DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis

Liu, Dezhi; Scalzo, Fabien; Starkman, Sidney; Rao, Neal; Hinman, Jason D; Kim, Doojin; Ali, Latisha K; Saver, Jeffrey L.; Noorian, Ali Reza; Ng, Kwan; Sheth, Sunil A; Yoo, Bryan; Liu, Xinfeng; Liebeskind, David S

doi:10.1159/000441153

Cited by 13 publications

(11 citation statements)

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“…Since the deep MCA territory is crossed by the corticospinal tract [ 22 ] and is prone to damage by poor collateral flow [ 23 ], this area may be susceptible to motor deficits, regardless of rt-PA thrombolysis. In some reports, patients with deep white matter or basal ganglia infarction have suffered from bad outcomes after thrombolysis or endovascular therapy [ 7 , 22 , 23 ]. Thus, even small lesions in this area could be critical to the outcome of mild ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) is superior to computed tomography (CT) for early detection of hyperacute and small ischemic lesions. Pretreatment DWI lesion patterns may be helpful in predicting clinical outcome in patients with acute ischemic stroke [ 6 , 7 ]. Steno-occlusive lesions of the cerebral artery are associated with unfavorable outcomes in patients with minor strokes [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke

et al. 2018

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BackgroundA significant proportion of patients with mild ischemic stroke become disabled despite receiving intravenous thrombolytic therapy. The purpose of this study was to assess the clinical and radiological factors associated with unfavorable outcomes in patients with minor ischemic stroke that received intravenous recombinant tissue plasminogen activator (rt-PA) therapy.MethodsWe identified anterior circulation stroke patients with initial National Institutes of Health Stroke Scale (NIHSS) scores ≤5 who received intravenous thrombolysis within 4.5 h of stroke onset and had pretreatment magnetic resonance (MR)/MR angiography using our prospective stroke database. We analyzed baseline characteristics, infarction patterns on diffusion-weighted imaging (DWI), and steno-occlusive lesions on MR angiography. Unfavorable outcome was defined as a modified Rankin Scale (mRS) score ≥ 2 at 90 days. Logistic regression was used to determine independent predictors of unfavorable outcomes.ResultsAmong 121 patients (85 men; mean age, 63.4 ± 11.3 years) included in this study, 46 (38%) had unfavorable outcomes at 90 days and DWI lesion patterns showing infarction in the deep middle cerebral artery (MCA) territory involving the perforating artery area was observed in 47 (38.8%) patients. On multivariable analysis, unfavorable outcomes at 90 days were associated with diabetes [odds ratio (OR), 3.41; 95% confidence interval (CI), 1.06–10.9; P = 0.039), NIHSS score on admission (OR, 2.11; 95% CI, 1.35–3.30; P = 0.001), and infarction in the deep MCA territory on DWI (OR, 4.19; 95% CI, 1.63–10.8; P = 0.003). Lesions in the deep MCA territory was independently associated with early neurological deterioration (P = 0.032). The patients without deep MCA territory infarction had a higher prevalence of cardiac embolism (P = 0.009).ConclusionsHigher NIHSS scores, diabetes, and deep MCA territory infarction may be useful for predicting unfavorable outcomes in patients with minor stroke treated with intravenous rt-PA therapy.Electronic supplementary materialThe online version of this article (10.1186/s12883-018-1033-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke

et al. 2018

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“…However, to date, lesion volumes have shown only moderate correlation with long-term clinical outcome measures 2 . Recent studies 5,7,28,29 demonstrated that models taking into account accurate lesion topography (in addition to lesion volume) improve stroke prediction outcome and identify patients likely to benefit most aggressive reperfusion intervention and personalized rehabilitation therapies. Indeed, when deciding whether to perform reperfusion therapy, it is important to confirm whether the lenticulostriate arteries are involved in the ischemia 16,30,31 .…”

