d-dimer and diffusion-weighted imaging pattern as two diagnostic indicators for cancer-related stroke

Abstract

The aim of this study was to evaluate the risk factors and elucidate the clinical characteristics of cancer-associated ischemic stroke to differentiate it from conventional ischemic stroke in China and East Asia. Between June 2012 and June 2016, a retrospective analysis was performed on 609 stroke patients with cancer. They were divided into 3 groups: cancer-stroke group (CSG, 203 cases), stroke group (SG, 203 cases), and cancer group (CG, 203 cases). The d-dimer levels and diffusion-weighted imaging lesion (DWI) pattern were compared to an age- and sex-matched control group. The most common cancer types were colorectal cancer (20.2%) and lung cancer (18.72%). The average d-dimer level in stroke patients and cancer patients were 0.34 and 1.50 mg/L, respectively. The descending levels of d-dimer from cancer types were lung cancer (2.06 mg/L), pancreas (1.74 mg/L), gastric (1.61 mg/L), among others. Univariate analysis of the CSG and the others shows there were significant differences in the prevalence of the levels of d-dimer and DWI pattern, hypertension, diabetes mellitus, and thrombus. CSG has a unique pathological characteristic including high plasma d-dimer levels and multiple vascular lesions. The results show that d-dimer and DWI can be used as diagnostic index in clinical practice.

The investigation on the hypercoagulability of hepatocellular carcinoma‐related cerebral infarction with thromboelastography

“…Besides having specific clinical features, cancer‐related CI also has specific pathogenesis that is worth exploring. Previous studies have found that in addition to the fact that some cancers can directly lead to CI (Budincevic et al., 2016 , Zheng et al., 2014 ), most cancer‐related CI is associated with hypercoagulability based on elevated serum D‐dimer level (Shen et al., 2020 , Rosenberg et al., 2020 , Gon et al., 2017 ). However, as has been found in other studies on the pathogenesis of cancer‐related CI, although patients are considered to be hypercoagulable, routine coagulation tests, such as thrombin time, PT, APTT, and INR, are normal in most patients with cancer‐related CI, suggesting that the tests are inadequate to assess blood clotting (Cheng et al., 2021 , Quan et al., 2020 , Qin et al., 2018 ).…”

Differential Diagnostic Value of Machine Learning–Based Models for Embolic Stroke

“…39 The DWI is commonly used to evaluate multipleterritory acute lesion patterns in patients with AF-related stroke or malignant disease. [20][21][22] DWI is particularly noted for its sensitivity (88%-100%) and specificity (86%-100%) in the early detection of small infarcts and thus has become a valuable tool for investigating ischemic stroke [20][21][22] and is commonly used in emergency department settings. 40 Cancer-related hypercoagulability is the underlying cause of CAT in 40% of affected patients.…”

“…The difference in DWI lesion patterns between AF-related stroke and CAT may facilitate differential diagnosis and early treatment. [20][21][22] Manual interpretation of DWI images imposes a high burden of human effort and monetary cost, and automatic interpretation via machine learning appears to be a promising solution. Machine learning uses algorithms to imitate the way that humans learn, and the performance of these algorithms improves upon exposure to more data over time.…”

Neurovascular Manifestations of Iron-Deficient Anemia: Narrative Review and Practical Reflections through a Teaching Case

“…Moreover, a multiple scattered lesion pattern, often reported in CAS, was associated to higher D-dimer values [ 17 , 18 , 19 ]. These findings support the link between infarction in multiple vascular territories and cancer-associated hypercoagulation as the underlying stroke mechanism.…”