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Yu JW, Zhao DL, Li RY, Wu Y, Chen XH, Ge H, Li C, Ju S. Association of culprit plaque enhancement ratio, hypoperfusion and HbA1c with recurrent ischemic stroke in patients with atherosclerotic stenosis of the middle cerebral artery. Eur J Radiol 2023; 168:111107. [PMID: 37776582 DOI: 10.1016/j.ejrad.2023.111107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/04/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE To investigate the differences in intracranial culprit plaque characteristics of the middle cerebral artery (MCA), collateral circulation and hypoperfusion in patients with and without recurrent ischemic stroke and to identify the association with the recurrent ischemic cerebrovascular events. METHOD Eighty-six patients with acute/subacute ischemic stroke caused by atherosclerotic plaques of the MCA were retrospectively enrolled and grouped into patients with recurrence (n = 36) and without recurrence (n = 50). All patients underwent high-resolution vessel wall imaging and dynamic susceptibility contrast-enhanced perfusion weighted imaging. The differences in culprit plaque characteristics, collateral circulation and hypoperfusion in the territory of the stenotic MCA were assessed between the two groups. The relationship between plaque characteristics and hypoperfusion was evaluated. The independent factors of recurrent ischemic stroke were identified by logistic regression analyses. RESULTS Higher HbA1c, culprit plaque enhancement grade, culprit plaque enhancement ratio, and lower time to peak map based on the Alberta Stroke Program Early CT score (TTP-ASPECTS) were observed in the recurrence group(all p < 0.050). Both plaque enhancement grade and enhancement ratio were significantly associated with TTP-ASPECTS (p = 0.030 and 0.039, respectively). HbA1c, culprit plaque enhancement ratio and TTP-ASPECTS were independent factors of the recurrence of ischemic stroke (all p < 0.050). The area under the curve of the combination including the above factors (AUC = 0.819) was significantly higher than that of any variable alone after adjustment (all p < 0.050). CONCLUSIONS Culprit plaque enhancement ratio, TTP-ASPECTS and HbA1c were independent factors of recurrent ischemic stroke. Their combination improved the accuracy in identifying the risk of recurrent ischemic stroke.
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Affiliation(s)
- Jia-Wei Yu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China
| | - Deng-Ling Zhao
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China.
| | - Rui-Ying Li
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China
| | - Yao Wu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China
| | - Xiao-Hui Chen
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China
| | - Hong Ge
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China
| | - Cheng Li
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China
| | - Shenghong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Gulou District, Nanjing 210009, Jiangsu Province, China
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Related Factors of Cerebral Hemorrhage after Cerebral Infarction and the Effect of Atorvastatin Combined with Intensive Nursing Care. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9546006. [PMID: 35959354 PMCID: PMC9357761 DOI: 10.1155/2022/9546006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 07/14/2022] [Indexed: 11/17/2022]
Abstract
Background Cerebral infarction is a common neurological disease with high incidence, which is the main factor causing death and disability in adults in China. Cerebral hemorrhage transformation is a common clinical complication. High NIHSS score at admission, atrial fibrillation, and small artery occlusion cerebral infarction can increase the risk of cerebral infarction complicated with hemorrhage transformation. Aim To explore the related factors of cerebral hemorrhage transformation after cerebral infarction and the value of atorvastatin calcium tablets combined with early intensive care measures. Methods In this study, a case-control study was conducted. Sixty patients with hemorrhagic transformation after cerebral infarction admitted to the Department of Neurology of our hospital from January 2017 to June 2021 were selected as the observation group, and 90 patients with cerebral infarction without hemorrhagic transformation during the same period were selected as the control group. The risk factors of hemorrhagic transformation after cerebral infarction were analyzed. Results The results of logistic regression model showed that the increased National Institutes of Health Stroke Scale (NIHSS) score at admission, hypertension, atrial fibrillation, TOAST classification of small artery occlusion, and large infarction lesions were the risk factors for hemorrhagic transformation in patients with cerebral infarction (P < 0.05). After 2 weeks and 4 weeks of treatment, the NIHSS scores of the intervention group were lower than those of the conventional group (P < 0.05). NIHSS scores of the two groups after treatment were significantly lower than those before treatment (P < 0.05). After three months of treatment, the patients in the intervention group with GOS score of 5 points accounted for 16.67%, and the patients with GOS score of 4 points accounted for 56.67%. The patients in the conventional group with GOS score of 5 points accounted for 6.67%, and the patients with GOS score of 4 points accounted for 33.33%. The prognosis of the intervention group was better than that of the conventional group on the whole (P < 0.05). Conclusion Patients with hypertension, large infarction lesions, high NIHSS score at admission, atrial fibrillation, and small artery occlusion cerebral infarction can increase the risk of bleeding transformation in patients with cerebral infarction. For patients with bleeding transformation, atorvastatin calcium tablets combined with early intensive nursing intervention has a certain value for improving the prognosis of patients.
