1
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Mojtahedi M, Bruggeman AE, van Voorst H, Ponomareva E, Kappelhof M, van der Lugt A, Hoving JW, Dutra BG, Dippel D, Cavalcante F, Yo L, Coutinho J, Brouwer J, Treurniet K, Tolhuisen ML, LeCouffe N, Arrarte Terreros N, Konduri PR, van Zwam W, Roos Y, Majoie CBLM, Emmer BJ, Marquering HA. Value of Automatically Derived Full Thrombus Characteristics: An Explorative Study of Their Associations with Outcomes in Ischemic Stroke Patients. J Clin Med 2024; 13:1388. [PMID: 38592252 PMCID: PMC10932251 DOI: 10.3390/jcm13051388] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: For acute ischemic strokes caused by large vessel occlusion, manually assessed thrombus volume and perviousness have been associated with treatment outcomes. However, the manual assessment of these characteristics is time-consuming and subject to inter-observer bias. Alternatively, a recently introduced fully automated deep learning-based algorithm can be used to consistently estimate full thrombus characteristics. Here, we exploratively assess the value of these novel biomarkers in terms of their association with stroke outcomes. (2) Methods: We studied two applications of automated full thrombus characterization as follows: one in a randomized trial, MR CLEAN-NO IV (n = 314), and another in a Dutch nationwide registry, MR CLEAN Registry (n = 1839). We used an automatic pipeline to determine the thrombus volume, perviousness, density, and heterogeneity. We assessed their relationship with the functional outcome defined as the modified Rankin Scale (mRS) at 90 days and two technical success measures as follows: successful final reperfusion, which is defined as an eTICI score of 2b-3, and successful first-pass reperfusion (FPS). (3) Results: Higher perviousness was significantly related to a better mRS in both MR CLEAN-NO IV and the MR CLEAN Registry. A lower thrombus volume and lower heterogeneity were only significantly related to better mRS scores in the MR CLEAN Registry. Only lower thrombus heterogeneity was significantly related to technical success; it was significantly related to a higher chance of FPS in the MR CLEAN-NO IV trial (OR = 0.55, 95% CI: 0.31-0.98) and successful reperfusion in the MR CLEAN Registry (OR = 0.88, 95% CI: 0.78-0.99). (4) Conclusions: Thrombus characteristics derived from automatic entire thrombus segmentations are significantly related to stroke outcomes.
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Affiliation(s)
- Mahsa Mojtahedi
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.v.V.); (M.L.T.); (P.R.K.); (H.A.M.)
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Agnetha E. Bruggeman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Henk van Voorst
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.v.V.); (M.L.T.); (P.R.K.); (H.A.M.)
| | | | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands;
| | - Jan W. Hoving
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Bruna G. Dutra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Diederik Dippel
- Department of Neurology, Erasmus MC UMC, 3015 GD Rotterdam, The Netherlands;
| | - Fabiano Cavalcante
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Lonneke Yo
- Department of Radiology, Catharina Ziekenhuis, 5623 EJ Eindhoven, The Netherlands
| | - Jonathan Coutinho
- Department of Neurology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (J.C.); (J.B.); (Y.R.)
| | - Josje Brouwer
- Department of Neurology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (J.C.); (J.B.); (Y.R.)
| | - Kilian Treurniet
- Research Bureau of Radiology and Nuclear Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
- Department of Radiology, The Hague Medical Center, 2262 BA The Hague, The Netherlands
| | - Manon L. Tolhuisen
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.v.V.); (M.L.T.); (P.R.K.); (H.A.M.)
| | - Natalie LeCouffe
- Department of Neurology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (J.C.); (J.B.); (Y.R.)
| | - Nerea Arrarte Terreros
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.v.V.); (M.L.T.); (P.R.K.); (H.A.M.)
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Praneeta R. Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.v.V.); (M.L.T.); (P.R.K.); (H.A.M.)