Section: Discussionmentioning

confidence: 99%

Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping

Grange

Garnier

et al. 2020

Sci Rep

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Distinction between deep and superficial middle cerebral artery (MCA) territories and their junctional vascular area (the internal borderzone or IBZ) constitutes a predictor of stroke patient outcome. However, the IBZ boundaries are not well-defined because of substantial anatomical variance. Here, we built a statistical estimate of the IBZ and tested its vulnerability to ischemia using an independent sample. First, we used delineated lesions of 122 patients suffering of chronic ischemic stroke grouped in deep, superficial and territorial topographies and statistical comparisons to generate a probabilistic estimate of the IBZ. The IBZ extended from the insular cortex to the internal capsule and the anterior part of the caudate nucleus head. The IBZ showed the highest lesion frequencies (~30% on average across IBZ voxels) in our chronic stroke patients but also in an independent sample of 87 acute patients. Additionally, the most important apparent diffusion coefficient reductions (−6%), which reflect stroke severity, were situated within our IBZ estimate. The IBZ was most severely injured in case of a territorial infarction. Then, our results are in favour of an increased IBZ vulnerability to ischemia. Moreover, our probabilistic estimates of deep, superficial and IBZ regions can help the everyday spatial classification of lesions.Identifying factors that can predict the clinical outcome of the patients is a major concern for acute stroke management. This is of particular importance in the context of reperfusion therapy. Diffusion weighted imaging (DWI) has driven considerable interest as a biomarker of patient functional outcome. Indeed, larger DWI lesion volumes are associated with worse outcome 1,2 . Besides ischemic volume and diffusion-perfusion mismatching, early neurological predictors are limited. Nevertheless, the spatial arrangement of injuries identified on DWI can be a surrogate as it is correlated with the pathogenic mechanisms of stroke and patient outcome 3,4 ; after intravenous thrombolysis 5 or not 4,6 . Indeed, infarct location within the middle cerebral artery (MCA) territory reflects stroke severity 7,8 and may be more influential than lesion volume 9 . Consequently, the lesion topography can motivate diverse therapeutic strategies either at the acute 5 , sub-acute or chronic stages of the illness. Moreover, working with spatial lesion pattern has several practical advantages in the emergency setup compared to volume analysis which is more complex and time consuming. MCA infarctions are commonly categorized according to the territories of the deep and the superficial perforating arteries. Additionally, it has been suggested to distinguish stroke situated in the borderzone between these two vascular fields, that is the Internal Borderzone or IBZ, from other infarct types 10,11 . Pure IBZ watershed infarcts are relatively rare 3 and underlying physiopathological mechanisms appear to be different from other strokes 6,12 . Because of their distal situation, IBZ infarcts are likely to reflect an ar...

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“…Index lesions are the most crucial factors, as they directly determine treatment and prognosis. Many retrospective studies require MRI information extracted from index lesions to analyze the association between lesion characteristics and clinical outcomes [19, 20].…”

Section: Discussionmentioning

confidence: 99%

The implementation of natural language processing to extract index lesions from breast magnetic resonance imaging reports

Liu

Han

et al. 2019

BMC Med Inform Decis Mak

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BackgroundThere are often multiple lesions in breast magnetic resonance imaging (MRI) reports and radiologists usually focus on describing the index lesion that is most crucial to clinicians in determining the management and prognosis of patients. Natural language processing (NLP) has been used for information extraction from mammography reports. However, few studies have investigated NLP in breast MRI data based on free-form text. The objective of the current study was to assess the validity of our NLP program to accurately extract index lesions and their corresponding imaging features from free-form text of breast MRI reports.MethodsThis cross-sectional study examined 1633 free-form text reports of breast MRIs from 2014 to 2017. First, the NLP system was used to extract 9 features from all the lesions in the reports according to the Breast Imaging Reporting and Data System (BI-RADS) descriptors. Second, the index lesion was defined as the lesion with the largest number of imaging features. Third, we extracted the values of each imaging feature and the BI-RADS category from each index lesion. To evaluate the accuracy of our system, 478 reports were manually reviewed by two individuals. The time taken to extract data by NLP was compared with that by reviewers.ResultsThe NLP system extracted 889 lesions from 478 reports. The mean number of imaging features per lesion was 6.5 ± 2.1 (range: 3–9; 95% CI: 6.362–6.638). The mean number of imaging features per index lesion was 8.0 ± 1.1 (range: 5–9; 95% CI: 7.901–8.099). The NLP system demonstrated a recall of 100.0% and a precision of 99.6% for correct identification of the index lesion. The recall and precision of NLP to correctly extract the value of imaging features from the index lesions were 91.0 and 92.6%, respectively. The recall and precision for the correct identification of the BI-RADS categories were 96.6 and 94.8%, respectively. NLP generated the total results in less than 1 s, whereas the manual reviewers averaged 4.47 min and 4.56 min per report.ConclusionsOur NLP method successfully extracted the index lesion and its corresponding information from free-form text.

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DWI Lesion Patterns Predict Outcome in Stroke Patients with Thrombolysis

Cited by 13 publications

References 30 publications

Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke

Clinical and radiological factors associated with unfavorable outcome after intravenous thrombolysis in patients with mild ischemic stroke

Boundary and vulnerability estimation of the internal borderzone using ischemic stroke lesion mapping

The implementation of natural language processing to extract index lesions from breast magnetic resonance imaging reports

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