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Bammer R, Amukotuwa SA. Navigating Supply Chain Disruptions of Iodinated Contrast Agent for Neuroimaging and How Business Intelligence Can Help the Decision Process. AJNR Am J Neuroradiol 2022; 43:944-950. [PMID: 35649725 DOI: 10.3174/ajnr.a7544] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/07/2022]
Abstract
A recent coronavirus disease 2019-related shutdown of the main production facility of iohexol in China has led to massive shortages of iodinated contrast material across the globe. This shortage has also jeopardized neuroimaging. In this article, we describe remedies to reduce iodinated contrast material use for stroke imaging, which is its primary use in neuroimaging, that we have implemented in our hospital network.
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Affiliation(s)
- R Bammer
- From Monash Imaging, Monash Health, Clayton, Victoria, Australia; and Department of Radiology, Monash University, Clayton, Victoria, Australia
| | - S A Amukotuwa
- From Monash Imaging, Monash Health, Clayton, Victoria, Australia; and Department of Radiology, Monash University, Clayton, Victoria, Australia
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Lansberg MG, Wintermark M, Kidwell CS, Albers GW. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sheridan DC, Pettersson D, Newgard CD, Selden NR, Jafri MA, Lin A, Rowell S, Hansen ML. Can QuickBrain MRI replace CT as first-line imaging for select pediatric head trauma? J Am Coll Emerg Physicians Open 2020; 1:965-973. [PMID: 33145547 PMCID: PMC7593443 DOI: 10.1002/emp2.12113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/15/2020] [Accepted: 05/01/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The current standard of care for initial neuroimaging in injured pediatric patients suspected of having traumatic brain injury is computed tomography (CT) that carries risks associated with radiation exposure. The primary objective of this trial was to evaluate the ability of a QuickBrain MRI (qbMRI) protocol to detect clinically important traumatic brain injuries in the emergency department (ED). The secondary objective of this trial was to compare qbMRI to CT in identifying radiographic traumatic brain injury. METHODS This was a prospective study of trauma patients less than 15 years of age with suspected traumatic brain injury at a level 1 pediatric trauma center in Portland, Oregon between August 2017 and March 2019. All patients in whom a head CT was deemed clinically necessary were approached for enrollment to also obtain a qbMRI in the acute setting. Clinically important traumatic brain injury was defined as the need for neurological surgery procedure, intubation, pediatric intensive care unit stay greater than 24 hours, a total hospital length of stay greater than 48 hours, or death. RESULTS A total of 73 patients underwent both CT and qbMRI. The median age was 4 years (interquartile range [IQR] = 1-10 years). Twenty-two patients (30%) of patients had a clinically important traumatic brain injury, and of those, there were 2 deaths (9.1%). QbMRI acquisition time had a median of 4 minutes and 52 seconds (IQR = 3 minutes 49 seconds-5 minutes 47 seconds). QbMRI had sensitivity for detecting clinically important traumatic brain injury of 95% (95% confidence interval [CI] = 77%-99%). For any radiographic injury, qbMRI had a sensitivity of 89% (95% CI = 78%-94%). CONCLUSION Our results suggest that qbMRI has good sensitivity to detect clinically important traumatic brain injuries. Further multi-institutional, prospective trials are warranted to either support or refute these findings.
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Affiliation(s)
- David C Sheridan
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Health & Science University Portland Oregon USA
| | - David Pettersson
- Department of Radiology Division for Neuroradiology Oregon Health & Science University Portland Oregon USA
| | - Craig D Newgard
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Health & Science University Portland Oregon USA
| | - Nathan R Selden
- Department of Neurological Surgery Division of Pediatric Neurosurgery Oregon Health & Science University Portland Oregon USA
| | - Mubeen A Jafri
- Department of Surgery Division of Pediatric Surgery Oregon Health & Science University Portland Oregon USA
| | - Amber Lin
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Health & Science University Portland Oregon USA
| | - Susan Rowell
- Department of Surgery Division of Trauma Surgery Oregon Health & Science University Portland Oregon USA
| | - Matthew L Hansen
- Center for Policy and Research in Emergency Medicine Department of Emergency Medicine Oregon Health & Science University Portland Oregon USA
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