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Bhurwani MMS, Boutelier T, Davis A, Gautier G, Swetz D, Rava RA, Raguenes D, Waqas M, Snyder KV, Siddiqui AH, Ionita CN. Identification of infarct core and ischemic penumbra using computed tomography perfusion and deep learning. J Med Imaging (Bellingham) 2023; 10:014001. [PMID: 36636489 PMCID: PMC9826796 DOI: 10.1117/1.jmi.10.1.014001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose The size and location of infarct and penumbra are key to decision-making for acute ischemic stroke (AIS) management. CT perfusion (CTP) software estimate infarct and penumbra volume using contralateral hemisphere relative thresholding. This approach is not robust and widely contested by the scientific community. In this study, we investigate the use of deep learning-based algorithms to efficiently locate infarct and penumbra tissue on CTP hemodynamic maps. Approach CTP scans were retrospectively collected for 60 and 59 patients in the infarct only and infarct + penumbra substudies respectively. Commercial CTP software was used to generate cerebral blood flow, cerebral blood volume, mean transit time, time to peak, and delay time maps. U-Net-shaped architectures were trained to segment infarct or infarct + penumbra. Test-time-augmentation, ensembling, and watershed segmentation were used as postprocessing techniques. Segmentation performance was evaluated using Dice coefficients (DC) and mean absolute volume errors (MAVE). Results The algorithm segmented infarct tissue resulted in DC of 0.64 ± 0.03 (0.63, 0.65), and MAVE of 4.91 ± 0.94 (4.5, 5.32) mL. In comparison, the commercial software predicted infarct with a DC of 0.31 ± 0.17 (0.26, 0.36) and MAVE of 9.77 ± 8.35 (7.12, 12.42) mL. The algorithm was able to segment infarct + penumbra with a DC of 0.61 ± 0.04 (0.6, 0.63), and MAVE of 6.51 ± 1.37 (5.91, 7.11) mL. In comparison, the commercial software predicted infarct + penumbra with a DC of 0.3 ± 0.19 (0.25, 0.35) and MAVE of 9.18 ± 7.55 (7.25, 11.11) mL. Conclusions Use of deep learning algorithms to assess severity of AIS in terms of infarct and penumbra volume is precise and outperforms current relative thresholding methods. Such an algorithm would enhance the reliability of CTP in guiding treatment decisions.
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Affiliation(s)
- Mohammad Mahdi Shiraz Bhurwani
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | | | | | | | - Dennis Swetz
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Ryan A. Rava
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | | | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Ciprian N. Ionita
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
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Wei YC, Huang WY, Jian CY, Hsu CCH, Hsu CC, Lin CP, Cheng CT, Chen YL, Wei HY, Chen KF. Semantic segmentation guided detector for segmentation, classification, and lesion mapping of acute ischemic stroke in MRI images. Neuroimage Clin 2022; 35:103044. [PMID: 35597030 PMCID: PMC9123273 DOI: 10.1016/j.nicl.2022.103044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE MRI images timely and accurately reflect ischemic injuries to the brain tissues and, therefore, can support clinical decision-making of acute ischemic stroke (AIS). To maximize the information provided by the MRI images, we leverage deep learning models to segment, classify, and map lesion distributions of AIS. METHODS We evaluated brain MRI images of AIS patients from 2017 to 2020 at a tertiary teaching hospital and developed the Semantic Segmentation Guided Detector Network (SGD-Net), composed of the first U-shaped model for segmentation in diffusion-weighted imaging (DWI) and the second model for binary classification of lesion size (lacune vs. non-lacune) and circulatory territory of lesion location (anterior vs. posterior circulation). Next, we modified the two-stage deep learning model into SGD-Net Plus by automatically segmenting AIS lesions in DWI images and registering the lesion in T1-weighted images and the brain atlases. RESULTS The final enrollment (216 patients with 4606 slices) was divided into 80% for model development and 20% for testing. S1 model segmented AIS lesions in DWI images accurately with a pixel accuracy > 99% (Dice 0.806-0.828 and IoU 0.675-707). In comprehensive evaluation of classification performance, the two-stage SGD-Net outperformed the traditional one-stage models in classifying AIS lesion size (accuracy 0.867-0.956 vs. 0.511-0.867, AUROC 0.962-0.992 vs. 0.528-0.937, AUPRC 0.964-0.994 vs. 0.549-0.938) and location (accuracy 0.860-0.930 vs. 0.326-0.721, AUROC 0.936-0.988 vs. 0.493-0.833, AUPRC 0.883-0.978 vs. 0.365-0.695). The precise lesion segmentation at the first stage of the deep learning model was the basis for further application. After that, the modified two-stage model SGD-Net Plus accurately reported the volume, region percentage, and lesion percentage of each region on the selected brain atlas. Its reports provided clear descriptions and quantifications of the AIS-related brain injuries on white matter tracts, Brodmann areas, and cytoarchitectonic areas. CONCLUSION Domain knowledge-oriented design of artificial intelligence applications can deepen our understanding of patients' conditions and strengthen the use of MRI for patient care. SGD-Net precisely segments AIS lesions on DWI and accurately classifies the lesions. In addition, SGD-Net Plus maps the AIS lesions and quantifies their occupancy in each brain region. They are practical tools to meet the clinical needs and enrich educational resources of neuroimage.
