of gender between two groups (p < 0.001, p < 0.001 and p = 0.001, respectively). Furthermore, there were statistical differences in E2 and testosterone levels between two groups in both male population (p = 0.035 and p = 0.028, respectively) and female population (p = 0.036 and p = 0.003, respectively). Besides, the AUC value of HbA1c, fasting blood sugar and cortisol levels were all over 0.7 (0.858, 0.780 and 0.752, respectively). The highest AUC value of various combinations was obtained from the combination of HbA1c and cortisol level, which was 0.898. CONCLUSIONS Patient with chronic hyperglycemia is closely related to contrast extravasation after PTAS. Specific mechanisms might be explored and regarded as promising candidates to prevent contrast extravasation.
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Affiliation(s)
- Wanchun Zhu
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Xuming Hua
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Zhenxing Liu
- Department of Neurosurgery, Liaocheng Brain Hospital, Liaocheng People's Hospital, Liaocheng, Shangdong Province 252000, China
| | - Xin Zhang
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
| | - Shiting Li
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
| | - Chaohui Jing
- Department of Neurosurgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
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Riederer I, Fingerle AA, Zimmer C, Noël PB, Makowski MR, Pfeiffer D. Potential of dual-layer spectral CT for the differentiation between hemorrhage and iodinated contrast medium in the brain after endovascular treatment of ischemic stroke patients. Clin Imaging 2021; 79:158-164. [PMID: 33962188 DOI: 10.1016/j.clinimag.2021.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/01/2021] [Accepted: 04/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND One possible complication after mechanical thrombectomy is hemorrhage. In conventional CT it is often difficult to differ between extravasation of iodinated contrast medium and blood. This differentiation, however, is essential for treatments with anticoagulants and antiplatelets. PURPOSE To evaluate dual-layer spectral Computed Tomography (DLSCT) for the differentiation between intracranial hemorrhage and iodinated contrast medium in ischemic stroke patients after mechanical thrombectomy. MATERIALS AND METHODS First, in vitro experiments were performed. Then, head CT images of 47 patients after mechanical thrombectomy were analyzed. Virtual non-contrast (VNC) images and iodine density maps (IDM) were calculated and evaluated. Region of interests (ROIs) analyses were performed. Sensitivity and specificity as well as ROC curves were calculated. RESULTS IDM and VNC images enabled clear differentiation between blood and iodine and reliable quantification of different iodine concentrations in vitro. A total of 23 hyperdense areas were detected in 13 patients, classified as hemorrhage (n = 7), iodinated contrast medium (n = 4) and a mixture of both (n = 12). Sensitivity and specificity for the detection of blood was 100%. CONCLUSION DLSCT enables differentiation between intracranial hemorrhage and iodinated contrast medium in patients after mechanical thrombectomy and might improve diagnostic imaging in post-interventional stroke patients.
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Affiliation(s)
- Isabelle Riederer
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany.
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
| | - Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, One Silverstein, Philadelphia, PA 19104, USA
| | - Marcus R Makowski
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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Flat Panel CT Scanning Is Helpful in Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Patients Undergoing Endovascular Thrombectomy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5527101. [PMID: 33954174 PMCID: PMC8060075 DOI: 10.1155/2021/5527101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/28/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Abstract
Purpose Hyperdense lesions are frequently revealed on flat panel CT (FP-CT) immediately after endovascular thrombectomy in patients with acute ischemic stroke. This study is aimed at discriminating hyperdense lesions caused by extravasation plus hemorrhage from those caused by contrast extravasation alone. Methods We retrospectively analyzed clinical and radiological data of patients who underwent an immediate postprocedure FP-CT scan and a follow-up noncontrast CT 24 hours after thrombectomy. We especially focused on the Maximum Hounsfield Units (HUmax) of each hyperdense lesion. A hyperdense lesion was judged to be hemorrhagic when it persisted on noncontrast CT and/or developed a mass effect. Results Of 81 patients included in this study, 32 (39.5%) patients presented 41 hyperdense lesions on FP-CT. The chance of hemorrhagic transformation is higher in patients with hyperdense lesions on FP-CT than that in patients without hyperdense lesions (23/32 vs. 1/49, p < 0.001). The HUmax of hyperdensity on FP-CT can predict hemorrhagic transformation with an area under the curve of 0.805 (95% CI: 0.67-0.94, p = 0.02). The sensitivity, specificity, positive, and negative predictive values of hyperdensity on FP-CT for hemorrhagic transformation were 96%, 84%, 72%, and 98%, respectively. A HUmax of >600 predicted hemorrhagic transformation with a sensitivity of 50% and a specificity of 100%. Conclusions The presence of hyperdensity on FP-CT can predict hemorrhagic transformation with a high sensitivity and negative predictive value. The measurement of HUmax of hyperdense lesion on FP-CT can be applied to the management of patients undergoing endovascular recanalization.
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21
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Watershed subarachnoid hemorrhage after middle cerebral artery rescue stenting in patients with acute ischemic stroke. Neuroradiology 2021; 63:1383-1388. [PMID: 33760956 PMCID: PMC8295148 DOI: 10.1007/s00234-021-02692-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
Cortical subarachnoid hemorrhage is an infrequent subtype of non-aneurysmal subarachnoid hemorrhage, rarely reported in watershed territories (wSAH) after carotid stenting. It has never been reported after treatment of middle cerebral artery stenosis (MCAS) that is increasingly used in selected patients, as rescue treatment of failed mechanical thrombectomy, due to recent advancements in endovascular interventions. We present a series of patients with MCAS that developed a wSAH after stenting.
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Baek JH, Kim BM, Heo JH, Kim DJ, Nam HS, Kim YD, Choi HS, Kim JH, Kim JW. Association between flat-panel computed tomography hyperattenuation and clinical outcome after successful recanalization by endovascular treatment. J Neurosurg 2020; 135:704-711. [PMID: 33361477 DOI: 10.3171/2020.7.jns193214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hyperattenuation on CT scanning performed immediately after endovascular treatment (EVT) is known to be associated with the final infarct. As flat-panel CT (FPCT) scanning is readily accessible within their angiography suite, the authors evaluated the ability of the extent of hyperattenuation on FPCT to predict clinical outcomes after EVT. METHODS Patients with successful recanalization (modified Thrombolysis in Cerebral Infarction grade 2b or 3) were reviewed retrospectively. The extent of hyperattenuation was assessed by the Alberta Stroke Program Early CT Score on FPCT (FPCT-ASPECTS). FPCT-ASPECTS findings were compared according to functional outcome and malignant infarction. The predictive power of the FPCT-ASPECTS with initial CT images before EVT (CT-ASPECTS) and follow-up diffusion-weighted images (MR-ASPECTS) was also compared. RESULTS A total of 235 patients were included. All patients were treated with mechanical thrombectomy, and 45.5% of the patients received intravenous tissue plasminogen activator. The mean (± SD) time from stroke onset to recanalization was 383 ± 290 minutes. The FPCT-ASPECTS was significantly different between patients with a favorable outcome and those without (mean 9.3 ± 0.9 vs 6.7 ± 2.6) and between patients with malignant infarction and those without (3.4 ± 2.9 vs 8.8 ± 1.4). The FPCT-ASPECTS was an independent factor for a favorable outcome (adjusted OR 3.28, 95% CI 2.12-5.01) and malignant infarction (adjusted OR 0.42, 95% CI 0.31-0.57). The area under the curve (AUC) of the FPCT-ASPECTS for a favorable outcome (0.862, cutoff ≥ 8) was significantly greater than that of the CT-ASPECTS (0.637) (p < 0.001) and comparable to that of the MR-ASPECTS (0.853) (p = 0.983). For malignant infarction, the FPCT-ASPECTS was also more predictive than the CT-ASPECTS (AUC 0.906 vs 0.552; p = 0.001) with a cutoff of ≤ 5. CONCLUSIONS The FPCT-ASPECTS was highly predictive of clinical outcomes in patients with successful recanalization. FPCT could be a practical method to immediately predict clinical outcomes and thereby aid in acute management after EVT.