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht UMC, Cardiovascular Research Institute Maastricht (CARIM), 6229 HX Maastricht, The Netherlands;
| | - Yvo Roos
- Department of Neurology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (J.C.); (J.B.); (Y.R.)
| | - Charles B. L. M. Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Bart J. Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
| | - Henk A. Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (H.v.V.); (M.L.T.); (P.R.K.); (H.A.M.)
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands; (A.E.B.); (M.K.); (J.W.H.); (B.G.D.); (F.C.); (C.B.L.M.M.); (B.J.E.)
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2
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Konduri P, Cavalcante F, van Voorst H, Rinkel L, Kappelhof M, van Kranendonk K, Treurniet K, Emmer B, Coutinho J, Wolff L, Hofmeijer J, Uyttenboogaart M, van Zwam W, Roos Y, Majoie C, Marquering H. Role of intravenous alteplase on late lesion growth and clinical outcome after stroke treatment. J Cereb Blood Flow Metab 2023; 43:116-125. [PMID: 37017421 PMCID: PMC10638991 DOI: 10.1177/0271678x231167755] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 01/24/2023] [Accepted: 03/03/2023] [Indexed: 04/06/2023]
Abstract
Several acute ischemic stroke mechanisms that cause lesion growth continue after treatment which is detrimental to long-term clinical outcome. The potential role of intravenous alteplase treatment (IVT), a standard in stroke care, in cessing the physiological processes causing post-treatment lesion development is understudied. We analyzed patients from the MR CLEAN-NO IV trial with good quality 24-hour and 1-week follow-up Non-Contrast CT scans. We delineated hypo- and hyper-dense regions on the scans as lesion. We performed univariable logistic and linear regression to estimate the influence of IVT on the presence (growth > 0 ml) and extent of late lesion growth. The association between late lesion growth and mRS was assessed using ordinal logistic regression. Interaction analysis was performed to evaluate the influence of IVT on this association. Of the 63/116 were randomized to included patients, IVT. Median growth was 8.4(-0.88-26) ml. IVT was not significantly associated with the presence (OR: 1.24 (0.57-2.74, p = 0.59) or extent (β = 5.1(-8.8-19), p = 0.47) of growth. Late lesion growth was associated with worse clinical outcome (aOR: 0.85(0.76-0.95), p < 0.01; per 10 ml). IVT did not influence this association (p = 0.18). We did not find evidence that IVT influences late lesion growth or the relationship between growth and worse clinical outcome. Therapies to reduce lesion development are necessary.
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Affiliation(s)
- Praneeta Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Fabiano Cavalcante
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Henk van Voorst
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Leon Rinkel
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Katinka van Kranendonk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Kilian Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology, Haaglanden MC, The Hague, The Netherlands
| | - Bart Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Jonathan Coutinho
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Lennard Wolff
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Jeanette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, the Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Yvo Roos
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Henk Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - on behalf of the MR CLEAN-NO IV Trial Investigators (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands)
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Department of Radiology, Haaglanden MC, The Hague, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, the Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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Kaesmacher J, Mujanovic A, Treurniet K, Kappelhof M, Meinel TR, Yang P, Liu J, Zhang Y, Zi W, Yang Q, Nogueira RG, Kimura K, Matsumaru Y, Suzuki K, Yan B, Mitchell PJ, Miao Z, Roos YBWEM, Majoie CBLM, Gralla J, Saver JL, Fischer U. Perceived acceptable uncertainty regarding comparability of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment. J Neurointerv Surg 2023; 15:227-232. [PMID: 35232755 PMCID: PMC9985721 DOI: 10.1136/neurintsurg-2022-018665] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Most trials comparing endovascular treatment (EVT) alone versus intravenous thrombolysis with alteplase (IVT) + EVT in directly admitted patients with a stroke are non-inferiority trials. However, the margin based on the level of uncertainty regarding non-inferiority of the experimental treatment that clinicians are willing to accept to incorporate EVT alone into clinical practice remains unknown. OBJECTIVE To characterize what experienced stroke clinicians would consider an acceptable level of uncertainty for hypothetical decisions on whether to administer IVT or not before EVT in patients admitted directly to EVT-capable centers. METHODS A web-based, structured survey was