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Affiliation(s)
- Yi-Chia Wei
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yu Jian
- Clinical Informatics and Medical Statistics Research Center, Chung Gung University, Taoyuan, Taiwan
| | - Chih-Chin Heather Hsu
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chung Hsu
- Institute of Data Science, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Tung Cheng
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yao-Liang Chen
- Department of Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Yu Wei
- Department of Electrical Engineering, National Taiwan University, Taipei, Taiwan
| | - Kuan-Fu Chen
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan; Clinical Informatics and Medical Statistics Research Center, Chung Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
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3
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Scheldeman L, Wouters A, Dupont P, Christensen S, Boutitie F, Cheng B, Ebinger M, Endres M, Fiebach JB, Gerloff C, Muir KW, Nighoghossian N, Pedraza S, Simonsen CZ, Thijs V, Thomalla G, Lemmens R. Diffusion-Weighted Imaging and Fluid-Attenuated Inversion Recovery Quantification to Predict Diffusion-Weighted Imaging-Fluid-Attenuated Inversion Recovery Mismatch Status in Ischemic Stroke With Unknown Onset. Stroke 2022; 53:1665-1673. [PMID: 35105179 DOI: 10.1161/strokeaha.121.036871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Visual rating of diffusion-weighted imaging (DWI)-fluid-attenuated inversion recovery (FLAIR) mismatch can be challenging. We evaluated quantification of DWI and FLAIR to predict DWI-FLAIR mismatch status in ischemic stroke. METHODS In screened patients from the WAKE-UP trial (Efficacy and Safety of Magnetic Resonance Imaging-Based Thrombolysis in Wake-Up Stroke), we retrospectively studied relative DWI (rDWI SI) and FLAIR signal intensity (rFLAIR SI). We defined the optimal mean rFLAIR SI and interquartile range of the rDWI SI in the DWI lesion to predict DWI-FLAIR mismatch status. We investigated agreement between each quantitative parameter and the DWI-FLAIR mismatch and the association between both quantitative parameters. We evaluated the predictive value of the quantitative parameters for excellent functional outcome by logistic regression, adjusted for DWI lesion volume, treatment, age, and National Institutes of Health Stroke Scale score. RESULTS In the rFLAIR and rDWI SI analysis, 213/369 and 241/421 subjects respectively had a DWI-FLAIR mismatch. A mean rFLAIR SI cutoff of 1.09 and interquartile range rDWI SI cutoff of 0.47 were optimal to predict the DWI-FLAIR mismatch with a sensitivity and specificity of 77% (95% CI, 71%-83%) and 67% (95% CI, 59%-74%), and 76% (95% CI, 70%-81%) and 72% (95% CI, 65%-79%), respectively. For both quantitative parameters, agreement with the DWI-FLAIR mismatch was fair (73%, κ=0.44 [95% CI, 0.35-0.54] for rFLAIR and 74%, κ=0.48 [95% CI, 0.39-0.56] for rDWI). Both quantitative parameters correlated moderately (Pearson R=0.54 [95% CI, 0.46-0.61], P<0.001, n=367). The interquartile range rDWI SI (n=188), but not the mean rFLAIR SI (n=172), was an independent predictor of excellent functional outcome (odds ratio, 0.67 per 0.1 unit increase of interquartile range rDWI SI, 95% CI, 0.51-0.89, P=0.01). CONCLUSIONS Agreement between the quantitative and qualitative approach may be insufficient to advocate DWI or FLAIR quantification as alternative for visual rating.
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Affiliation(s)
- Lauranne Scheldeman
- Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R.L.).,Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium. (L.S., A.W., R.L.).,Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium (L.S., A.W., R.L.)
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R.L.).,Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium. (L.S., A.W., R.L.).,Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium (L.S., A.W., R.L.).,Neurology, Amsterdam University Medical Centers, the Netherlands (A.W.)
| | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven - University of Leuven, Belgium. (P.D.).,Leuven Brain Institute, Belgium (P.D.)
| | | | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, France (F.B.).,Université Lyon 1, Villeurbanne, France (F.B.)
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.C., C.G., G.T.)
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany. (M. Ebinger, M. Endres, J.B.F.)
| | - Matthias Endres
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany. (M. Ebinger, M. Endres, J.B.F.).,Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, Germany. (M. Endres).,Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Germany (M. Ebinger).,German Center for Cardiovascular Research (DZHK), partner site Berlin (M. Endres).,German Center for Neurodegenerative Diseases (DZNE), partner site Berlin (M. Endres).,ExcellenceCluster NeuroCure (M. Endres)
| | - Jochen B Fiebach
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Germany. (M. Ebinger, M. Endres, J.B.F.)
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.C., C.G., G.T.)
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, United Kingdom (K.W.M.)
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA- Lyon (N.N.).,Hospices Civils de Lyon, France (N.N.)
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomedica de Girona (IDIBGI), Parc Hospitalari Marti i Julia de Salt - Edifici M2, Girona, Spain (S.P.)
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Denmark (C.Z.S.)
| | - Vincent Thijs
- Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia (V.T.).,Department of Neurology, Austin Health, Heidelberg, Victoria, Australia (V.T.)
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Germany (B.C., C.G., G.T.)
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Belgium (L.S., A.W., R.L.).,Department of Neurosciences, Experimental Neurology, KU Leuven - University of Leuven, Belgium. (L.S., A.W., R.L.).,Center for Brain and Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium (L.S., A.W., R.L.)
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Zhang J, Ta N, Fu M, Tian FH, Wang J, Zhang T, Wang B. Use of DWI-FLAIR Mismatch to Estimate the Onset Time in Wake-Up Strokes. Neuropsychiatr Dis Treat 2022; 18:355-361. [PMID: 35228801 PMCID: PMC8881675 DOI: 10.2147/ndt.s351943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/06/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To compare the MRI characteristics of patients with wake-up ischemic stroke (WUS) and with ischemic stroke with known onset time (clear-onset-time stroke, COS) to clarify the role of diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch in estimating the onset time of WUS patients. PATIENTS AND METHODS Two hundred patients with acute ischemic stroke were selected for complete brain MRI within six hours of symptom onset, including DWI and FLAIR sequences. The patients were divided into WUS (n = 78) and COS (n = 122) groups, based on whether the time of onset was known. The general conditions and imaging characteristics were collected to compare the DWI-FLAIR mismatch features between the two groups at different time intervals. RESULTS There was no significant difference in the DWI-FLAIR mismatch on MRI within 2 hour after the first found abnormality between the two groups (50.0% vs 71.8%, p = 0.180). With increasing time, the DWI-FLAIR mismatch decreased substantially in the WUS group, while a higher DWI-FLAIR mismatch presence persisted in the COS group within a four-hour interval from the onset of symptoms to the MRI. The DWI-FLAIR mismatch was significantly lower in the WUS group than in the COS group from symptom identification to MRI at 2-3 h, 3-4 h, and 4-5 h intervals (15% vs 60%, 10.5% vs 48%, 6.7% vs 45.4%; p < 0.01). CONCLUSION Our results suggest that the presence of DWI-FLAIR mismatch within 2 h of the first found abnormality was not significantly different between WUS and COS. Therefore, Patients with WUS within 2 hours after the first detected abnormality may be suitable for intravenous thrombolysis.