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Affiliation(s)
- Jang-Hyun Baek
- 1Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Byung Moon Kim
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Ji Hoe Heo
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Dong Joon Kim
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Hyo Suk Nam
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Young Dae Kim
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Hyun Seok Choi
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Jun-Hwee Kim
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Jin Woo Kim
- 4Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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23
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Portela de Oliveira E, Chakraborty S, Patel M, Finitsis S, Iancu D. Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome. Neuroradiol J 2020; 34:120-127. [PMID: 33283627 DOI: 10.1177/1971400920975259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Cerebral hyperdensities can appear on head computed tomography (CT) images performed early after endovascular treatment (EVT) in patients with acute ischemic stroke and may be secondary to contrast staining or hemorrhagic transformation. The aim of this study was to determine how the high-density sign on CT affects mortality and clinical outcome and whether CT parameters predict hemorrhagic conversion or unfavorable outcome. METHODS We retrospectively reviewed a database of patients who underwent EVT with mechanical thrombectomy for acute ischemic stroke over 7 years. Included were acute stroke patients with a CT examination within 24 h post-EVT with mechanical thrombectomy, demonstrating areas of hyperdensity. We evaluated morphologic characteristics of these lesions, location, CT Hounsfield units and largest area, as well as patient demographics, EVT methods and patient outcome. RESULTS A total of 29 patients met the strict inclusion criteria. Complete recanalization was achieved in 58.6% (17/29). Seventeen (58.6%) cases of post-intervention cerebral hyperdensities were related to contrast staining and 12 (41.4%) cases to contrast staining and hemorrhage. Patient mortality was significantly higher in the hemorrhagic group (50.0% versus 5.9%, p = 0.003). The increased density on CT was associated with higher hemorrhagic risk (odds ratio 1.05, p = 0.036). CONCLUSION Patients with the high-density sign on CT images after mechanical thrombectomy for acute ischemic stroke demonstrated increased mortality and worse clinical outcome, primarily when these hyperdensities were related to hemorrhage. CT imaging parameters as higher density areas can help in the differentiation of hemorrhage from contrast staining.
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Affiliation(s)
| | - Santanu Chakraborty
- Department of Radiology, University of Ottawa; Medical Imaging Division, The Ottawa Hospital, Canada
| | - Mihilkumar Patel
- Department of Radiology, University of Ottawa; Medical Imaging Division, The Ottawa Hospital, Canada
| | - Stefanos Finitsis
- Department of Radiology, Aristotle University of Thessaloniki, Greece
| | - Daniela Iancu
- Department of Radiology, University of Montreal, Canada
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24
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Copelan AZ, Smith ER, Drocton GT, Narsinh KH, Murph D, Khangura RS, Hartley ZJ, Abla AA, Dillon WP, Dowd CF, Higashida RT, Halbach VV, Hetts SW, Cooke DL, Keenan K, Nelson J, Mccoy D, Ciano M, Amans MR. Recent Administration of Iodinated Contrast Renders Core Infarct Estimation Inaccurate Using RAPID Software. AJNR Am J Neuroradiol 2020; 41:2235-2242. [PMID: 33214184 DOI: 10.3174/ajnr.a6908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/01/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Automated CTP software is increasingly used for extended window emergent large-vessel occlusion to quantify core infarct. We aimed to assess whether RAPID software underestimates core infarct in patients with an extended window recently receiving IV iodinated contrast. MATERIALS AND METHODS We reviewed a prospective, single-center data base of 271 consecutive patients who underwent CTA ± CTP for acute ischemic stroke from May 2018 through January 2019. Patients with emergent large-vessel occlusion confirmed by CTA in the extended window (>6 hours since last known well) and CTP with RAPID postprocessing were included. Two blinded raters independently assessed CT ASPECTS on NCCT performed at the time of CTP. RAPID software used relative cerebral blood flow of <30% as a surrogate for irreversible core infarct. Patients were dichotomized on the basis of receiving recent IV iodinated contrast (<8 hours before CTP) for a separate imaging study. RESULTS The recent IV contrast and contrast-naïve cohorts comprised 23 and 15 patients, respectively. Multivariate linear regression analysis demonstrated that recent IV contrast administration was independently associated with a decrease in the RAPID core infarct estimate (proportional increase = 0.34; 95% CI, 0.12-0.96; P = .04). CONCLUSIONS Patients who received IV iodinated contrast in proximity (<8 hours) to CTA/CTP as part of a separate imaging study had a much higher likelihood of core infarct underestimation with RAPID compared with contrast-naïve patients. Over-reliance on RAPID postprocessing for treatment disposition of patients with extended window emergent large-vessel occlusion should be avoided, particularly with recent IV contrast administration.
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Affiliation(s)
- A Z Copelan
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - E R Smith
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.).,Department of Radiology (E.R.S.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - G T Drocton
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - K H Narsinh
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - D Murph
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - R S Khangura
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - Z J Hartley
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - A A Abla
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.).,Neurosurgery (A.A.A.), University of California, San Francisco, San Francisco, California
| | - W P Dillon
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - C F Dowd
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - R T Higashida
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - V V Halbach
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - S W Hetts
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - D L Cooke
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - K Keenan
- Department of Neurology (K.K.), University of California Davis, Sacramento, California
| | - J Nelson
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - D Mccoy
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - M Ciano
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
| | - M R Amans
- From the Departments of Diagnostic and Interventional Neuroradiology (A.Z.C., E.R.S., G.T.D., K.H.N., D.M., R.S.K., Z.J.H., A.A.A., W.P.D., C.F.D., R.T.H., V.V.H., S.W.H., D.L.C., J.N., D.M., M.C., M.R.A.)
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25
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Whitney E, Khan YR, Alastra A, Schiraldi M, Siddiqi J. Contrast Extravasation Post Thrombectomy in Patients With Acute Cerebral Stroke: A Review and Recommendations for Future Studies. Cureus 2020; 12:e10616. [PMID: 33123430 PMCID: PMC7584332 DOI: 10.7759/cureus.10616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Mechanical thrombectomy (MT) for cerebral revascularization in acute stroke is now considered standard of care in select patients. Patients are assessed routinely after MT with CT scanning. The phenomenon of contrast staining is well documented in the literature and is posited to be related to increased blood-brain barrier (BBB) permeability of susceptible and/or infarcting brain tissue allowing angiographic contrast to be visualized outside the normal cerebral vasculature. In some cases, this can progress to include frank blood/contrast extravasation or even more seriously lead to intraparenchymal hemorrhage (IPH) with less favorable clinical outcomes. The relationship of this staining phenomenon and how it may have a cause or effect relationship with progression to hemorrhage is unclear. Many studies have been performed trying to better characterize this radiographic finding in terms of accurate diagnosis and potential for influencing prognosis. A literature review included a glaring lack of standardization in the application of terminology and quantitative/qualitative analysis. Dual energy CT (DECT) appears to be the best imaging modality to differentiate blood from contrast, but its application is limited since it is not as available as conventional CT. The possibility that risk factors are associated with progression of mixed density (blood and contrast) extravasations to frank IPH with resultant poorer outcomes is suggested in some studies. Overall, there remains a lack of consensus on how to best interpret this radiographic finding in altering any future stroke treatment(s). Recommendations of how to overcome this are postulated by the authors, which include standardization of terminology, progression toward more DECT use.
