Cerebral blood volume index may be a predictor of independent outcome of thrombectomy in stroke patients with low ASPECTS

Li, Bing-Hu; Wang, Jianhong; Yang, Shu; Wang, Duo-Zi; Zhang, Qi; Cheng, Xu-Dong; Yu, Neng-Wei; Guo, Feifei

doi:10.1016/j.jocn.2022.07.006

Cited by 12 publications

(8 citation statements)

References 14 publications

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“…7 Prognostic perfusion imaging parameters included relative cerebral blood flow (rCBF) <30%, time to maximum (Tmax) volumes, the hypoperfusion intensity ratio, the mismatch profile, and the cerebral blood volume (CBV) index. [8][9][10][11][12] In AIS patients with anterior circulation occlusions, it has been shown that the presence of collaterals is another important predictor of radiologic and clinical outcome. 13 These findings indicate that imaging parameters may be excellent prognostic indicators for patients with AIS.…”

Section: Al Found That Althoughmentioning

confidence: 99%

“…Additionally, it has been shown that perfusion imaging enhances prognostication in AIS 7 . Prognostic perfusion imaging parameters included relative cerebral blood flow (rCBF) <30%, time to maximum (Tmax) volumes, the hypoperfusion intensity ratio, the mismatch profile, and the cerebral blood volume (CBV) index 8–12 . In AIS patients with anterior circulation occlusions, it has been shown that the presence of collaterals is another important predictor of radiologic and clinical outcome 13 .…”

Section: Introductionmentioning

confidence: 99%

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Utilizing imaging parameters for functional outcome prediction in acute ischemic stroke: A machine learning study

Ozkara,

Karabacak,

Hoseinyazdi

et al. 2024

Journal of Neuroimaging

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Background and PurposeWe aimed to predict the functional outcome of acute ischemic stroke patients with anterior circulation large vessel occlusions (LVOs), irrespective of how they were treated or the severity of the stroke at admission, by only using imaging parameters in machine learning models.MethodsConsecutive adult patients with anterior circulation LVOs who were scanned with CT angiography (CTA) and CT perfusion were queried in this single‐center, retrospective study. The favorable outcome was defined as a modified Rankin score (mRS) of 0‐2 at 90 days. Predictor variables included only imaging parameters. CatBoost, XGBoost, and Random Forest were employed. Algorithms were evaluated using the area under the receiver operating characteristic curve (AUROC), the area under the precision‐recall curve (AUPRC), accuracy, Brier score, recall, and precision. SHapley Additive exPlanations were implemented.ResultsA total of 180 patients (102 female) were included, with a median age of 69.5. Ninety‐two patients had an mRS between 0 and 2. The best algorithm in terms of AUROC was XGBoost (0.91). Furthermore, the XGBoost model exhibited a precision of 0.72, a recall of 0.81, an AUPRC of 0.83, an accuracy of 0.78, and a Brier score of 0.17. Multiphase CTA collateral score was the most significant feature in predicting the outcome.ConclusionsUsing only imaging parameters, our model had an AUROC of 0.91 which was superior to most previous studies, indicating that imaging parameters may be as accurate as conventional predictors. The multiphase CTA collateral score was the most predictive variable, highlighting the importance of collaterals.

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Section: Al Found That Althoughmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Utilizing imaging parameters for functional outcome prediction in acute ischemic stroke: A machine learning study

Ozkara,

Karabacak,

Hoseinyazdi

et al. 2024

Journal of Neuroimaging

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“…The CBV can be estimated via pretreatment CT perfusion (CTP) imaging [ 1 , 9 , 10 , 11 ]. Multiple different definitions have been used to quantify the CBV with varying success [ 6 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…The majority of automated CTP software platforms have quantified the CBV relative to the non-affected or normal cerebral hemisphere [ 12 , 13 , 15 , 16 , 18 , 21 ]. The RAPID (IschemaView, Menlo Park, CA, USA) software platform quantifies the CBV using different thresholds of rCBV < 34%, rCBV < 38%, and rCBV < 42% in the region with a delayed contrast transit of Tmax > 6 s. These values are derived by dividing the average of all CBV values from Tmax > 6 s regions within the ischemic hemisphere by the average of all CBV values from unaffected brain tissue with a Tmax ≤ 4 s [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

The Relative Cerebral Blood Volume (rCBV) < 42% Is Independently Associated with Collateral Status in Anterior Circulation Large Vessel Occlusion