distributed to a cross-section of 600 academic neurologists/neurointerventionalists. For this purpose, a response framework for a hypothetical trial comparing IVT+EVT (standard of care) with EVT alone (experimental arm) was designed. In this trial, a similar proportion of patients in each arm achieved functional independence at 90 days. Invited physicians were asked at what level of certainty they would feel comfortable skipping IVT in clinical practice, considering these hypothetical trial results. RESULTS There were 180 respondents (response rate: 30%) and 165 with complete answers. The median chosen acceptable uncertainty suggesting reasonable comparability between both treatments was an absolute difference in the rate of day 90 functional independence of 3% (mode 5%, IQR 1-5%), with higher chosen margins observed in interventionalists (aOR 2.20, 95% CI 1.06 to 4.67). CONCLUSION Physicians would generally feel comfortable skipping IVT before EVT at different certainty thresholds. Most physicians would treat with EVT alone if randomized trial data suggested that the number of patients achieving functional independence at 90 days was similar between the two groups, and one could be sufficiently sure that no more than 3 out of 100 patients would not achieve functional independence at 90 days due to skipping IVT.
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Affiliation(s)
- Johannes Kaesmacher
- Department for Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Department for Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.,Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Kilian Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Manon Kappelhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Thomas R Meinel
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Pengfei Yang
- Neurovascular Center, Naval Medical University, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Naval Medical University, Shanghai, China
| | - Yongwei Zhang
- Neurovascular Center, Naval Medical University, Shanghai, China
| | - Wenjie Zi
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, Sichuan, China
| | - Qingwu Yang
- Department of Neurology, Army Medical University Xinqiao Hospital, Chongqing, Sichuan, China
| | - Raul G Nogueira
- Department of Neurology, Grady Memorial Hospital, Chickasha, Oklahoma, USA
| | - Kazumi Kimura
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Yuji Matsumaru
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kentaro Suzuki
- Department of Neurology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Bernard Yan
- Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Peter J Mitchell
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Jan Gralla
- Department for Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Jeffrey L Saver
- Department of Neurology, UCLA, Los Angeles, California, USA.,Comprehensive Stroke Center and Neurology, David Geffen School of Medicine, Los Angeles, California, USA
| | - Urs Fischer
- Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland
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4
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Konduri P, Bucker A, Boers A, Dutra B, Samuels N, Treurniet K, Berkhemer O, Yoo A, van Zwam W, van Oostenbrugge R, van der Lugt A, Dippel D, Roos Y, Bot J, Majoie C, Marquering H. Risk factors of late lesion growth after acute ischemic stroke treatment. Front Neurol 2022; 13:977608. [PMID: 36277932 PMCID: PMC9581245 DOI: 10.3389/fneur.2022.977608] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Even days after treatment of acute ischemic stroke due to a large vessel occlusion, the infarct lesion continues to grow. This late, subacute growth is associated with unfavorable functional outcome. In this study, we aim to identify patient characteristics that are risk factors of late, subacute lesion growth. Methods Patients from the MR CLEAN trial cohort with good quality 24 h and 1-week follow up non-contrast CT scans were included. Late Lesion growth was defined as the difference between the ischemic lesion volume assessed after 1-week and 24-h. To identify risk factors, patient characteristics associated with lesion growth (categorized in quartiles) in univariable ordinal analysis (p < 0.1) were included in a multivariable ordinal regression model. Results In the 226 patients that were included, the median lesion growth was 22 (IQR 10–45) ml. In the multivariable model, lower collateral capacity [aOR: 0.62 (95% CI: 0.44–0.87); p = 0.01], longer time to treatment [aOR: 1.04 (1–1.08); p = 0.04], unsuccessful recanalization [aOR: 0.57 (95% CI: 0.34–0.97); p = 0.04], and larger midline shift [aOR: 1.18 (95% CI: 1.02–1.36); p = 0.02] were associated with late lesion growth. Conclusion Late, subacute, lesion growth occurring between 1 day and 1 week after ischemic stroke treatment is influenced by lower collateral capacity, longer time to treatment, unsuccessful recanalization, and larger midline shift. Notably, these risk factors are similar to the risk factors of acute lesion growth, suggesting that understanding and minimizing the effects of the predictors for late lesion growth could be beneficial to mitigate the effects of ischemia.