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Affiliation(s)
- Eric Whitney
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Yasir R Khan
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Anthony Alastra
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Michael Schiraldi
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.,Neurosurgery, Redlands Community Hospital, Redlands, USA
| | - Javed Siddiqi
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.,Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA.,Neurosurgery, Arrowhead Regional Medical Center, Colton, USA.,Neurosurgery, California University of Science and Medicine, Colton, USA
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26
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Bae S, Ahn SS, Kim BM, Kim DJ, Kim YD, Nam HS, Heo JH, Lee SK. Hyperattenuating lesions after mechanical thrombectomy in acute ischaemic stroke: factors predicting symptomatic haemorrhage and clinical outcomes. Clin Radiol 2020; 76:80.e15-80.e23. [PMID: 32950255 DOI: 10.1016/j.crad.2020.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Abstract
AIM To evaluate the clinical significance of hyperattenuating lesions on CT after mechanical thrombectomy for acute ischaemic stroke, and to identify imaging factors that predict symptomatic haemorrhage and unfavourable outcomes. MATERIALS AND METHODS Seventy-eight patients with acute ischaemic stroke in the anterior circulation who underwent mechanical thrombectomy were evaluated. All patients underwent post-interventional unenhanced computed tomography (CT) within 24 h and follow-up CT or magnetic resonance imaging (MRI) within 7 days. Baseline characteristics and clinical outcomes were compared between patients with and without hyperattenuating lesions. In patients with hyperattenuating lesions, clinical and imaging factors that predict symptomatic haemorrhage and unfavourable outcomes were determined. RESULTS Fifty-six of 78 patients (71.8%) demonstrated hyperattenuating lesions on post-interventional CT. Patients with hyperattenuating lesions showed lower Alberta Stroke Program Early CT score (ASPECTS), persistent/symptomatic haemorrhage, and unfavourable outcomes than those without. In patients with hyperattenuating lesions, larger hyperattenuating lesion volume (>21.3 ml; OR, 55.60, p<0.001) and perilesional oedema (OR, 46.04, p=0.015) were independent factors predicting symptomatic haemorrhage. Older age (OR, 1.2, p=0.006) and lower ASPECTS (OR, 0.45, p=0.046) were independent factors predicting unfavourable outcomes in patients with hyperattenuating lesions. Adding the volume of the hyperattenuating lesion to age and ASPECTS increased the predictive performance of unfavourable outcomes (area under the curve 0.874 versus 0.934, p=0.043). CONCLUSIONS Hyperattenuating lesions on post-interventional CT are associated with increased risk of symptomatic haemorrhage and unfavourable outcomes. Larger hyperattenuating lesion volume is an independent factor of symptomatic haemorrhage and it has added predictive value for unfavourable outcomes.
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Affiliation(s)
- S Bae
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang 10444, South Korea
| | - S S Ahn
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul 03722, South Korea.
| | - B M Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - D J Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Y D Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - H S Nam
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - J H Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - S-K Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science and Center for Clinical Image Data Science, Yonsei University College of Medicine, Seoul 03722, South Korea
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27
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Iida T, Yamauchi K, Takenaka S, Sakai H. The Relationship between Bleeding and Contrast Extravasation Judged by Dual Energy CT after Acute Thrombectomy. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:243-248. [PMID: 37502615 PMCID: PMC10370522 DOI: 10.5797/jnet.oa.2019-0094] [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: 10/31/2019] [Accepted: 03/23/2020] [Indexed: 07/29/2023]
Abstract
Objective There are many cases in which computed tomography (CT) after acute thrombectomy demonstrates high-density areas, but it may be difficult to judge whether this is hemorrhage or contrast extravasation. Dual energy CT (DECT) is an imaging method that enables discrimination of substances by acquiring X-ray image data of two different energies. Methods We performed DECT to distinguish hemorrhage from contrast extravasation in cases with high-density areas on CT after acute thrombectomy at our hospital, and we compared with T2*-weighted image on the following day. Results Six patients comprising 22 areas had high-density areas on CT after acute thrombectomy. In all, 20 of the 22 high-density areas were determined to be contrast extravasation by DECT, and no cases of subsequent symptomatic cerebral hemorrhage were observed. However, 11 areas with new microbleeds were confirmed in the 20 extravasation areas on MRI-T2* images the day after thrombectomy. Conclusion This examination suggested that the contrast extravasation and its concentration are involved in the presence of low-intensity areas on T2*.
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Affiliation(s)
- Tomohiro Iida
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
- Department of Neurosurgery, Gifu Prefectural General Medical Center, Gifu, Gifu, Japan
| | - Keita Yamauchi
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
| | - Shunsuke Takenaka
- Department of Neurosurgery, Japan Organization of Occupational Health and Safety Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, Japan
| | - Hideki Sakai
- Department of Neurosurgery, National Hospital Organization Toyohashi Medical Center, Toyohashi, Aichi, Japan
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28
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Contrast Extravasation is Predictive of Poor Clinical Outcomes in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke in the Anterior Circulation. J Stroke Cerebrovasc Dis 2019; 29:104494. [PMID: 31727596 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104494] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/24/2019] [Accepted: 10/21/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate whether contrast extravasation on dual-energy computed tomography (DECT) in patients with acute ischemic stroke (AIS) after endovascular therapy (EVT) are related to hemorrhagic transformation (HT) and poor short-term clinical outcomes. METHODS A retrospective analysis was conducted on AIS patients who underwent EVT at Xuanwu hospital between November 2016 and January 2019. DECT was performed on all patients within 24 hours after EVT. Baseline demographic and clinical data were analyzed between patients with and without contrast extravasation and between patients with HT and non-HT, good and poor outcomes at 3 months post-EVT. RESULTS A total of 166 patients were included in the study with 51 (30.7%) patients experiencing contrast extravasation. Compared to patients without contrast extravasation, patients with contrast extravasation had longer onset to reperfusion time (444.8 minutes versus 374.0 minutes, P = .044) and higher percentages of greater than 3 retriever passes (16.7% versus 31.4%, P = .030). Contrast extravasation was associated with higher risk of HT (P = .038), poor outcome after discharge (P = .030), and longer hospital stay (P = .034). Multivariate analysis showed that contrast extravasation occurrence was an independent factor for HT (OR = 2.150, 95% CI 1.060-4.360, P = .034) and poor short-term outcome (OR = 2.936; 95% CI 1.147-7.518, P = .025). CONCLUSIONS The presence of contrast extravasation within 24 hours of EVT may be associated with higher risks of HT and may be predictive of unfavorable functional outcomes in AIS patients.
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An H, Zhao W, Wang J, Wright JC, Elmadhoun O, Wu D, Shang S, Wu C, Li C, Wu L, Chen J, Duan J, Zhang H, Song H, Ding Y, Ji X. Contrast Staining may be Associated with Intracerebral Hemorrhage but Not Functional Outcome in Acute Ischemic Stroke Patients Treated with Endovascular Thrombectomy. Aging Dis 2019; 10:784-792. [PMID: 31440384 PMCID: PMC6675522 DOI: 10.14336/ad.2018.0807] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/07/2018] [Indexed: 12/17/2022] Open
Abstract
To evaluate the incidence of post-interventional contrast staining (PICS) in acute ischemic stroke (AIS) Chinese patients who were treated with endovascular thrombectomy (ET) and investigate potential association of PICS with functional outcome and intracerebral hemorrhage (ICH). This observational study was based on a single-center prospective registry study. AIS patients who underwent ET from January 2013 to February 2017 were recruited into this study. All patients had dual-energy CT (DECT) scan of the head at 12 to 24 hours post-ET. The primary outcome was the incidence of PICS. Secondary outcomes were total ICH, symptomatic ICH (sICH), 3-month functional outcome, and long-term functional outcome. One hundred and eighty patients were enrolled in this study. PICS was detected in 50 patients (28%) based on the post-interventional CT scan. We first used basic statistical analyses, showing that the incidence of both total ICH (60% vs. 25%, p<0.001) and sICH (18% vs. 8%, p=0.044) were higher in patients with PICS than those without, and fewer patients achieved no disability (mRS≤1) in the PICS group compared to the control group at both 3-month and long-term follow-up (p<0.01 each). However, multivariate regression analysis further revealed that PICS only increased total (adjusted odds ratio, 7.38; 95% confidence interval 1.66 to 32.9; p=0.009) but not sICH risk. Furthermore, the logistic regression analyses did not show statistical difference in good clinical outcomes or mortality between the two groups. PICS is a common phenomenon in Chinese AIS patients. It is associated with total ICH after ET, but it seems to have no effect on functional outcome and sICH. Further large-scale studies are warranted to validate these results.