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Affiliation(s)
- Jinfeng Zhang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China.,Cerebrovascular Disease Research Institute of Inner Mongolia Autonomous Region, Baotou, Inner Mongolia, People's Republic of China
| | - Na Ta
- Practical Teaching Skills Center, Baotou Medical College, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China
| | - Meng Fu
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China.,Cerebrovascular Disease Research Institute of Inner Mongolia Autonomous Region, Baotou, Inner Mongolia, People's Republic of China
| | - Fan Hua Tian
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China.,Cerebrovascular Disease Research Institute of Inner Mongolia Autonomous Region, Baotou, Inner Mongolia, People's Republic of China
| | - Jie Wang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China.,Cerebrovascular Disease Research Institute of Inner Mongolia Autonomous Region, Baotou, Inner Mongolia, People's Republic of China
| | - Tianyou Zhang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China.,Cerebrovascular Disease Research Institute of Inner Mongolia Autonomous Region, Baotou, Inner Mongolia, People's Republic of China
| | - Baojun Wang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, People's Republic of China.,Cerebrovascular Disease Research Institute of Inner Mongolia Autonomous Region, Baotou, Inner Mongolia, People's Republic of China
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5
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Kishi F, Nakagawa I, Park H, Kotsugi M, Myouchin K, Motoyama Y, Nakase H. Low relative diffusion weighted image signal intensity can predict good prognosis after endovascular thrombectomy in patients with acute ischemic stroke. J Neurointerv Surg 2021; 14:618-622. [PMID: 34140286 DOI: 10.1136/neurintsurg-2021-017583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND It is vital to identify a surrogate last-known-well time to perform proper endovascular thrombectomy in acute ischemic stroke; however, no established imaging biomarker can easily and quickly identify eligibility for endovascular thrombectomy and predict good clinical prognosis. OBJECTIVE To investigate whether low relative diffusion-weighted imaging (DWI) signal intensity can be used as a predictor of good clinical outcome after endovascular thrombectomy in patients with acute ischemic stroke. METHODS We retrospectively identified consecutive patients with acute ischemic stroke who were treated with endovascular thrombectomy within 24 hours of the last-known-well time and achieved successful recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b). Relative DWI signal intensity was calculated as DWI signal intensity in the infarcted area divided by DWI signal intensity in the contralateral hemisphere. Good prognosis was defined as a modified Rankin Scale score of 0-2 at 90 days after stroke onset (good prognosis group). RESULTS 49 patients were included in the analysis. Relative DWI signal intensity was significantly lower in the group with good prognosis than in the those with poor prognosis (median (IQR) 1.32 (1.27-1.44) vs 1.56 (1.43-1.66); p<0.01), and the critical cut-off value for predicting good prognosis was 1.449 (area under the curve 0.78). Multiple logistic regression analysis revealed association of good prognosis after endovascular thrombectomy with low relative DWI signal intensity (OR=6.84; 95% CI 1.13 to 41.3; p=0.04). CONCLUSIONS Low relative DWI signal intensity was associated with good prognosis after endovascular thrombectomy. Its ability to predict good clinical outcome shows potential for determining patient suitability for endovascular thrombectomy.
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Affiliation(s)
- Fumihisa Kishi
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - HunSoo Park
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Kaoru Myouchin
- Department of Radiology, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Yasushi Motoyama
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
| | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University School of Medicine Graduate School of Medicine, Kashihara, Nara, Japan
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Rava RA, Podgorsak AR, Waqas M, Snyder KV, Levy EI, Davies JM, Siddiqui AH, Ionita CN. Use of a convolutional neural network to identify infarct core using computed tomography perfusion parameters. Proc SPIE Int Soc Opt Eng 2021; 11596. [PMID: 33707811 DOI: 10.1117/12.2579753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Purpose Computed tomography perfusion (CTP) is used to diagnose ischemic strokes through contralateral hemisphere comparisons of various perfusion parameters. Various perfusion parameter thresholds have been utilized to segment infarct tissue due to differences in CTP software and patient baseline hemodynamics. This study utilized a convolutional neural network (CNN) to eliminate the need for non-universal parameter thresholds to segment infarct tissue. Methods CTP data from 63 ischemic stroke patients was retrospectively collected and perfusion parameter maps were generated using Vitrea CTP software. Infarct ground truth labels were segmented from diffusion-weighted imaging (DWI) and CTP and DWI volumes were registered. A U-net based CNN was trained and tested five separate times using each CTP parameter (cerebral blood flow (CBF), cerebral blood volume (CBV), time-to-peak (TTP), mean-transit-time (MTT), delay time). 8,352 infarct slices were utilized with a 60:30:10 training:testing:validation split and Monte Carlo cross-validation was conducted using 20 iterations. Infarct volumes were reconstructed following segmentation from each CTP slice. Infarct spatial and volumetric agreement was compared between each CTP parameter and DWI. Results Spatial agreement metrics (Dice coefficient, positive predictive value) for each CTP parameter in predicting infarct volumes are: CBF=(0.67, 0.76), CBV=(0.44, 0.62), TTP=(0.60, 0.67), MTT=(0.58, 0.62), delay time=(0.57, 0.60). 95% confidence intervals for volume differences with DWI infarct are: CBF=14.3±11.5 mL, CBV=29.6±21.2 mL, TTP=7.7±15.2 mL, MTT=-10.7±18.6 mL, delay time=-5.7±23.6 mL. Conclusions CBF is the most accurate CTP parameter in segmenting infarct tissue. Segmentation of infarct using a CNN has the potential to eliminate non-universal CTP contralateral hemisphere comparison thresholds.
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Affiliation(s)
- Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY, 14260.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203
| | - Alexander R Podgorsak
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY, 14260.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Medical Physics, University at Buffalo, Buffalo NY, 14260
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Jason M Davies
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, Buffalo NY, 14260.,Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo NY, 14203.,Department of Medical Physics, University at Buffalo, Buffalo NY, 14260.,Department of Neurosurgery, University at Buffalo Jacobs School of Medicine, Buffalo NY, 14203
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7
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Rava RA, Snyder KV, Mokin M, Waqas M, Podgorsak AR, Allman AB, Senko J, Bhurwani MMS, Hoi Y, Davies JM, Levy EI, Siddiqui AH, Ionita CN. Enhancing performance of a computed tomography perfusion software for improved prediction of final infarct volume in acute ischemic stroke patients. Neuroradiol J 2021; 34:222-237. [PMID: 33472519 DOI: 10.1177/1971400920988668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Computed tomography perfusion (CTP) is crucial for acute ischemic stroke (AIS) patient diagnosis. To improve infarct prediction, enhanced image processing and automated parameter selection have been implemented in Vital Images' new CTP+ software. We compared CTP+ with its previous version, commercially available software (RAPID and Sphere), and follow-up diffusion-weighted imaging (DWI). Data from 191 AIS patients between March 2019 and January 2020 was retrospectively collected and allocated into endovascular intervention (n = 81) and conservative treatment (n = 110) cohorts. Intervention patients were treated for large vessel occlusion, underwent mechanical thrombectomy, and achieved successful reperfusion of thrombolysis in cerebral infarction 2b/2c/3. Conservative treatment patients suffered large or small vessel occlusion and did not receive intravenous thrombolysis or mechanical thrombectomy. Infarct and penumbra were assessed using intervention and conservative treatment patients, respectively. Infarct and penumbra volumes were segmented from CTP+ and compared with 24-h DWI along with RAPID, Sphere, and Vitrea. Mean infarct differences (95% confidence intervals) and Spearman correlation coefficients (SCCs) between DWI and each CTP software product for intervention patients are: CTP+ = (5.8 ± 5.9 ml, 0.62), RAPID = (10.0 ± 5.2 ml, 0.73), Sphere = (3.0 ± 6.0 ml, 0.56), Vitrea = (7.2 ± 4.9 ml, 0.66). For conservative treatment patients, mean infarct differences and SCCs are: CTP+ = (-8.0 ± 5.4 ml, 0.64), RAPID = (-25.6 ± 11.5 ml, 0.60), Sphere = (-25.6 ± 8.0 ml, 0.66), Vitrea = (1.3 ± 4.0 ml, 0.72). CTP+ performed similarly to RAPID and Sphere in addition to its semi-automated predecessor, Vitrea, when assessing intervention patient infarct volumes. For conservative treatment patients, CTP+ outperformed RAPID and Sphere in assessing penumbra. Semi-automated Vitrea remains the most accurate in assessing penumbra, but CTP+ provides an improved workflow from its predecessor.