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Affiliation(s)
- Praneeta Konduri
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- *Correspondence: Praneeta Konduri
| | - Amber Bucker
- Department of Radiology, University Medical Center Groningen, Groningen, Netherlands
| | - Anna Boers
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Nico-Lab, Amsterdam, Netherlands
| | - Bruna Dutra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Noor Samuels
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Kilian Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Department of Radiology, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Olvert Berkhemer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Albert Yoo
- Department of Radiology, Texas Stroke Institute, Dallas-Fort Worth, Dallas, TX, United States
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Diederik Dippel
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Yvo Roos
- Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Joost Bot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
| | - Henk Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Amsterdam, Netherlands
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5
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Konduri P, van Voorst H, Bucker A, van Kranendonk K, Boers A, Treurniet K, Berkhemer O, Yoo AJ, van Zwam W, van Oostenbrugge R, van der Lugt A, Dippel D, Roos Y, Bot J, Majoie C, Marquering H. Posttreatment Ischemic Lesion Evolution Is Associated With Reduced Favorable Functional Outcome in Patients With Stroke. Stroke 2021; 52:3523-3531. [PMID: 34289708 DOI: 10.1161/strokeaha.120.032331] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Ischemic lesion volume can increase even 24 hours after onset of an acute ischemic stroke. In this study, we investigated the association of lesion evolution with functional outcome and the influence of successful recanalization on this association. METHODS We included patients from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) who received good quality noncontrast CT images 24 hours and 1 week after stroke onset. The ischemic lesion delineations included infarct, edema, and hemorrhagic transformation. Lesion evolution was defined as the difference between the volumes measured on the 1-week and 24-hour noncontrast CTs. The association of lesion evolution with functional outcome was evaluated using unadjusted and adjusted logistic regression. Adjustments were made for baseline, clinical, and imaging parameters that were associated P<0.10) in univariate analysis with favorable functional outcome, defined as modified Rankin Scale score of ≤2. Interaction analysis was performed to evaluate the influence of successful recanalization, defined as modified Arterial Occlusion Lesion score of 3 points, on this association. RESULTS Of the 226 patients who were included, 69 (31%) patients achieved the favorable functional outcome. Median lesion evolution was 22 (interquartile range, 10-45) mL. Lesion evolution was significantly inversely correlated with favourable functional outcome: unadjusted odds ratio, 0.76 (95% CI, 0.66-0.86; per 10 mL of lesion evolution; P<0.01) and adjusted odds ratio: 0.85 (95% CI, 0.72-0.97; per 10 mL of lesion evolution; P=0.03). There was no significant interaction of successful recanalization on the association of lesion evolution and favorable functional outcome (odds ratio, 1.01 [95% CI, 0.77-1.36]; P=0.94). CONCLUSIONS In our population, subacute ischemic lesion evolution is associated with unfavorable functional outcome. This study suggests that even 24 hours after onset of stroke, deterioration of the brain continues, which has a negative effect on functional outcome. This finding may warrant additional treatment in the subacute phase.
