Acute Ischemic Stroke Infarct Topology: Association with Lesion Volume and Severity of Symptoms at Admission and Discharge

Payabvash, Sam; Taleb, Shayandokht; Benson, John C.; McKinney, Alexander M.

doi:10.3174/ajnr.a4970

Cited by 40 publications

(42 citation statements)

References 23 publications

(49 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While lesion volume may be a therapeutic target in treatments of tissue plasminogen activator and mechanical embolectomy, lesion location can impact what deficits are seen and modulate the impact of lesion size 45. The importance of lesion location versus lesion size may vary with task, with simpler motor tasks such as VGR having a heavier reliance on lesion location, whereas tasks involving more diffuse brain networks, including PM, OH, and OHA, potentially being more impacted by lesion volume.…”

Section: Discussionmentioning

confidence: 99%

Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery

Hawe

Findlater

Kenzie

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundUnderstanding how the size of acute lesions and white matter hyperintensities (WMH) impact stroke recovery can improve our ability to predict outcomes and tailor treatments. The aim of this exploratory study was to investigate the role of acute lesion volume and WMH volume on longitudinal recovery of specific sensory, motor, and cognitive impairments after stroke using robotic and clinical measures.Methods and ResultsEighty‐two individuals were assessed at 1, 6, 12, and 26 weeks poststroke with robotic tasks and commonly used clinical measures. The volumes of acute lesions and WMH were measured on fluid‐attenuated inversion recovery images. Linear mixed models were used to investigate the role of acute lesions and WMH on parameters derived from the robotic tasks and clinical measures. Regression analysis determined the added value of acute lesion and WMH volumes along with measures of initial performance to predict outcomes at 6 months. Acute lesion volume has widespread effects on sensory, motor, and overall functional recovery poststroke. The impact of WMH was specific to cognitive impairments. Apart from the robotic position sense task, neither lesion volume nor WMH measure had significant ability to predict outcomes at 6 months over using initial impairment as measured by robotic assessments alone.ConclusionsWhile acute lesion volume and WMH may impact different impairments poststroke, their clinical utility in predicting outcomes at 6 months poststroke is limited.

show abstract

Section: Discussionmentioning

confidence: 99%

Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery

Hawe

Findlater

Kenzie

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…1). A wide spectrum of lesion sizes is possible in stroke, with for example, the intracerebral hemorrhage volume in acute stoke reported in [26] as ranging from 1 -101.5 ml (median 10.1 ml) and average infarction volume in acute stroke reported in [27] as 39.5 ± 84.9 ml.…”

Section: A Numerical Model and Data Generationmentioning

confidence: 99%

Bi-Frequency Symmetry Difference EIT—Feasibility and Limitations of Application to Stroke Diagnosis

McDermott

O’Halloran

Avery

et al. 2020

IEEE J. Biomed. Health Inform.

View full text Add to dashboard Cite

Bi-Frequency Symmetry Difference (BFSD)-EIT can detect, localize and identify unilateral perturbations in symmetric scenes. Here, we test the viability and robustness of BFSD-EIT in stroke diagnosis. Methods: A realistic 4-layer Finite Element Method (FEM) head model with and without bleed and clot lesions is developed. Performance is assessed with test parameters including: measurement noise, electrode placement errors, contact impedance errors, deviations in assumed tissue conductivity, deviations in assumed anatomy, and a frequency-dependent background. A final test is performed using ischemic patient data. Results are assessed using images and quantitative metrics. Results: BFSD-EIT may be feasible for stroke diagnosis if a signal-to-noise ratio (SNR) of ≥60dB is achievable. Sensitivity to errors in electrode positioning is seen with a tolerance of only ±5mm, but a tolerance of up to ±30mm is possible if symmetry is maintained between symmetrically opposite partner electrodes. The technique is robust to errors in contact impedance and assumed tissue conductivity up to at least ±50%. Asymmetric internal anatomy affects performance but may be tolerable for tissues with frequency-dependent conductivity. Errors in assumed external geometry marginally affect performance. A frequency-dependent background does not affect performance with carefully chosen frequency points or use of multiple frequency points across a band. The Global Left-Hand Side (LHS) & Right-Hand Side (RHS) Mean Intensity metric is particularly robust to errors. Conclusion: BFSD-EIT is a promising technique for stroke diagnosis, provided parameters are within the tolerated ranges. Significance: BFSD-EIT may prove an important step forward in imaging of static scenes such as stroke.