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Affiliation(s)
- Ryan A Rava
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | - Kenneth V Snyder
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Maxim Mokin
- Department of Neurosurgery, University of South Florida, Tampa, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Alexander R Podgorsak
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Medical Physics, University at Buffalo, USA
| | - Ariana B Allman
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | - Jillian Senko
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | - Mohammad Mahdi Shiraz Bhurwani
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA
| | | | - Jason M Davies
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA.,Department of Bioinformatics, University at Buffalo, USA
| | - Elad I Levy
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Adnan H Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA
| | - Ciprian N Ionita
- Department of Biomedical Engineering, University at Buffalo, USA.,Canon Stroke and Vascular Research Center, Buffalo, USA.,Department of Neurosurgery, University at Buffalo, USA.,Department of Medical Physics, University at Buffalo, USA
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8
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Izawa D, Matsumoto H, Nishiyama H, Toki N, Nakao N. Clinical Evaluations of the Ischemic Core in Acute Ischemic Stroke Using Modified Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores by Ischemic Reversibility Using the Signal Intensity. J Neuroendovasc Ther 2021; 15:574-582. [PMID: 37501747 PMCID: PMC10370786 DOI: 10.5797/jnet.oa.2020-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/30/2020] [Indexed: 07/29/2023]
Abstract
Objective Early recanalization of acute stroke caused by large vessel occlusion (LVO) may improve high signal intensity (HSI) on diffusion-weighted imaging (DWI). In this study, we investigated whether subtraction of reversible ischemic lesions (RIL) from the HSI lesions on DWI improves the diagnostic accuracy for the ischemic core. Methods A total of 35 patients from April 2013 and December 2019 were included in this study. These patients presented acute ischemic stroke due to anterior circulation LVO and underwent thrombectomy. All patients underwent DWI within 48 hours after thrombectomy. HSI ratios were calculated, and compared between ischemic lesions and contralateral normal tissue. Ischemic lesions with improvement in the HSI ratio from initial to postoperative DWI were defined as RIL. Based on a receiver operating characteristic (ROC) curve analysis that compared the HSI ratio of all ischemic lesions, the cutoff value of HSI ratio of RILs was calculated. Results In all, 127 ischemic lesions were identified in 35 patients. HSI ratios of RILs were significantly lower than those of irreversible ischemic lesions (IILs) (p <0.0001). Based on a ROC curve analysis that compared the HSI ratio of all 127 lesions, the cutoff value of the HSI ratio of RILs was 1.4. After applying this cutoff value to the 127 ischemic lesions of the 35 patients, 20 patients (57%) were identified as having RILs with a HSI ratio of <1.4. In this 20 patients, the postoperative National Institutes of Health Stroke Scale (NIHSS) score at 24 hours was significantly lower (p = 0.007) and improvement in the NIHSS score was significantly higher (p = 0.018) than in the other patients. Conclusion A HSI ratio of <1.4 on preoperative DWI may reflect ischemic reversibility. In this study, the HSI ratio correlated with clinical findings associated with cerebral ischemia, and our method may be useful in assessing ischemic cores.
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Affiliation(s)
- Daisuke Izawa
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Hiroyuki Matsumoto
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Hirokazu Nishiyama
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Naotsugu Toki
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Naoyuki Nakao
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan
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9
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Rava RA, Podgorsak AR, Waqas M, Snyder KV, Mokin M, Levy EI, Davies JM, Siddiqui AH, Ionita CN. Investigation of convolutional neural networks using multiple computed tomography perfusion maps to identify infarct core in acute ischemic stroke patients. J Med Imaging (Bellingham) 2021; 8:014505. [PMID: 33585662 PMCID: PMC7874969 DOI: 10.1117/1.jmi.8.1.014505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/19/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose: To assess acute ischemic stroke (AIS) severity, infarct is segmented using computed tomography perfusion (CTP) software, such as RAPID, Sphere, and Vitrea, relying on contralateral hemisphere thresholds. Since this approach is potentially patient dependent, we investigated whether convolutional neural networks (CNNs) could achieve better performances without the need for contralateral hemisphere thresholds. Approach: CTP and diffusion-weighted imaging (DWI) data were retrospectively collected for 63 AIS patients. Cerebral blood flow (CBF), cerebral blood volume (CBV), time-to-peak, mean-transit-time (MTT), and delay time maps were generated using Vitrea CTP software. U-net shaped CNNs were developed, trained, and tested for 26 different input CTP parameter combinations. Infarct labels were segmented from DWI volumes registered with CTP volumes. Infarct volumes were reconstructed from two-dimensional CTP infarct segmentations. To remove erroneous segmentations, conditional random field (CRF) postprocessing was applied and compared with prior results. Spatial and volumetric infarct agreement was assessed between DWI and CTP (CNNs and commercial software) using median infarct difference, median absolute error, dice coefficient, positive predictive value. Results: The most accurate combination of parameters for CNN segmenting infarct using CRF postprocessing was CBF, CBV, and MTT (4.83 mL, 10.14 mL, 0.66, 0.73). Commercial software results are: RAPID = (2.25 mL, 21.48 mL, 0.63, 0.70), Sphere = (7.57 mL, 17.74 mL, 0.64, 0.70), Vitrea = (6.79 mL, 15.28 mL, 0.63, 0.72). Conclusions: Use of CNNs with multiple input perfusion parameters has shown to be accurate in segmenting infarcts and has the ability to improve clinical workflow by eliminating the need for contralateral hemisphere comparisons.