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Affiliation(s)
- Praneeta Konduri
- Department of Biomedical Engineering and Physics (P.K., H.v.V., A.B., H.M.), Amsterdam UMC, location AMC, the Netherlands
- Department of Radiology and Nuclear Medicine (P.K., H.v.V., H.v.V., K.v.K., K.T., O.B., C.M., H.M.), Amsterdam UMC, location AMC, the Netherlands
| | - Henk van Voorst
- Department of Biomedical Engineering and Physics (P.K., H.v.V., A.B., H.M.), Amsterdam UMC, location AMC, the Netherlands
- Department of Radiology and Nuclear Medicine (P.K., H.v.V., H.v.V., K.v.K., K.T., O.B., C.M., H.M.), Amsterdam UMC, location AMC, the Netherlands
| | - Amber Bucker
- Department of Biomedical Engineering and Physics (P.K., H.v.V., A.B., H.M.), Amsterdam UMC, location AMC, the Netherlands
| | - Katinka van Kranendonk
- Department of Radiology and Nuclear Medicine (P.K., H.v.V., H.v.V., K.v.K., K.T., O.B., C.M., H.M.), Amsterdam UMC, location AMC, the Netherlands
| | - Anna Boers
- Department of Radiology, University Medical Center Groningen, the Netherlands (A.B.)
- Nico-lab, Amsterdam, Netherlands (A.B.)
| | - Kilian Treurniet
- Department of Radiology and Nuclear Medicine (P.K., H.v.V., H.v.V., K.v.K., K.T., O.B., C.M., H.M.), Amsterdam UMC, location AMC, the Netherlands
- Department of Radiology, Haaglanden Medisch Centrum, The Hague, the Netherlands (K.T.)
| | - Olvert Berkhemer
- Department of Radiology and Nuclear Medicine (P.K., H.v.V., H.v.V., K.v.K., K.T., O.B., C.M., H.M.), Amsterdam UMC, location AMC, the Netherlands
- Department of Neurology (O.B., D.D.), Erasmus MC University Medical Center, Rotterdam, Netherlands
- Department of Radiology & Nuclear Medicine (O.B., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Albert J Yoo
- Department of Radiology, Texas Stroke Institute, Dallas-Fort Worth (A.J.Y.)
| | - Wim van Zwam
- Department of Radiology (W.v.Z.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)
| | - Robert van Oostenbrugge
- Department of Neurology (R.v.O.), Maastricht University Medical Center and Cardiovascular Research Institute Maastricht (CARIM)
| | - Aad van der Lugt
- Department of Radiology & Nuclear Medicine (O.B., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Diederik Dippel
- Department of Neurology (O.B., D.D.), Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Yvo Roos
- Department of Neurology (Y.R.), Amsterdam UMC, location AMC, the Netherlands
| | - Joost Bot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit van Amsterdam (J.B.)
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine (P.K., H.v.V., H.v.V., K.v.K., K.T., O.B., C.M., H.M.), Amsterdam UMC, location AMC, the Netherlands
| | - Henk Marquering
- Department of Biomedical Engineering and Physics (P.K., H.v.V., A.B., H.M.), Amsterdam UMC, location AMC, the Netherlands
- Department of Radiology and Nuclear Medicine (P.K., H.v.V., H.v.V., K.v.K., K.T., O.B., C.M., H.M.), Amsterdam UMC, location AMC, the Netherlands
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6
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Konduri P, van Kranendonk K, Boers A, Treurniet K, Berkhemer O, Yoo AJ, van Zwam W, van Oostenbrugge R, van der Lugt A, Dippel D, Roos Y, Bot J, Majoie C, Marquering H. The Role of Edema in Subacute Lesion Progression After Treatment of Acute Ischemic Stroke. Front Neurol 2021; 12:705221. [PMID: 34354669 PMCID: PMC8329530 DOI: 10.3389/fneur.2021.705221] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/18/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Ischemic lesions commonly continue to progress even days after treatment, and this lesion growth is associated with unfavorable functional outcome in acute ischemic stroke patients. The aim of this study is to elucidate the role of edema in subacute lesion progression and its influence on unfavorable functional outcome by quantifying net water uptake. Methods: We included all 187 patients from the MR CLEAN trial who had high quality follow-up non-contrast CT at 24 h and 1 week. Using a CT densitometry-based method to calculate the net water uptake, we differentiated total ischemic lesion volume (TILV) into edema volume (EV) and edema-corrected infarct volume (ecIV). We calculated these volumes at 24 h and 1 