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Affiliation(s)
- Hong An
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianguo Wang
- 3Department of Rehabilitation, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Joshua C Wright
- 4Wayne State University School of Medicine, Detroit, MI, USA
| | - Omar Elmadhoun
- 5Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA.,6Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Massachusetts, USA
| | - Di Wu
- 2China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shuyi Shang
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- 7Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longfei Wu
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,2China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jian Chen
- 8Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jiangang Duan
- 7Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hongqi Zhang
- 8Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- 1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- 2China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,5Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- 2China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China.,8Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Wang X, Yang B, Zhu H, Jiao L. Contrast extravasation after angioplasty for symptomatic stenosis of the middle cerebral artery: A case report. Interv Neuroradiol 2019; 25:710-713. [PMID: 31269842 DOI: 10.1177/1591019919860830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Contrast extravasation is a common phenomenon in acute ischaemic stroke patients who are treated with endovascular therapy, but it is rarely reported in selective angioplasty of intracranial artery stenosis. In this case we present the treatment and follow-up studies of a patient with severe stenosis in the M1 segment of the middle cerebral artery. We observed extravasation of contrast medium in the brain tissue around the stent after the operation by a computed tomography scan taken immediately, but the patient did not experience any neurological deficits during the operation and the 4-year follow-up. Also the contrast extravasation did not transform into haemorrhage or hyperperfusion.
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Affiliation(s)
- Xiaohui Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haojing Zhu
- Department of Neurology, the Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Xu C, Zhou Y, Zhang R, Chen Z, Zhong W, Gong X, Ding X, Lou M. Metallic Hyperdensity Sign on Noncontrast CT Immediately after Mechanical Thrombectomy Predicts Parenchymal Hemorrhage in Patients with Acute Large-Artery Occlusion. AJNR Am J Neuroradiol 2019; 40:661-667. [PMID: 30846439 DOI: 10.3174/ajnr.a6008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Parenchymal hemorrhage is a severe complication following mechanical recanalization in patients with acute ischemic stroke with large-vessel occlusion. This study aimed to assess whether the metallic hyperdensity sign on noncontrast CT performed immediately after mechanical thrombectomy can predict parenchymal hemorrhage at 24 hours. MATERIALS AND METHODS We included consecutive patients with acute ischemic stroke with large-vessel occlusion who underwent noncontrast CT immediately after mechanical thrombectomy between January 2014 and September 2018. The metallic hyperdensity sign was defined as a nonpetechial intracerebral hyperdense lesion (diameter, ≥1 cm) in the basal ganglia and a maximum CT density of >90 HU. The sensitivity, specificity, and positive and negative predictive values of the metallic hyperdensity sign in predicting parenchymal hemorrhage were calculated. RESULTS A total of 198 patients were included. The metallic hyperdensity sign was found in 59 (29.7%) patients, and 51 (25.7%) patients had parenchymal hemorrhage at 24 hours. Patients with the metallic hyperdensity sign are more likely to have parenchymal hemorrhage than those without it (76.3% versus 4.3%, P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the metallic hyperdensity sign in predicting parenchymal hemorrhage were 88.2%, 90.5%, 76.3%, and 95.7%, respectively. CONCLUSIONS The presence of the metallic hyperdensity sign on noncontrast CT performed immediately after mechanical thrombectomy in patients with large-vessel occlusion could predict the occurrence of parenchymal hemorrhage at 24 hours, which might be helpful in postinterventional management within 24 hours after mechanical thrombectomy.
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Affiliation(s)
- C Xu
- From the Departments of Neurology (C.X., Y.Z., R.Z., Z.C., W.Z, X.G., M.L.)
| | - Y Zhou
- From the Departments of Neurology (C.X., Y.Z., R.Z., Z.C., W.Z, X.G., M.L.)
| | - R Zhang
- From the Departments of Neurology (C.X., Y.Z., R.Z., Z.C., W.Z, X.G., M.L.)
| | - Z Chen
- From the Departments of Neurology (C.X., Y.Z., R.Z., Z.C., W.Z, X.G., M.L.)
| | - W Zhong
- From the Departments of Neurology (C.X., Y.Z., R.Z., Z.C., W.Z, X.G., M.L.)
| | - X Gong
- From the Departments of Neurology (C.X., Y.Z., R.Z., Z.C., W.Z, X.G., M.L.)
| | - X Ding
- Radiology (X.D.), the Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - M Lou
- From the Departments of Neurology (C.X., Y.Z., R.Z., Z.C., W.Z, X.G., M.L.)
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Riederer I, Si-Mohamed S, Ehn S, Bar-Ness D, Noël PB, Fingerle AA, Pfeiffer F, Rummeny EJ, Douek P, Pfeiffer D. Differentiation between blood and iodine in a bovine brain-Initial experience with Spectral Photon-Counting Computed Tomography (SPCCT). PLoS One 2019; 14:e0212679. [PMID: 30802258 PMCID: PMC6388929 DOI: 10.1371/journal.pone.0212679] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/07/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives To evaluate the accuracy of Spectral Photon-Counting Computed Tomography (SPCCT) in the quantification of iodine concentrations and its potential for the differentiation between blood and iodine. Methods Tubes with blood and a concentration series of iodine were scanned with a preclinical SPCCT system (both in vitro and in an ex vivo bovine brain tissue sample). Iodine density maps (IDM) and virtual non-contrast (VNC) images were generated using the multi-bin spectral information to perform material decomposition. Region-of-interest (ROI) analysis was performed within the tubes to quantitatively determine the absolute content of iodine (mg/ml). Results In conventional CT images, ROI analysis showed similar Hounsfield Unit (HU) values for the tubes with blood and iodine (59.9 ± 1.8 versus 59.2 ± 1.5). Iodine density maps enabled clear differentiation between blood and iodine in vitro, as well as in the bovine brain model. Quantitative measurements of the different iodine concentrations matched well with those of actual known concentrations even for very small iodine concentrations with values below 1mg/ml (RMSE = 0.19). Conclusions SPCCT providing iodine maps and virtual non-contrast images allows material decomposition, differentiation between blood and iodine in vitro and ex vivo in a bovine brain model and reliably quantifies the iodine concentration.
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Affiliation(s)
- Isabelle Riederer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, Technical University of Munich, Munich, Germany
- * E-mail:
| | - Salim Si-Mohamed
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Sebastian Ehn
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Daniel Bar-Ness
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Peter B. Noël
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Alexander A. Fingerle
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
- Chair of Biomedical Physics & Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst J. Rummeny
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
| | - Philippe Douek
- Department of Interventional Radiology and Cardio-vascular and Thoracic Diagnostic Imaging, Louis Pradel University Hospital, Bron, France
- University Claude Bernard Lyon 1, CREATIS, CNRS UMR 5220, INSERM U1206, INSA-Lyon, France
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, Munich, Germany
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Chen WH, Yi TY, Wu YM, Zhang MF, Lin DL, Lin XH. Parenchymal hyperdensity on C-arm CT images after endovascular therapy for acute ischaemic stroke predicts a poor prognosis. Clin Radiol 2019; 74:399-404. [PMID: 30773226 DOI: 10.1016/j.crad.2019.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
AIM To investigate whether hyperdense areas (HDAs) observed after endovascular treatment on multisection computed tomography (CT) are related to outcome. MATERIALS AND METHODS Data on 82 patients with acute anterior circulation ischaemic stroke resulting from intracranial large artery occlusion were analysed retrospectively All patients underwent mechanical thrombectomy and/or emergency angioplasty, and partial or complete recanalisation was successfully achieved. C-arm CT was performed immediately after endovascular treatment for all patients. Clinical and radiological data were compared between patients with and those without HDA and between patients with good and those with poor outcomes. RESULTS Compared with non-HDA patients, HDA patients were more likely to present with severe neurological deficits (admission National Institutes of Health Stroke Scale [NIHSS] score: 18 versus 16, p=0.037) and had a higher number of stent retriever passes performed (2.9±1.3 versus 1.4±1, p<0.001), longer onset-to-presentation times (229±78 versus 171±90 minutes; p=0.002), longer onset-to-recanalisation times (418±94 versus 331±105 minutes; p<0.001), and longer puncture-to-recanalisation times (103±47 versus 69±42 minutes; p=0.001). Fewer HDA patients had a good prognosis (35.7% versus 70%, p<0.001). Multivariate analysis showed the presence of HDAs was an independent negative prognostic factor (OR=0.208; p=0.002). CONCLUSION HDAs on C-arm CT appear to be common in patients with acute ischaemic stroke who underwent successful endovascular treatment. HDA presence suggests a poor prognosis despite successful reperfusion.