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Affiliation(s)
- Ryan A. Rava
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
| | - Alexander R. Podgorsak
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Medical Physics, Buffalo New York, United States
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Kenneth V. Snyder
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Maxim Mokin
- University of South Florida, Department of Neurosurgery, Tampa, Florida, United States
| | - Elad I. Levy
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Jason M. Davies
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
- University at Buffalo, Department of Bioinformatics, Buffalo, New York, United States
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
| | - Ciprian N. Ionita
- University at Buffalo, Department of Biomedical Engineering, Buffalo, New York, United States
- Canon Stroke and Vascular Research Center, Buffalo, New York, United States
- University at Buffalo, Department of Medical Physics, Buffalo New York, United States
- University at Buffalo, Department of Neurosurgery, Buffalo, New York, United States
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10
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Rava RA, Snyder KV, Mokin M, Waqas M, Allman AB, Senko JL, Podgorsak AR, Shiraz Bhurwani MM, Hoi Y, Siddiqui AH, Davies JM, Levy EI, Ionita CN. Assessment of a Bayesian Vitrea CT Perfusion Analysis to Predict Final Infarct and Penumbra Volumes in Patients with Acute Ischemic Stroke: A Comparison with RAPID. AJNR Am J Neuroradiol 2020; 41:206-212. [PMID: 31948951 DOI: 10.3174/ajnr.a6395] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Brain CTP is used to estimate infarct and penumbra volumes to determine endovascular treatment eligibility for patients with acute ischemic stroke. We aimed to assess the accuracy of a Bayesian CTP algorithm in determining penumbra and final infarct volumes. MATERIALS AND METHODS Data were retrospectively collected for 105 patients with acute ischemic stroke (55 patients with successful recanalization [TICI 2b/2c/3] and large-vessel occlusions and 50 patients without interventions). Final infarct volumes were calculated using DWI and FLAIR 24 hours following CTP imaging. RAPID and the Vitrea Bayesian CTP algorithm (with 3 different settings) predicted infarct and penumbra volumes for comparison with final infarct volumes to assess software performance. Vitrea settings used different combinations of perfusion maps (MTT, TTP, CBV, CBF, delay time) for infarct and penumbra quantification. Patients with and without interventions were included for assessment of predicted infarct and penumbra volumes, respectively. RESULTS RAPID and Vitrea default setting had the most accurate final infarct volume prediction in patients with interventions ([Spearman correlation coefficient, mean infarct difference] default versus FLAIR: [0.77, 4.1 mL], default versus DWI: [0.72, 4.7 mL], RAPID versus FLAIR: [0.75, 7.5 mL], RAPID versus DWI: [0.75, 6.9 mL]). Default Vitrea and RAPID were the most and least accurate in determining final infarct volume for patients without an intervention, respectively (default versus FLAIR: [0.76, -0.4 mL], default versus DWI: [0.71, -2.6 mL], RAPID versus FLAIR: [0.68, -49.3 mL], RAPID versus DWI: [0.65, -51.5 mL]). CONCLUSIONS Compared with RAPID, the Vitrea default setting was noninferior for patients with interventions and superior in penumbra estimation for patients without interventions as indicated by mean infarct differences and correlations with final infarct volumes.
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Affiliation(s)
- R A Rava
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.) .,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - K V Snyder
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - M Mokin
- Department of Neurosurgery (M.M.), University of South Florida, Tampa, Florida
| | - M Waqas
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - A B Allman
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - J L Senko
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - A R Podgorsak
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Medical Physics (A.R.P.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - M M Shiraz Bhurwani
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - Y Hoi
- Canon Medical Systems USA (Y.H.), Tustin, California
| | - A H Siddiqui
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - J M Davies
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - E I Levy
- Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
| | - C N Ionita
- From the Departments of Biomedical Engineering (R.A.R., A.B.A., J.L.S., A.R.P., M.M.S.B., C.N.I.).,Neurosurgery (K.V.S., M.W., A.R.P., A.H.S., J.M.D., E.I.L., C.N.I.).,Canon Stroke and Vascular Research Center (R.A.R., K.V.S., M.W., A.B.A., J.L.S., A.R.P., M.M.S.B., A.H.S., J.M.D., E.I.L., C.N.I.), Buffalo, New York
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11
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Wouters A, Dupont P, Christensen S, Norrving B, Laage R, Thomalla G, Kemp S, Lansberg M, Thijs V, Albers GW, Lemmens R. Multimodal magnetic resonance imaging to identify stroke onset within 6 h in patients with large vessel occlusions. Eur Stroke J 2019; 3:185-192. [PMID: 31008349 DOI: 10.1177/2396987317753486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 12/05/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Mechanical thrombectomy within 6 h after stroke onset improves the outcome in patients with large vessel occlusions. The aim of our study was to establish a model based on diffusion weighted and perfusion weighted imaging to provide an accurate prediction for the 6 h time-window in patients with unknown time of stroke onset. Patients and methods A predictive model was designed based on data from the DEFUSE 2 study and validated in a subgroup of patients with large vessel occlusions from the AXIS 2 trial. Results We constructed the model in 91 patients from DEFUSE 2. The following parameters were independently associated with <6 h time-window and included in the model: interquartile range and median relative diffusion weighted imaging, hypoperfusion intensity ratio, core volume and the interaction between median relative diffusion weighted imaging and hypoperfusion intensity ratio as predictors of the 6 h time-window. The area under the curve was 0.80 with a positive predictive value of 0.90 (95%CI 0.79-0.96). In the validation cohort (N = 90), the area under the curve was 0.73 (P for difference = 0.4) with a positive predictive value of 0.85 (95%CI 0.69-0.95). Discussion After validation in a larger independent dataset the model can be considered to select patients for endovascular treatment in whom stroke onset is unknown. Conclusion In patients with large vessel occlusion and unknown time of stroke onset an automated multivariate imaging model is able to select patients who are likely within the 6 h time-window.