week after stroke and determined their progression in the subacute period. We assessed the effect of 24-h lesion characteristics on EV and ecIV progression. We evaluated the influence of edema and edema-corrected infarct progression on favorable functional outcome after 90 days (modified Rankin Scale: 0-2) after correcting for potential confounders. Lastly, we compared these volumes between subgroups of patients with and without successful recanalization using the Mann-Whitney U-test. Results: Median TILV increased from 37 (IQR: 18-81) ml to 68 (IQR: 30-130) ml between 24 h and 1 week after stroke, while the net water uptake increased from 22 (IQR: 16-26)% to 27 (IQR: 22-32)%. The TILV progression of 20 (8.8-40) ml was mostly caused by ecIV with a median increase of 12 (2.4-21) ml vs. 6.5 (2.7-15) ml of EV progression. Larger TILV, EV, and ecIV volumes at 24 h were all associated with more edema and lesion progression. Edema progression was associated with unfavorable functional outcome [aOR: 0.53 (0.28-0.94) per 10 ml; p-value: 0.05], while edema-corrected infarct progression showed a similar, non-significant association [aOR: 0.80 (0.62-0.99); p-value: 0.06]. Lastly, edema progression was larger in patients without successful recanalization, whereas ecIV progression was comparable between the subgroups. Conclusion: EV increases in evolving ischemic lesions in the period between 1 day and 1 week after acute ischemic stroke. This progression is larger in patients without successful recanalization and is associated with unfavorable functional outcome. However, the extent of edema cannot explain the total expansion of ischemic lesions since edema-corrected infarct progression is larger than the edema progression.
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Affiliation(s)
- Praneeta Konduri
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Katinka van Kranendonk
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Anna Boers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Nico.lab, Amsterdam, Netherlands
| | - Kilian Treurniet
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Haaglanden Medisch Centrum, The Hague, Netherlands
| | - Olvert Berkhemer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Albert J Yoo
- Department of Radiology, Texas Stroke Institute, Dallas-Fort Worth, TX, United States
| | - Wim van Zwam
- Department of Radiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Diederik Dippel
- Department of Neurology, Erasmus MC-University Medical Center, Rotterdam, Netherlands
| | - Yvo Roos
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Joost Bot
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Charles Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Henk Marquering
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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7
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Compérat E, Egevad L, Lopez-Beltran A, Camparo P, Algaba F, Amin M, Epstein JI, Hamberg H, Hulsbergen-van de Kaa C, Kristiansen G, Montironi R, Pan CC, Heloir F, Treurniet K, Sykes J, Van der Kwast TH. An interobserver reproducibility study on invasiveness of bladder cancer using virtual microscopy and heatmaps. Histopathology 2013; 63:756-66. [DOI: 10.1111/his.12214] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/19/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Eva Compérat
- Department of Pathology; Groupe Hospitalier La Pitié-Salpêtrière; Université Pierre et Marie Curie; Paris France
| | - Lars Egevad
- Department of Pathology; Karolinska University Hospital; Stockholm Sweden
| | | | | | - Ferran Algaba
- Department of Pathology; Fundacio Puigvert; Barcelona Spain
| | - Mahul Amin
- Department of Pathology; Cedars-Sinai Medical Center; Los Angeles CA USA
| | | | - Hans Hamberg
- Department of Pathology; Västeras Central Hospital; Västeras Sweden
| | | | | | | | - Chin-Chen Pan
- Department of Pathology; Taipei Veterans General Hospital; Taipei Taiwan
| | | | - Kilian Treurniet
- Department of Pathology; University of Leiden; Leiden The Netherlands
| | - Jenna Sykes
- Department of Biostatistics; Princess Margaret Hospital; University of Toronto; Toronto ON Canada
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