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Affiliation(s)
- W-H Chen
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - T-Y Yi
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China.
| | - Y-M Wu
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - M-F Zhang
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - D-L Lin
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
| | - X-H Lin
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China
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Van Hedent S, Hokamp NG, Laukamp KR, Buls N, Kessner R, Rose B, Ros P, Jordan D. Differentiation of Hemorrhage from Iodine Using Spectral Detector CT: A Phantom Study. AJNR Am J Neuroradiol 2018; 39:2205-2210. [PMID: 30409850 DOI: 10.3174/ajnr.a5872] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/28/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Conventional CT often cannot distinguish hemorrhage from iodine extravasation following reperfusion therapy for acute ischemic stroke. We investigated the potential of spectral detector CT in differentiating these lesions. MATERIALS AND METHODS Centrifuged blood with increasing hematocrit (5%-85%) was used to model hemorrhage. Pure blood, blood-iodine mixtures (75/25, 50/50, and 25/75 ratios), and iodine solutions (0-14 mg I/mL) were scanned in a phantom with attenuation ranging from 12 to 75 HU on conventional imaging. Conventional and virtual noncontrast attenuation was compared and investigated for correlation with calculation of relative virtual noncontrast attenuation. Values for all investigated categories were compared using the Mann-Whitney U test. Sensitivity and specificity of virtual noncontrast, relative virtual noncontrast, conventional CT attenuation, and iodine quantification for hemorrhage detection were determined with receiver operating characteristic analysis. RESULTS Conventional image attenuation was not significantly different among all samples containing blood (P > .05), while virtual noncontrast attenuation showed a significant decrease with a decreasing blood component (P < .01) in all blood-iodine mixtures. Relative virtual noncontrast values were significantly different among all investigated categories (P < .01), with correct hemorrhagic component size estimation for all categories within a 95% confidence interval. Areas under the curve for hemorrhage detection were 0.97, 0.87, 0.29, and 0.16 for virtual noncontrast, relative virtual noncontrast, conventional CT attenuation, and iodine quantification, respectively. A ≥10-HU virtual noncontrast, ≥20-HU virtual noncontrast, ≥40% relative virtual noncontrast, and combined ≥10-HU virtual noncontrast and ≥40% relative virtual noncontrast attenuation threshold had a sensitivity/specificity for detecting hemorrhage of 100%/23%, 89%/95%, 100%/82%, and 100%/100%, respectively. CONCLUSIONS Spectral detector CT can accurately differentiate blood from iodinated contrast in a phantom setting.
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Affiliation(s)
- S Van Hedent
- From the Departments of Radiology (S.V.H., N.G.H., K.R.L., R.K., P.R., D.J.)
- Case Western Reserve University School of Medicine (S.V.H., N.G.H., K.R.L., R.K., B.R., P.R., D.J.), Cleveland, Ohio
- Institute for Diagnostic and Interventional Radiology (N.G.H., K.R.L.), University Hospital Cologne, Cologne, Germany
- Vrije Universiteit Brussel (S.V.H., N.B.), Brussels, Belgium
- Department of Radiology (S.V.H., N.B.), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - N Große Hokamp
- From the Departments of Radiology (S.V.H., N.G.H., K.R.L., R.K., P.R., D.J.)
- Case Western Reserve University School of Medicine (S.V.H., N.G.H., K.R.L., R.K., B.R., P.R., D.J.), Cleveland, Ohio
| | - K R Laukamp
- From the Departments of Radiology (S.V.H., N.G.H., K.R.L., R.K., P.R., D.J.)
- Case Western Reserve University School of Medicine (S.V.H., N.G.H., K.R.L., R.K., B.R., P.R., D.J.), Cleveland, Ohio
- Institute for Diagnostic and Interventional Radiology (N.G.H., K.R.L.), University Hospital Cologne, Cologne, Germany
| | - N Buls
- Vrije Universiteit Brussel (S.V.H., N.B.), Brussels, Belgium
- Department of Radiology (S.V.H., N.B.), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - R Kessner
- From the Departments of Radiology (S.V.H., N.G.H., K.R.L., R.K., P.R., D.J.)
- Case Western Reserve University School of Medicine (S.V.H., N.G.H., K.R.L., R.K., B.R., P.R., D.J.), Cleveland, Ohio
| | - B Rose
- Pathology (B.R.), University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University School of Medicine (S.V.H., N.G.H., K.R.L., R.K., B.R., P.R., D.J.), Cleveland, Ohio
| | - P Ros
- From the Departments of Radiology (S.V.H., N.G.H., K.R.L., R.K., P.R., D.J.)
- Case Western Reserve University School of Medicine (S.V.H., N.G.H., K.R.L., R.K., B.R., P.R., D.J.), Cleveland, Ohio
| | - D Jordan
- From the Departments of Radiology (S.V.H., N.G.H., K.R.L., R.K., P.R., D.J.)
- Case Western Reserve University School of Medicine (S.V.H., N.G.H., K.R.L., R.K., B.R., P.R., D.J.), Cleveland, Ohio
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Kilic İD, Hakeem A, Marmagkiolis K, Paixao A, Grunwald I, Mutlu D, AbouSherif S, Gundogdu B, Kulaksizoglu S, Ates I, Wholey M, Goktekin O, Cilingiroglu M. Endovascular Therapy for Acute Ischemic Stroke: A Comprehensive Review of Current Status. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:424-431. [PMID: 30025660 DOI: 10.1016/j.carrev.2018.07.010] [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: 05/12/2018] [Revised: 07/01/2018] [Accepted: 07/09/2018] [Indexed: 11/15/2022]
Abstract
Stroke remains among the leading causes of disability and death worldwide. Fibrinolytic therapy is associated with poor patency and functional outcomes. Recently, multiple randomized trials have been published that have consolidated the role of endovascular therapy for ischemic stroke due to large vessel occlusion in the anterior cerebral circulation. This manuscript reviews the current understanding of the endovascular management of acute stroke including technical aspects and current evidence base.
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Affiliation(s)
- İsmail D Kilic
- Pamukkale University Hospital, Department of Cardiology, Denizli, Turkey
| | - Abdul Hakeem
- University of Arkansas for Medical Sciences, Department of Cardiology, Little Rock, AR, USA
| | | | - Andre Paixao
- Arkansas Heart Hospital, Department of Cardiology, Little Rock, AR, USA.
| | - Iris Grunwald
- Anglia Ruskin University, Department of Neuroscience, Chelmsford, Essex, UK
| | - Deniz Mutlu
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Sara AbouSherif
- Kings College London, Cardiovascular Research Division London, UK
| | - Betul Gundogdu
- University of Arkansas for Medical Sciences, Department of Neurology, Little Rock, AR, USA.
| | - Sibel Kulaksizoglu
- Antalya Education and Research Hospital, Department of Biochemistry, Antalya, Turkey
| | - Ismail Ates
- Medicalpark Hospital Complex, Department of Cardiology, Antalya, Turkey
| | - Mark Wholey
- University of Pittsburgh Medical Centre, Department of Cardiology, Pittsburgh, PA, USA.
| | - Omer Goktekin
- Bezmialem University, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Cilingiroglu
- University of Arkansas for Medical Sciences, Department of Cardiology, Little Rock, AR, USA; Arkansas Heart Hospital, Department of Cardiology, Little Rock, AR, USA; Koc University, School of Medicine, Istanbul, Turkey.
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Bonatti M, Lombardo F, Zamboni GA, Vittadello F, Currò Dossi R, Bonetti B, Pozzi Mucelli R, Bonatti G. Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications. AJNR Am J Neuroradiol 2018; 39:441-447. [PMID: 29348131 DOI: 10.3174/ajnr.a5513] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/05/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage represents a potentially severe complication of revascularization of acute ischemic stroke. The aim of our study was to assess the capability of iodine extravasation quantification on dual-energy CT performed immediately after mechanical thrombectomy to predict hemorrhagic complications. MATERIALS AND METHODS Because this was a retrospective study, the need for informed consent was waived. Eighty-five consecutive patients who underwent brain dual-energy CT immediately after mechanical thrombectomy for acute ischemic stroke between August 2013 and January 2017 were included. Two radiologists independently evaluated dual-energy CT images for the presence of parenchymal hyperdensity, iodine extravasation, and hemorrhage. Maximum iodine concentration was measured. Follow-up CT examinations performed until patient discharge were reviewed for intracerebral hemorrhage development. The correlation between dual-energy CT parameters and intracerebral hemorrhage development was analyzed by the Mann-Whitney U test and Fisher exact test. Receiver operating characteristic curves were generated for continuous variables. RESULTS Thirteen of 85 patients (15.3%) developed hemorrhage. On postoperative dual-energy CT, parenchymal hyperdensities and iodine extravasation were present in 100% of the patients who developed intracerebral hemorrhage and in 56.3% of the patients who did not (P = .002 for both). Signs of bleeding were present in 35.7% of the patients who developed intracerebral hemorrhage and in none of the patients who did not (P < .001). Median maximum iodine concentration was 2.63 mg/mL in the patients who developed intracerebral hemorrhage and 1.4 mg/mL in the patients who did not (P < .001). Maximum iodine concentration showed an area under the curve of 0.89 for identifying patients developing intracerebral hemorrhage. CONCLUSIONS The presence of parenchymal hyperdensity with a maximum iodine concentration of >1.35 mg/mL may identify patients developing intracerebral hemorrhage with 100% sensitivity and 67.6% specificity.