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Affiliation(s)
- Anke Wouters
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Leuven, Belgium.,Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Soren Christensen
- Stanford Stroke Center, Stanford University Medical Center, Palo Alto, USA
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden
| | - Rico Laage
- Guided Development GmbH, Heidelberg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Kemp
- Stanford Stroke Center, Stanford University Medical Center, Palo Alto, USA
| | - Maarten Lansberg
- Stanford Stroke Center, Stanford University Medical Center, Palo Alto, USA
| | - Vincent Thijs
- 9Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Gregory W Albers
- Stanford Stroke Center, Stanford University Medical Center, Palo Alto, USA
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Leuven, Belgium.,Center for Brain & Disease Research, Laboratory of Neurobiology, VIB, Leuven, Belgium.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium
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12
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Chen MM, Chen PM, Hailey L, Mortin M, Rapp K, Agrawal K, Huisa B, Modir R, Meyer DM, Hemmen T, Meyer BC. Mapping a Reliable Stroke Onset Time Course Using Signal Intensity on DWI Scans. J Neuroimaging 2019; 29:476-480. [PMID: 30932243 DOI: 10.1111/jon.12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 03/19/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Identifying a last known well (LKW) time surrogate for acute stroke is vital to increase stroke treatment. Diffusion-weighted imaging (DWI) signal intensity initially increases from onset of stroke but mapping a reliable time course to the signal intensity has not been demonstrated. METHODS We retrospectively reviewed stroke code patients between 1/2016 and 6/2017 from the prospective; Institutional review board (IRB) approved University of California San Diego Stroke Registry. Patients who had magnetic resonance imaging of brain from onset, with or without intervention, are included. All ischemic strokes were confirmed and timing from onset to imaging was calculated. Raw DWI intensity is measured using IMPAX software and compared to contralateral side for control for a relative DWI intensity (rDWI). LKW and magnetic resonance imaging (MRI) time were collected by chart review. Correlation is assessed using Pearson correlation coefficient between DWI intensity, rDWI, and time to MRI imaging. 1.5T, 3T, and combined modalities were examined. RESULTS Seventy-eight patients were included in this analysis. Overall, there was statistically significant positive correlation (.53, P < .001) between DWI intensity and LKW time irrespective of scanner strength. Using 1.5T analyses, there was good correlation (.46, P < .001). 3T MRI analysis further showed comparatively stronger positive correlation (.66, P < .001). CONCLUSIONS There is good correlation between DWI intensity and minutes from onset to MRI. This suggests a time-dependent DWI intensity response and supports the potential use of DWI intensity measurements to extrapolate an LKW time. Further studies are being pursued to increase both experience and generalizability.
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Affiliation(s)
- Michael M Chen
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Patrick M Chen
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Lovella Hailey
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Melissa Mortin
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Karen Rapp
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Kunal Agrawal
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Branko Huisa
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Royya Modir
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Dawn M Meyer
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Thomas Hemmen
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
| | - Brett C Meyer
- Department of Neurosciences, University of San Diego Health, Stroke Center, San Diego, CA
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13
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Galinovic I, Dicken V, Heitz J, Klein J, Puig J, Guibernau J, Kemmling A, Gellissen S, Villringer K, Neeb L, Gregori J, Weiler F, Pedraza S, Thomalla G, Fiehler J, Gerloff C, Fiebach JB. Homogeneous application of imaging criteria in a multicenter trial supported by investigator training: A report from the WAKE-UP study. Eur J Radiol 2018; 104:115-119. [DOI: 10.1016/j.ejrad.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/27/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
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14
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Wouters A, Cheng B, Christensen S, Dupont P, Robben D, Norrving B, Laage R, Thijs VN, Albers GW, Thomalla G, Lemmens R. Automated DWI analysis can identify patients within the thrombolysis time window of 4.5 hours. Neurology 2018; 90:e1570-e1577. [DOI: 10.1212/wnl.0000000000005413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 02/05/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo develop an automated model based on diffusion-weighted imaging (DWI) to detect patients within 4.5 hours after stroke onset and compare this method to the visual DWI-FLAIR (fluid-attenuated inversion recovery) mismatch.MethodsWe performed a subanalysis of the “DWI-FLAIR mismatch for the identification of patients with acute ischemic stroke within 4.5 hours of symptom onset” (PRE-FLAIR) and the “AX200 for ischemic stroke” (AXIS 2) trials. We developed a prediction model with data from the PRE-FLAIR study by backward logistic regression with the 4.5-hour time window as dependent variable and the following explanatory variables: age and median relative DWI (rDWI) signal intensity, interquartile range (IQR) rDWI signal intensity, and volume of the core. We obtained the accuracy of the model to predict the 4.5-hour time window and validated our findings in an independent cohort from the AXIS 2 trial. We compared the receiver operating characteristic curve to the visual DWI-FLAIR mismatch.ResultsIn the derivation cohort of 118 patients, we retained the IQR rDWI as explanatory variable. A threshold of 0.39 was most optimal in selecting patients within 4.5 hours after stroke onset resulting in a sensitivity of 76% and specificity of 63%. The accuracy was validated in an independent cohort of 200 patients. The predictive value of the area under the curve of 0.72 (95% confidence interval 0.64–0.80) was similar to the visual DWI-FLAIR mismatch (area under the curve = 0.65; 95% confidence interval 0.58–0.72; p for difference = 0.18).ConclusionsAn automated analysis of DWI performs at least as good as the visual DWI-FLAIR mismatch in selecting patients within the 4.5-hour time window.
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15
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McGarry BL, Jokivarsi KT, Knight MJ, Grohn OHJ, Kauppinen RA. Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia. J Vis Exp 2017; 2017. [PMID: 28979652 PMCID: PMC5624498 DOI: 10.3791/55277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
MRI provides a sensitive and specific imaging tool to detect acute ischemic stroke by means of a reduced diffusion coefficient of brain water. In a rat model of ischemic stroke, differences in quantitative T1 and T2 MRI relaxation times (qT1 and qT2) between the ischemic lesion (delineated by low diffusion) and the contralateral non-ischemic hemisphere increase with time from stroke onset. The time dependency of MRI relaxation time differences is heuristically described by a linear function and thus provides a simple estimate of stroke onset time. Additionally, the volumes of abnormal qT1 and qT2 within the ischemic lesion increase linearly with time providing a complementary method for stroke timing. A (semi)automated computer routine based on the quantified diffusion coefficient is presented to delineate acute ischemic stroke tissue in rat ischemia. This routine also determines hemispheric differences in qT1 and qT2 relaxation times and the location and volume of abnormal qT1 and qT2 voxels within the lesion. Uncertainties associated with onset time estimates of qT1 and qT2 MRI data vary from ± 25 min to ± 47 min for the first 5 hours of stroke. The most accurate onset time estimates can be obtained by quantifying the volume of overlapping abnormal qT1 and qT2 lesion volumes, termed 'Voverlap' (± 25 min) or by quantifying hemispheric differences in qT2 relaxation times only (± 28 min). Overall, qT2 derived parameters outperform those from qT1. The current MRI protocol is tested in the hyperacute phase of a permanent focal ischemia model, which may not be applicable to transient focal brain ischemia.
