Computer-Assisted Volumetric Measurement of Core Infarct Volume in Pediatric Patients: Feasibility for Clinical Use and Development of Quantitative Metrics for Outcome Prediction

Abstract

BACKGROUND AND PURPOSE:Infarct volume may predict clinical outcome in acute stroke, but manual segmentation techniques limit its routine use. We hypothesized that computer-assisted volumetric analysis to quantify acute infarct volume will show no difference compared with manual segmentation but will show increased speed of performance and will correlate with outcome.

Maternal Undernutrition Modulates Neonatal Rat Cerebrovascular Structure, Function, and Vulnerability to Mild Hypoxic-Ischemic Injury via Corticosteroid-Dependent and -Independent Mechanisms

“…In addition to its focus on the corticosteroid-dependent and -independent effects of MUN on baseline cerebrovascular characteristics and neurobehavior, our experimental design also examined how MUN and corticosteroids influenced cerebral responses to hypoxic ischemia, a common cardiovascular stressor in neonates. In particular, our model evaluated mild hypoxic-ischemic injury [35], which is more common clinically than the widespread hemispheric injury produced by other neonatal models of more severe hypoxicischemic injury [41]. Consistent with other studies of neonatal stress [75,76], our model of mild hypoxic ischemia increased corticosterone levels 2 h after HI injury (Figure 2E,F), but this effect dissipated by 24 h. MET treatment ablated the increase in corticosterone values at 2 h post-hypoxia, but had no effect at 24 h, suggesting that MUN programmed a robust but transient, MET-sensitive increase in corticosterone following mild HI injury.…”

“…As a short-term cardiovascular stress, our model also included a mild hypoxic-ischemic challenge induced by unilateral carotid ligation at P9/P10 followed 24 h later by 90 min of exposure to 8% O 2 and harvest at P11/P12. The mild hypoxic-ischemic (HI) insult used in our model generally produced no large infarcts, which rendered it optimally relevant to the mild patterns of injury characteristic of the majority of HI brain injuries in human neonates [41]. The endpoints measured included circulating levels of corticosterone to track involvement of the HPA axis, changes in the smooth muscle phenotype of cerebral arteries as indicated by confocal microscopy, and the contractility of neonatal cerebral arteries as revealed by myography.…”

Harnessing Neuroimaging Capability in Pediatric Stroke: Proceedings of the Stroke Imaging Laboratory for Children Workshop

“…Dr. R. Filippi presented a novel computer assisted volumetric method, which markedly simplifies automated volume measurement of stroke lesions, and has been developed and validated with clinical outcome severity in pediatric acute infarcts. 69 Additional improvements in automated stroke lesion detection and measurement will be realized with better methods of registration and segmentation of brain lesions.…”

Automated Estimation of Acute Infarct Volume from Noncontrast Head CT Using Image Intensity Inhomogeneity Correction

“…It is also used to estimate the size and age of the stroke, as IV-tPA or intra-arterial thrombectomy may be contraindicated for larger [1–5] and more mature strokes [6–8]. Infarct size also correlates with long-term functional outcome [9, 10]. Very early stroke can be difficult to discern on NCCT, and a number of criteria have been published regarding early NCCT signs of acute stroke [11–13], with studies showing limited consensus among experienced readers [14, 15].…”