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Affiliation(s)
- M Bonatti
- From the Departments of Radiology (M.B., F.L., G.B.)
| | - F Lombardo
- From the Departments of Radiology (M.B., F.L., G.B.)
| | - G A Zamboni
- Department of Radiology (G.A.Z., R.P.M.), University of Verona, Verona, Italy
| | - F Vittadello
- Explora-Research and Statistical Analysis (F.V.), Vigodarzere, Italy
| | - R Currò Dossi
- Neurology (R.C.D., B.B.), Bolzano Central Hospital, Bolzano, Italy
| | - B Bonetti
- Neurology (R.C.D., B.B.), Bolzano Central Hospital, Bolzano, Italy
| | - R Pozzi Mucelli
- Department of Radiology (G.A.Z., R.P.M.), University of Verona, Verona, Italy
| | - G Bonatti
- From the Departments of Radiology (M.B., F.L., G.B.)
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Yedavalli V, Sammet S. Contrast Extravasation versus Hemorrhage after Thrombectomy in Patients with Acute Stroke. J Neuroimaging 2017; 27:570-576. [PMID: 28514045 PMCID: PMC5665701 DOI: 10.1111/jon.12446] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Intra-arterial recanalization postprocedural imaging in stroke patients can result in diagnostic complications due to hyperdensities on noncontrast computed tomography (CT), which may represent either contrast extravasation or intracranial hemorrhage. If these lesions are hemorrhage, then they are risk factors becoming symptomatic, which, if not distinguished, can alter clinical management. We investigate the effects of iodinated contrast on postprocedural magnetic resonance imaging (MRI) and prevalence of equivocal imaging interpretations of postprocedural extravasated contrast versus hemorrhage while identifying protocol pitfalls. METHODS We identified 10 patients diagnosed with ischemic stroke who underwent intra-arterial recanalization in a 5-year period. These patients demonstrated a hyperdensity on a postprocedural CT within 24 hours, underwent an MRI within 48 hours, and an additional confirmatory noncontrast CT at least 72 hours postprocedure. RESULTS Postprocedural MRI in all 10 stroke patients demonstrated T1 - and T2 -relaxation time changes due to residual iodine contrast agents. This lead to false positive postprocedural hemorrhage MRI interpretations in 2/10 patients, 3/10 false negative interpretations of contrast extravasation, and 5/10 equivocal interpretations suggesting extravasation or hemorrhage. Of these five cases, two were performed with gadolinium. CONCLUSION MRI done within 48 hours postprocedure can lead to false positive hemorrhage or false negative contrast extravasation interpretations in stroke patients possibly due to effects from the administered angiographic contrast. Additionally, MRI should be done both after 72 hours for confirmation and without gadolinium contrast as the effects of the gadolinium contrast and residual angiographic contrast could lead to misdiagnosis.
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Affiliation(s)
- Vivek Yedavalli
- Department of Diagnostic Radiology, Advocate Illinois Masonic Medical Center, Chicago, IL
- Department of Radiology, University of Chicago, Chicago, IL
| | - Steffen Sammet
- Department of Radiology, University of Chicago, Chicago, IL
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Cabral FB, Castro-Afonso LH, Nakiri GS, Monsignore LM, Fábio S, Dos Santos AC, Pontes-Neto OM, Abud DG. Hyper-attenuating brain lesions on CT after ischemic stroke and thrombectomy are associated with final brain infarction. Interv Neuroradiol 2017; 23:594-600. [PMID: 28950737 DOI: 10.1177/1591019917729550] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose Hyper-attenuating lesions, or contrast staining, on a non-contrast brain computed tomography (NCCT) scan have been investigated as a predictor for hemorrhagic transformation after endovascular treatment of acute ischemic stroke (AIS). However, the association of hyper-attenuating lesions and final ischemic areas are poorly investigated in this setting. The aim of the present study was to assess correlations between hyper-attenuating lesions and final brain infarcted areas after thrombectomy for AIS. Methods Data from patients with AIS of the anterior circulation who underwent endovascular treatment were retrospectively assessed. Images of the brain NCCT scans were analyzed in the first hours and late after treatment. The hyper-attenuating areas were compared to the final ischemic areas using the Alberta Stroke Program Early CT Score (ASPECTS). Results Seventy-one of the 123 patients (65.13%) treated were included. The association between the hyper-attenuating region in the post-thrombectomy CT scan and final brain ischemic area were sensitivity (58.3% to 96.9%), specificity (42.9% to 95.6%), positive predictive values (71.4% to 97.7%), negative predictive values (53.8% to 79.5%), and accuracy values (68% to 91%). The highest sensitivity values were found for the lentiform (96.9%) and caudate nuclei (80.4%) and for the internal capsule (87.5%), and the lowest values were found for the M1 (58.3%) and M6 (66.7%) cortices. Conclusions Hyper-attenuating lesions on head NCCT scans performed after endovascular treatment of AIS may predict final brain infarcted areas. The prediction appears to be higher in the deep brain regions compared with the cortical regions.
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Affiliation(s)
- F B Cabral
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - L H Castro-Afonso
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - G S Nakiri
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - L M Monsignore
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Src Fábio
- 2 Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - A C Dos Santos
- 3 Division of Diagnostic Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - O M Pontes-Neto
- 2 Division of Neurology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - D G Abud
- 1 Division of Interventional Neuroradiology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Kamalian S, Lev MH, Pomerantz SR. Dual-Energy Computed Tomography Angiography of the Head and Neck and Related Applications. Neuroimaging Clin N Am 2017; 27:429-443. [DOI: 10.1016/j.nic.2017.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Yeo LLL, Tan BYQ, Andersson T. Review of Post Ischemic Stroke Imaging and Its Clinical Relevance. Eur J Radiol 2017; 96:145-152. [PMID: 28237773 DOI: 10.1016/j.ejrad.2017.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
In this day and age, multiple imaging modalities are available to the stroke physician in the post-treatment phase.The practical challenge for physicians who treat stroke is to evaluate the pros and cons of each technique and select the best choice for the situation. The choice of imaging modality remains contentious at best and varies among different institutions and centres. This is no simple task an there are many factors to consider, including the differential diagnosis which need to be evaluated, the availability and reliability of the imaging technique and time and expertise required to perform and interpret the scanning. Other ancillary competing interest also come into play such as the financial cost of the modality, the requirement for patient monitoring during the imaging procedure and patient comfort. In an effort to clear some of the ambiguity surrounding this topic we present some of the current techniques in use and others, which are still in the realm of research and have not yet transitioned into clinical practice.