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Affiliation(s)
- Bryony L McGarry
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
| | - Kimmo T Jokivarsi
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Michael J Knight
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
| | - Olli H J Grohn
- Department of Neurobiology, A.I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Risto A Kauppinen
- School of Experimental Psychology and Clinical Research and Imaging Center Bristol, University of Bristol, Bristol, UK
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Legge J, Graham A, Male S, Copeland D, Lee R, Goyal N, Zand R. Fluid-Attenuated Inversion Recovery (FLAIR) Signal Intensity Can Identify Stroke Within 6 and 8 Hours. J Stroke Cerebrovasc Dis 2017; 26:1582-1587. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/16/2017] [Accepted: 02/20/2017] [Indexed: 11/25/2022] Open
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Xu X, Wu C, Zu Q, Lu S, Liu X, Gao Q, Liu S, Shi H. Temporal evolution of the signal intensity of hyper-acute ischemic lesions in a canine stroke model: influence of hyperintense acute reperfusion marker. Jpn J Radiol 2017; 35:161-7. [DOI: 10.1007/s11604-017-0615-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
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Liu S, Xu X, Cheng Q, Zu Q, Lu S, Yu J, Liu X, Wang B, Teng G, Shi H. Simple quantitative measurement based on DWI to objectively judge DWI-FLAIR mismatch in a canine stroke model. Diagn Interv Radiol 2016; 21:348-54. [PMID: 26038954 DOI: 10.5152/dir.2015.14443] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Diffusion-weighted imaging (DWI) - fluid attenuated inversion recovery (FLAIR) mismatch was proven useful to time the onset of wake-up stroke; however, identifying the status of FLAIR imaging has been mostly subjective. We aimed to evaluate the value of relative DWI signal intensity (rDWI), and relative apparent diffusion coefficient (rADC) in identifying the FLAIR status in the acute period. METHODS Autologous clot was used to embolize left middle cerebral artery in 20 dogs. Magnetic resonance imaging was performed 3-6 hours and 24 hours after embolization. DWI-FLAIR mismatch was defined as hyperintense signal detected on DWI, but not on FLAIR. The mean values of rDWI or rADC of FLAIR- and FLAIR+ lesions were compared and the critical cutoff values of rDWI and rADC for identifying the FLAIR status were determined. RESULTS Stroke models were successfully established in all animals. DWI+ lesions were found in all 20 dogs from three hours, while FLAIR+ lesions were found in three, 11, 16, 19, and 20 dogs at five time points after embolization, respectively. The mean rDWI values were significantly different between FLAIR- and FLAIR+ lesions (P < 0.001), but rADC values were not (P = 0.73). Using rDWI=1.90 as the threshold value, excellent diagnostic efficacy was achieved (AUC, 0.88; sensitivity, 0.77; specificity, 0.88). However, rADC appeared not useful (AUC, 0.48; sensitivity, 0.52; specificity, 0.58) in identifying the FLAIR status. CONCLUSION In our embolic canine stroke model, rDWI was useful to identify FLAIR imaging status in the acute period, while rADC was not.
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Affiliation(s)
- Sheng Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Radiology, Zhong-da Hospital, Medical School of Southeast University, Nanjing, China.
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Wouters A, Dupont P, Norrving B, Laage R, Thomalla G, Albers GW, Thijs V, Lemmens R. Prediction of Stroke Onset Is Improved by Relative Fluid-Attenuated Inversion Recovery and Perfusion Imaging Compared to the Visual Diffusion-Weighted Imaging/Fluid-Attenuated Inversion Recovery Mismatch. Stroke 2016; 47:2559-64. [DOI: 10.1161/strokeaha.116.013903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/12/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Acute stroke patients with unknown time of symptom onset are ineligible for thrombolysis. The diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) mismatch is a reasonable predictor of stroke within 4.5 hours of symptom onset, and its clinical usefulness in selecting patients for thrombolysis is currently being investigated. The accuracy of the visual mismatch rating is moderate, and we hypothesized that the predictive value of stroke onset within 4.5 hours could be improved by including various clinical and imaging parameters.
Methods—
In this study, 141 patients in whom magnetic resonance imaging was obtained within 9 hours after symptom onset were included. Relative FLAIR signal intensity was calculated in the region of nonreperfused core. Mean
T
max
was calculated in the total region with
T
max
>6 s. Mean relative FLAIR, mean
T
max
, lesion volume with
T
max
>6 s, age, site of arterial stenosis, core volume, and location of infarct were analyzed by logistic regression to predict stroke onset time before or after 4.5 hours.
Results—
Receiver-operating characteristic curve analysis revealed an area under the curve of 0.68 (95% confidence interval 0.59–0.78) for the visual diffusion-weighted imaging/FLAIR mismatch, thereby correctly classifying 69% of patients with an onset time before or after 4.5 hours. Age, relative FLAIR, and
T
max
increased the accuracy significantly (
P
<0.01) to an area under the curve of 0.82 (95% confidence interval 0.74–0.89). This new predictive model correctly categorized 77% of patients according to stroke onset before versus after 4.5 hours.
Conclusions—
In patients with unknown stroke onset, the accuracy of predicting time from symptom onset within 4.5 hours is improved by obtaining relative FLAIR and perfusion imaging.
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Affiliation(s)
- Anke Wouters
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Patrick Dupont
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Bo Norrving
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Rico Laage
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Götz Thomalla
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Gregory W. Albers
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Vincent Thijs
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
| | - Robin Lemmens
- From the Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven–University of Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); VIB, Vesalius Research Center, Laboratory of Neurobiology, B-3000 Leuven, Belgium (A.W., R. Lemmens); Department of Neurology, University Hospitals Leuven, B-3000 Leuven, Belgium (A.W., R. Lemmens); Laboratory for Cognitive Neurology, KU Leuven, Herestraat 49, 3000 Leuven, Belgium (P.D.); Department
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McGarry BL, Rogers HJ, Knight MJ, Jokivarsi KT, Gröhn OH, Kauppinen RA. Determining Stroke Onset Time Using Quantitative MRI: High Accuracy, Sensitivity and Specificity Obtained from Magnetic Resonance Relaxation Times. Cerebrovasc Dis Extra 2016. [PMCID: PMC5040899 DOI: 10.1159/000448814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Many ischaemic stroke patients are ineligible for thrombolytic therapy due to unknown onset time. Quantitative MRI (qMRI) is a potential surrogate for stroke timing. Rats were subjected to permanent middle cerebral artery occlusion and qMRI parameters including hemispheric differences in apparent diffusion coefficient, T2-weighted signal intensities, T1 and T2 relaxation times (qT1, qT2) and f1, f2 and Voverlap were measured at hourly intervals at 4.7 or 9.4 T. Accuracy and sensitivity for identifying strokes scanned within and beyond 3 h of onset was determined. Accuracy for Voverlap, f2 and qT2 (>90%) was significantly higher than other parameters. At a specificity of 1, sensitivity was highest for Voverlap (0.90) and f2 (0.80), indicating promise of these qMRI indices in the clinical assessment of stroke onset time.