Lakhani,

Balar,

Koneru

et al. 2024

JCM

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Background: The pretreatment CT perfusion (CTP) marker the relative cerebral blood volume (rCBV) < 42% lesion volume has recently been shown to predict 90-day functional outcomes; however, studies assessing correlations of the rCBV < 42% lesion volume with other outcomes remain sparse. Here, we aim to assess the relationship between the rCBV < 42% lesion volume and the reference standard digital subtraction angiography (DSA)-derived American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN) collateral score, hereby referred as the DSA CS. Methods: In this retrospective evaluation of our prospectively collected database, we included acute stroke patients triaged by multimodal CT imaging, including CT angiography and perfusion imaging, with confirmed anterior circulation large vessel occlusion between 1 September 2017 and 1 October 2023. Group differences were assessed using the Student’s t test, Mann–Whitney U test and Chi-Square test. Spearman’s rank correlation and logistic regression analyses were used to assess associations between rCBV < 42% and DSA CS. Results: In total, 222 patients (median age: 69 years, 56.3% female) met our inclusion criteria. In the multivariable logistic regression analysis, taking into account age, sex, race, hypertension, hyperlipidemia, diabetes, atrial fibrillation, prior stroke or transient ischemic attack, the admission National Institute of Health stroke scale, the premorbid modified Rankin score, the Alberta stroke program early CT score (ASPECTS), and segment occlusion, the rCBV < 42% lesion volume (adjusted OR: 0.98, p < 0.05) was independently associated with the DSA CS. Conclusion: The rCBV < 42% lesion volume is independently associated with the DSA CS.

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“…Mechanical thrombectomy (MT) has become an effective standard treatment for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). 1,2 However, reperfusion injury is the main complication of concern after the procedure, which may cause intracranial hemorrhage (ICH) and is associated with severe neurological deterioration. 3 Either hemorrhagic or transient contrast extravasation is frequently observed on noncontrast brain computer tomography (CT) after intra-arterial intervention.…”

Section: Introductionmentioning

confidence: 99%

Immediate CT Change after Thrombectomy Predicting Symptomatic Hemorrhagic Transformation

Yang

Huang

et al. 2023

Journal of the Chinese Medical Association

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Background: The prognostic value of contrast accumulation from noncontrast brain computed tomography (CT) conducted immediately after intra mechanical thrombectomy (MT) in patients with acute ischemic stroke to predict symptomatic hemorrhage was studied. Methods: Patients with acute ischemic stroke treated using MT between February 2015 and April 2019 were included. Contrast accumulation was defined as a high attenuation area observed on noncontrast brain CT conducted immediately after thrombectomy treatment, and the patients were categorized into (1) symptomatic hemorrhage, (2) asymptomatic hemorrhage, and (3) no hemorrhage according to the presence of hemorrhagic transformation and their clinical conditions. The pattern and extent of contrast accumulation were compared between patients with and without symptomatic hemorrhage. The maximal Hounsfield unit (HU) of cortical involvement in contrast accumulation was evaluated by calculating the sensitivity, specificity, odds ratio, and area under the receiver operating characteristic (ROC) curve. Results: In total, 101 patients with anterior circulation acute ischemic stroke were treated by endovascular intervention. Nine patients developed symptomatic hemorrhage and 17 developed asymptomatic hemorrhage. Contrast accumulation was associated with all types of hemorrhagic transformation (p < 0.01), and cortical involvement pattern was more frequently associated with symptomatic hemorrhage (p < 0.01). The area under the ROC curve was 0.887. The sensitivity and specificity for HU > 100 in cortical involvement predicting symptomatic hemorrhage after endovascular treatment were 77.8% and 95.7%, respectively, with an odds ratio of 77.0 (95% CI, 11.94-496.50; p < 0.01). Conclusion: Cortical involvement of contrast accumulation with a maximal HU > 100 predicts symptomatic hemorrhage after endovascular reperfusion treatment.

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Cerebral blood volume index may be a predictor of independent outcome of thrombectomy in stroke patients with low ASPECTS

Cited by 12 publications

References 14 publications

Utilizing imaging parameters for functional outcome prediction in acute ischemic stroke: A machine learning study

Utilizing imaging parameters for functional outcome prediction in acute ischemic stroke: A machine learning study

The Relative Cerebral Blood Volume (rCBV) < 42% Is Independently Associated with Collateral Status in Anterior Circulation Large Vessel Occlusion

Immediate CT Change after Thrombectomy Predicting Symptomatic Hemorrhagic Transformation

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