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Affiliation(s)
- Leonard L L Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Tommy Andersson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
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Schneider T, Mahraun T, Schroeder J, Frölich A, Hoelter P, Wagner M, Darcourt J, Cognard C, Bonafé A, Fiehler J, Siemonsen S, Buhk JH. Intraparenchymal Hyperattenuations on Flat-Panel CT Directly After Mechanical Thrombectomy are Restricted to the Initial Infarct Core on Diffusion-Weighted Imaging. Clin Neuroradiol 2016; 28:91-97. [PMID: 27637922 DOI: 10.1007/s00062-016-0543-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/23/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The presence of intraparenchymal hyperattenuations (IPH) on flat-panel computed tomography (FP-CT) after endovascular recanalization in stroke patients is a common phenomenon. They are thought to occur in ischemic areas with breakdown of the blood-brain barrier but previous studies that investigated a mutual interaction are scarce. We aimed to assess the relationship of IPH localization with prethrombectomy diffusion-weighted imaging (DWI) lesions. METHODS This retrospective multicenter study included 27 acute stroke patients who underwent DWI prior to FP-CT following mechanical thrombectomy. After software-based coregistration of DWI and FP-CT, lesion volumetry was conducted and overlapping was analyzed. RESULTS Two different patterns were observed: IPH corresponding to the DWI lesion and IPH exceeding the DWI lesion. The latter showed demarcated infarction of DWI exceeding IPH at 24 h. No major hemorrhage following IPH was observed. Most IPH were manifested within the basal ganglia and insular cortex. CONCLUSION The IPH primarily appeared within the initial ischemic core and secondarily within the penumbral tissue that progressed to infarction. The IPH represent the minimum final infarct volume, which may help in periinterventional decision making.
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Affiliation(s)
- Tanja Schneider
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany.
| | - Tobias Mahraun
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Julian Schroeder
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Frölich
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Philip Hoelter
- Department of Neuroradiology, University Clinic Erlangen, Erlangen, Germany
| | - Marlies Wagner
- Institute of Neuroradiology, Goethe University Hospital, Frankfurt, Germany
| | - Jean Darcourt
- Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France
| | - Christophe Cognard
- Départment de Neuroradiologie diagnostique et thérapeutique, University Hospital of Purpan, Toulouse, France
| | - Alain Bonafé
- Départment de Neuroradiologie, Hospitalier Universitaire Gui de Chauliac, Montpellier, France
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
| | - Jan-Hendrik Buhk
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Haus O22, 20246, Hamburg, Germany
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Djurdjevic T, Rehwald R, Knoflach M, Matosevic B, Kiechl S, Gizewski ER, Glodny B, Grams AE. Prediction of infarction development after endovascular stroke therapy with dual-energy computed tomography. Eur Radiol 2016; 27:907-917. [PMID: 27255400 PMCID: PMC5591619 DOI: 10.1007/s00330-016-4412-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 04/14/2016] [Accepted: 05/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES After intraarterial recanalisation (IAR), the haemorrhage and the blood-brain barrier (BBB) disruption can be distinguished using dual-energy computed tomography (DECT). The aim of the present study was to investigate whether future infarction development can be predicted from DECT. METHODS DECT scans of 20 patients showing 45 BBB disrupted areas after IAR were assessed and compared with follow-up examinations. Receiver operator characteristic (ROC) analyses using densities from the iodine map (IM) and virtual non-contrast (VNC) were performed. RESULTS Future infarction areas are denser than future non-infarction areas on IM series (23.44 ± 24.86 vs. 5.77 ± 2.77; p < 0.0001) and more hypodense on VNC series (29.71 ± 3.33 vs. 35.33 ± 3.50; p < 0.0001). ROC analyses for the IM series showed an area under the curve (AUC) of 0.99 (cut-off: <9.97 HU; p < 0.05; sensitivity 91.18 %; specificity 100.00 %; accuracy 0.93) for the prediction of future infarctions. The AUC for the prediction of haemorrhagic infarctions was 0.78 (cut-off >17.13 HU; p < 0.05; sensitivity 90.00 %; specificity 62.86 %; accuracy 0.69). The VNC series allowed prediction of infarction volume. CONCLUSIONS Future infarction development after IAR can be reliably predicted with the IM series. The prediction of haemorrhages and of infarction size is less reliable. KEY POINTS • The IM series (DECT) can predict future infarction development after IAR. • Later haemorrhages can be predicted using the IM and the BW series. • The volume of definable hypodense areas in VNC correlates with infarction volume.
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Affiliation(s)
- Tanja Djurdjevic
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Rafael Rehwald
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Matosevic
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Astrid Ellen Grams
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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Dekeyzer S, Nikoubashman O, Lutin B, De Groote J, Vancaester E, De Blauwe S, Hemelsoet D, Wiesmann M, Defreyne L. Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough. J Neurointerv Surg 2016; 9:394-398. [PMID: 27036980 DOI: 10.1136/neurintsurg-2016-012290] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining. Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment. METHODS We retrospectively reviewed the imaging data of 84 patients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days. RESULTS PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities <40 HU (for ruling hemorrhage out) and ≥140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%. CONCLUSIONS There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19-24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.
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Affiliation(s)
- Sven Dekeyzer
- Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany.,Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany.,Institute for Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Bart Lutin
- Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
| | - Jeroen De Groote
- Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
| | | | | | - Dimitri Hemelsoet
- Department of Neurology, University Hospital (UZ) Ghent, Ghent, Belgium
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Aachen, Germany
| | - Luc Defreyne
- Department of Vascular and Interventional Radiology, University Hospital (UZ) Ghent, Ghent, Belgium
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Mao Y, Nan GX, Zhang L, Huang YJ. Contrast extravasation mimics cerebral hemorrhage in acute ischemic stroke after Solitaire FR clot retrieval and intraarterial thrombolysis: a case report. Acta Neurol Belg 2015; 115:723-5. [PMID: 25944512 DOI: 10.1007/s13760-015-0481-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Ying Mao
- Department of Neurology, China-Japan Union Hospital of Jilin University, No. 126 Xian Tai Street, Changchun, 130021, China
| | - Guang-Xian Nan
- Department of Neurology, China-Japan Union Hospital of Jilin University, No. 126 Xian Tai Street, Changchun, 130021, China.
| | - Li Zhang
- Department of Neurology, China-Japan Union Hospital of Jilin University, No. 126 Xian Tai Street, Changchun, 130021, China
| | - Yu-Jing Huang
- Department of Neurology, China-Japan Union Hospital of Jilin University, No. 126 Xian Tai Street, Changchun, 130021, China
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45
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Song SY, Ahn SY, Rhee JJ, Lee JW, Hur JW, Lee HK. Extent of Contrast Enhancement on Non-Enhanced Computed Tomography after Intra-Arterial Thrombectomy for Acute Infarction on Anterior Circulation: As a Predictive Value for Malignant Brain Edema. J Korean Neurosurg Soc 2015; 58:321-7. [PMID: 26587184 PMCID: PMC4651991 DOI: 10.3340/jkns.2015.58.4.321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/08/2015] [Accepted: 10/12/2015] [Indexed: 01/19/2023] Open
Abstract
Objective To determine whether the use of contrast enhancement (especially its extent) predicts malignant brain edema after intra-arterial thrombectomy (IAT) in patients with acute ischemic stroke. Methods We reviewed the records of patients with acute ischemic stroke who underwent IAT for occlusion of the internal carotid artery or the middle cerebral artery between January 2012 and March 2015. To estimate the extent of contrast enhancement (CE), we used the contrast enhancement area ratio (CEAR)-i.e., the ratio of the CE to the area of the hemisphere, as noted on immediate non-enhanced brain computed tomography (NECT) post-IAT. Patients were categorized into two groups based on the CEAR values being either greater than or less than 0.2. Results A total of 39 patients were included. Contrast enhancement was found in 26 patients (66.7%). In this subgroup, the CEAR was greater than 0.2 in 7 patients (18%) and less than 0.2 in the other 19 patients (48.7%). On univariate analysis, both CEAR ≥0.2 and the presence of subarachnoid hemorrhage were significantly associated with progression to malignant brain edema (p<0.001 and p=0.004), but on multivariate analysis, only CEAR ≥0.2 showed a statistically significant association (p=0.019). In the group with CEAR ≥0.2, the time to malignant brain edema was shorter (p=0.039) than in the group with CEAR <0.2. Clinical functional outcomes, based on the modified Rankin scale, were also significantly worse in patients with CEAR ≥0.2 (p=0.003) Conclusion The extent of contrast enhancement as noted on NECT scans obtained immediately after IAT could be predictive of malignant brain edema and a poor clinical outcome.