show abstract

“…The median NIHSS score at presentation was 20 (interquartile: [15][16][17][18][19][20][21][22][23]. The average onsetto-catheterization time was 4.9 6 2.5 h; and 25 (53%) had left M1 segment occlusion.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The nonparametric mapping tool included in the MRIcron software package (McCausland Center for Brain Imaging, University of South Carolina, Columbia, SC) was used for the voxel-based lesion symptom analysis. 18,19 Given the limited number of patients, all left hemispheric infarct lesions were flipped onto the right hemisphere. For dichotomized outcome variables, a binary group, binary image comparison was performed for each voxel (infarcted vs non-infarcted) using the successful recanalization or disability/death as the dependent variables.…”

Section: Voxel-based Image Analysismentioning

confidence: 99%

Cerebral regions preserved by successful endovascular recanalization of acute M1 segment occlusions: a voxel based analysis

Payabvash

Taleb

Qureshi

2017

BJR

Self Cite

View full text Add to dashboard Cite

Objective: To identify cerebral regions preserved by successful recanalization of the middle cerebral artery M1 segment and their association with early clinical outcome. Methods: 47 patients who underwent endovascular treatment for acute unilateral M1 segment occlusion were included. Successful recanalization was defined by a modified thrombolysis in cerebral infarction score of 2b/3. Final infarct volumes were segmented on follow-up MRI/ CT, 2-7 days post-symptom onset. The differences in topography of infarct lesions associated with successful vs unsuccessful recanalization were assessed using voxelbased analysis. Favourable outcome was defined by a modified Rankin Scale score #2 at discharge, and disability/death by score .2. Results: Successful recanalization of M1 segment occlusion was achieved in 26/47 (55%) patients, which was associated with higher rate of favourable outcome (54% vs 9%, p 5 0.002) and smaller final infarct volumes (34.3 6 43.7 vs 98.1 6 47.7 ml, p , 0.001). In voxel-based analysis, patients with successful recanalization had a lower rate of infarction in precentral gyrus and posterior insular ribbon compared with those without recanalization. Favourable outcome was achieved in 16 (34%) patients, who were younger (62.2 6 13.9 vs 70.9 6 13.9, p 5 0.048), had higher rate of successful recanalization (88% vs 39%, p 5 0.002) and had smaller infarct volumes (25.2 6 23.6 vs 82.2 6 57.1 ml, p , 0.001) compared with those with disability/death. In voxel-based analysis, infarction of the insula, precentral gyrus, middle centrum semiovale and corona radiata were associated with disability/death. Conclusion: Successful endovascular recanalization of acute M1 segment occlusion tends to preserve posterior insular ribbon and precentral gyrus from infarction; and infarction of these regions was associated with higher rates of disability/death. Advances in knowledge: The knowledge of the topographic location of potentially salvageable cerebral tissue can provide additional information for treatment triage and selection of patients with acute stroke for endovascular treatment based on the "areas at risk" rather than the "volume at risk". Also, such knowledge can help with preferential recanalization, where the neurointerventionalist may choose to preferentially recanalize certain branches supplying salvageable and eloquent cerebral regions in favour of timely reperfusion treatment.

show abstract

Acute Ischemic Stroke Infarct Topology: Association with Lesion Volume and Severity of Symptoms at Admission and Discharge

Abstract: Acute ischemic infarcts of the insulae, lentiform nuclei, and middle corona radiata tend to have larger volumes, more severe presentations, and worse outcomes, whereas brain stem and thalamic infarcts have greater symptom severity relative to smaller lesion volumes.

Cited by 40 publications

References 23 publications

Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery

Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery

Bi-Frequency Symmetry Difference EIT—Feasibility and Limitations of Application to Stroke Diagnosis

Cerebral regions preserved by successful endovascular recanalization of acute M1 segment occlusions: a voxel based analysis

Contact Info

Product

Resources

About