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Affiliation(s)
- Bryony L. McGarry
- School of Experimental Psychology, University of Bristol, London, UK
- *Bryony L. McGarry, School of Experimental Psychology, University of Bristol, 12a Priory Road, Clifton, Bristol BS8 1TU (UK), E-Mail
| | - Harriet J. Rogers
- Imaging and Biophysics, Institute of Child Health, University College London, London, UK
| | - Michael J. Knight
- School of Experimental Psychology, University of Bristol, London, UK
| | - Kimmo T. Jokivarsi
- Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Olli H.J. Gröhn
- Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
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McGarry BL, Rogers HJ, Knight MJ, Jokivarsi KT, Sierra A, Gröhn OHJ, Kauppinen RA. Stroke onset time estimation from multispectral quantitative magnetic resonance imaging in a rat model of focal permanent cerebral ischemia. Int J Stroke 2016; 11:677-82. [DOI: 10.1177/1747493016641124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/22/2016] [Indexed: 11/15/2022]
Abstract
Background Quantitative T2 relaxation magnetic resonance imaging allows estimation of stroke onset time. Aims We aimed to examine the accuracy of quantitative T1 and quantitative T2 relaxation times alone and in combination to provide estimates of stroke onset time in a rat model of permanent focal cerebral ischemia and map the spatial distribution of elevated quantitative T1 and quantitative T2 to assess tissue status. Methods Permanent middle cerebral artery occlusion was induced in Wistar rats. Animals were scanned at 9.4T for quantitative T1, quantitative T2, and Trace of Diffusion Tensor (Dav) up to 4 h post-middle cerebral artery occlusion. Time courses of differentials of quantitative T1 and quantitative T2 in ischemic and non-ischemic contralateral brain tissue (ΔT1, ΔT2) and volumes of tissue with elevated T1 and T2 relaxation times ( f1, f2) were determined. TTC staining was used to highlight permanent ischemic damage. Results ΔT1, ΔT2, f1, f2, and the volume of tissue with both elevated quantitative T1 and quantitative T2 (VOverlap) increased with time post-middle cerebral artery occlusion allowing stroke onset time to be estimated. VOverlap provided the most accurate estimate with an uncertainty of ±25 min. At all times-points regions with elevated relaxation times were smaller than areas with Dav defined ischemia. Conclusions Stroke onset time can be determined by quantitative T1 and quantitative T2 relaxation times and tissue volumes. Combining quantitative T1 and quantitative T2 provides the most accurate estimate and potentially identifies irreversibly damaged brain tissue.
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Affiliation(s)
- Bryony L McGarry
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Harriet J Rogers
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Michael J Knight
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Kimmo T Jokivarsi
- Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Alejandra Sierra
- Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Olli HJ Gröhn
- Department of Neurobiology, University of Eastern Finland, Kuopio, Finland
| | - Risto A Kauppinen
- School of Experimental Psychology, University of Bristol, Bristol, UK
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Geraldo AF, Berner LP, Haesebaert J, Chabrol A, Cho TH, Derex L, Hermier M, Louis-Tisserand G, Chamard L, Klaerke Mikkelsen I, Ribe L, Østergaard L, Hjort N, Pedraza S, Thomalla G, Baron JC, Nighoghossian N, Berthèzene Y. Does b1000–b0 Mismatch Challenge Diffusion-Weighted Imaging–Fluid Attenuated Inversion Recovery Mismatch in Stroke? Stroke 2016; 47:877-81. [DOI: 10.1161/strokeaha.115.011501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/04/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Ana Filipa Geraldo
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Lise-Prune Berner
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Julie Haesebaert
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Aurélie Chabrol
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Tae-Hee Cho
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Laurent Derex
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Marc Hermier
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Guy Louis-Tisserand
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Leila Chamard
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Irene Klaerke Mikkelsen
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Lars Ribe
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Leif Østergaard
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Niels Hjort
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Salvador Pedraza
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Götz Thomalla
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Jean-Claude Baron
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Norbert Nighoghossian
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
| | - Yves Berthèzene
- From the Departments of Neuroradiology (A.F.G., L.-P.B., A.C., M.H., G.L.-T., L.C., Y.B.) and Stroke Medicine (T.-H.C., L.D., N.N.), Université Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France; Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France (J.H.); Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark (I.K.M., L.R., L.Ø., N.H.); Department of Radiology,
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Emeriau S, Benaïssa A, Toubas O, Pombourcq F, Pierot L. Can MRI quantification help evaluate stroke age? J Neuroradiol 2016; 43:155-62. [PMID: 26783145 DOI: 10.1016/j.neurad.2015.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diffusion-weighted imaging (DWI) fluid-attenuated inversion recovery (FLAIR) mismatch has a proven ability to estimate stroke-to-magnetic resonance imaging (MRI) delay. We evaluated the possibility of enhancing this estimation by quantifying MRI (DWI and FLAIR) signals, and compared this approach to the visual evaluation of DWI-FLAIR mismatch. MATERIALS AND METHODS This retrospective study included 194 patients presenting an ischemic stroke in the middle cerebral artery territory that had been explored with 3T MRI within 12h. According to the study design, written informed consent was waived and patient information was anonymized and de-identified prior to analysis. DWI-FLAIR mismatch was visually estimated by two radiologists and a quantification of MRI signals based on a manual segmentation of stroke lesion volume was performed. Using their receiver operating curve and area under the curve (AUC), we identified the variables of MRI quantification that were predictive of stroke-to-MRI delay, then compared their performance against visual classification. RESULTS The quantitative variables identified as predictive of stroke-to-MRI delay were: 1st quartile, 3rd quartile and median values of B0; 1st quartile, 3rd quartile, median and relative values of B1000; 1st quartile and relative values of the apparent diffusion coefficient. FLAIR was not found to be predictive. The AUC values of these variables ranged between 0618±0.053 and 0.683±0.048. The relative value of B1000 appeared to be the best predictive quantitative variable, with predictive values comparable to visual classification. CONCLUSIONS The quantification of MRI signal may be a helpful tool for stroke dating but cannot outperform the visual estimation of stroke lesion age.
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Affiliation(s)
- Samuel Emeriau
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - Azzedine Benaïssa
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Olivier Toubas
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Francis Pombourcq
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Laurent Pierot
- CHU de Reims, Reims University, Hôpital Maison-Blanche, Department of Neuroradiology, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Rogers HJ, Mcgarry BL, Knight MJ, Jokivarsi KT, Gröhn OH, Kauppinen RA. Timing the ischaemic stroke by 1H-MRI: improved accuracy using absolute relaxation times over signal intensities. Neuroreport 2014; 25:1180-5. [DOI: 10.1097/wnr.0000000000000238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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