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Affiliation(s)
- Seung Yoon Song
- Department of Neurosurgery, Cheongju St. Mary's Hospitial, Cheongju, Korea
| | - Seong Yeol Ahn
- Department of Neurosurgery, Cheongju St. Mary's Hospitial, Cheongju, Korea
| | - Jong Ju Rhee
- Department of Neurosurgery, Cheongju St. Mary's Hospitial, Cheongju, Korea
| | - Jong Won Lee
- Department of Neurosurgery, Cheongju St. Mary's Hospitial, Cheongju, Korea
| | - Jin Woo Hur
- Department of Neurosurgery, Cheongju St. Mary's Hospitial, Cheongju, Korea
| | - Hyun Koo Lee
- Department of Neurosurgery, Cheongju St. Mary's Hospitial, Cheongju, Korea
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Re: validating a threshold of ocular gaze deviation for the prediction of acute ischaemic stroke. A reply. Clin Radiol 2015; 70:1152-3. [DOI: 10.1016/j.crad.2015.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 06/26/2015] [Accepted: 06/29/2015] [Indexed: 11/23/2022]
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47
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Payabvash S, Khan AA, Qureshi MH, Saeed O, Suri MFK, Qureshi AI. Detection of Intraparenchymal Hemorrhage After Endovascular Therapy in Patients with Acute Ischemic Stroke Using Immediate Postprocedural Flat-Panel Computed Tomography Scan. J Neuroimaging 2015; 26:213-8. [PMID: 26282065 DOI: 10.1111/jon.12277] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/14/2015] [Accepted: 05/28/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To assess the diagnostic value of parenchymal hyperdense lesions visualized on the flat-panel CT scan in detecting/excluding intraparenchymal hemorrhage (IPH) after the endovascular treatment of acute stroke patients. METHODS Two separate cohorts of acute ischemic stroke patients who underwent endovascular treatment were evaluated. In the first group, patients were evaluated for hyperdense parenchymal lesions immediately after the treatment with flat-panel CT scan; whereas, in the second group, patients underwent multidetector CT scan post procedure. IPH was defined as hyperdensity that persisted for >24 hours on follow up CT scan. RESULTS A total of 30 patients were evaluated with flat panel, and 135 with multidetector CT scan immediately after the endovascular treatment. Hyperdense lesions were visualized on 7/30 (23%) of those evaluated with flat-panel CT versus 74/135 (55%) of those evaluated with multidetector CT scan. Based on 24-hour follow up imaging, hyperdense parenchymal lesions on immediate postprocedural flat-panel or multidetector CT studies had 100% sensitivity and negative predictive value for IPH; whereas, the specificity, and positive predictive value of such lesions were 88% and, 57% on the flat panel; and 53% and, 27% on the multidetector CT study, respectively. CONCLUSION The absence of hyperdense lesions on immediate postprocedural flat-panel CT scan of ischemic stroke patients can exclude IPH with a high sensitivity and negative predictive value. The hyperdense parenchymal lesions visualized on flat-panel versus multidetector CT studies may have comparable sensitivity and negative predictive value for the detection of IPH.
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Affiliation(s)
- Seyedmehdi Payabvash
- Zeenat Qureshi Stroke Institute, Centracare Health System, St. Cloud, MN.,Department of Radiology, University of Minnesota, Minneapolis, MN
| | - Asif A Khan
- Zeenat Qureshi Stroke Institute, Centracare Health System, St. Cloud, MN
| | - Mushtaq H Qureshi
- Zeenat Qureshi Stroke Institute, Centracare Health System, St. Cloud, MN
| | - Omar Saeed
- Zeenat Qureshi Stroke Institute, Centracare Health System, St. Cloud, MN
| | - M Fareed K Suri
- Zeenat Qureshi Stroke Institute, Centracare Health System, St. Cloud, MN
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute, Centracare Health System, St. Cloud, MN
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Kim JM, Park KY, Lee WJ, Byun JS, Kim JK, Park MS, Ahn SW, Shin HW. The cortical contrast accumulation from brain computed tomography after endovascular treatment predicts symptomatic hemorrhage. Eur J Neurol 2015; 22:1453-8. [PMID: 26130213 DOI: 10.1111/ene.12764] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The prognostic value of contrast accumulation from non-contrast brain computed tomography taken immediately after endovascular reperfusion treatment in acute ischaemic stroke patients to predict symptomatic hemorrhage was studied. METHODS Between July 2007 and August 2014, acute anterior circulation ischaemic stroke patients who were treated by intra-arterial thrombolysis or thrombectomy were included. Contrast accumulation was defined as a high attenuation area from non-contrast brain computed tomography immediately taken after endovascular reperfusion treatment, and patients were categorized into three groups according to the presence and location of contrast: (i) negative, (ii) cortical involvement and (iii) non-cortical involvement. The rates of symptomatic hemorrhage after 24 h and functional outcome at discharge were compared between patients with and without cortical involvement. RESULTS Of 64 patients who were treated by endovascular intervention, contrast accumulation was detected in 56, including 33 patients with cortical involvement and 23 patients without cortical involvement. The cortical involvement pattern was more frequently associated with symptomatic hemorrhage (13 vs. 1 patient, P = 0.003) and with grave outcome at discharge with modified Rankin Scale 5 or 6 (14 vs. 4, P = 0.048) than the non-cortical involvement group. Multivariate logistic regression analysis including initial collateral status and occlusion site disclosed that cortical involvement pattern independently predicted symptomatic hemorrhage after endovascular treatment (odds ratio 19.0, confidence interval 1.6-227.6, P = 0.020). CONCLUSION Our study provides evidence that the cortical involvement of contrast accumulation is associated with symptomatic hemorrhage after endovascular reperfusion treatment.
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Affiliation(s)
- J M Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - K Y Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - W J Lee
- Department of Neuroradiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - J S Byun
- Department of Neuroradiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - J K Kim
- Department of Neuroradiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - M S Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - S W Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - H W Shin
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Abstract
Because of the different attenuations of tissues at different energy levels, dual-energy CT offers tissue differentiation and characterization, reduction of artifacts, and remodeling of contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR), hereby creating new opportunities and insights in CT imaging. The applications for dual-energy imaging in neuroradiology are various and still expanding. Automated bone removal is used in CT angiography and CT venography of the intracranial vessels. Monoenergetic reconstructions can be used in patients with or without metal implants in the brain and spine to reduce artifacts, improve CNR and SNR, or to improve iodine conspicuity. Differentiation of iodine and hemorrhage is used in high-density lesions, after intra-arterial recanalization in stroke patients or after administration of contrast media. Detection of underlying (vascular and non-vascular) pathology and spot sign can be used in patients presenting with (acute) intracranial hemorrhage.
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Affiliation(s)
- Alida A. Postma
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Annika A. R. Stadler
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Joachim E. Wildberger
- Department of Radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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50
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Amans MR, Cooke DL, Vella M, Dowd CF, Halbach VV, Higashida RT, Hetts SW. Contrast staining on CT after DSA in ischemic stroke patients progresses to infarction and rarely hemorrhages. Interv Neuroradiol 2014; 20:106-15. [PMID: 24556308 DOI: 10.15274/inr-2014-10016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 09/08/2013] [Indexed: 11/12/2022] Open
Abstract
Contrast staining of brain parenchyma identified on non-contrast CT performed after DSA in patients with acute ischemic stroke (AIS) is an incompletely understood imaging finding. We hypothesize contrast staining to be an indicator of brain injury and suspect the fate of involved parenchyma to be cerebral infarction. Seventeen years of AIS data were retrospectively analyzed for contrast staining. Charts were reviewed and outcomes of the stained parenchyma were identified on subsequent CT and MRI. Thirty-six of 67 patients meeting inclusion criteria (53.7%) had contrast staining on CT obtained within 72 hours after DSA. Brain parenchyma with contrast staining in patients with AIS most often evolved into cerebral infarction (81%). Hemorrhagic transformation was less likely in cases with staining compared with hemorrhagic transformation in the cohort that did not have contrast staining of the parenchyma on post DSA CT (6% versus 25%, respectively, OR 0.17, 95% CI 0.017 - 0.98, p = 0.02). Brain parenchyma with contrast staining on CT after DSA in AIS patients was likely to infarct and unlikely to hemorrhage.
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Affiliation(s)
- Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA -
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Maya Vella
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Christopher F Dowd
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Van V Halbach
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Randall T Higashida
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA
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