Multimodal MRI-Based Triage for Acute Stroke Therapy: Challenges and Progress

Bang, Oh Young; Chung, Jong‐Won; Son, Jeong Pyo; Ryu, Wi‐Sun; Kim, Dong‐Eog; Seo, Woo‐Keun; Kim, Gyeong‐Moon; Kim, Yoon‐Chul

doi:10.3389/fneur.2018.00586

Cited by 19 publications

(18 citation statements)

References 74 publications

(86 reference statements)

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“…CT and MRI are mainly used in the diagnosis and treatment of acute cerebral infarction. However, the following advantages of MRI become necessary for examination (Bang et al, 2018). First, DWI combined with ADC is superior to any CT techniques for imaging the infarct core (Kohrmann and Schellinger, 2009).…”

Section: Discussionmentioning

confidence: 99%

Intracranial Atherosclerotic Disease-Related Acute Middle Cerebral Artery Occlusion Can Be Predicted by Diffusion-Weighted Imaging

et al. 2019

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Background: The differentiation of large vessel occlusion caused by intracranial atherosclerotic stenosis (ICAS) or intracranial embolism significantly impacts the course of treatment (i.e., intravenous thrombolysis versus mechanical thrombectomy) for acute cerebral infarction. Currently, there is no objective evidence to indicate ICAS-related middle cerebral artery M1 segment occlusion before treatment. In cases of ICAS, it is often observed that the infarct core caused by ICAS-related M1 segment middle cerebral artery occlusion (MCAO) is located in deeper parts of the brain (basal ganglia or semiovoid region).Objective: To evaluate whether the location of the infarct core, identified using diffusion-weighted imaging (DWI), can be used to differentiate ICAS from intracranial embolism.Methods: Thirty-one consecutive patients diagnosed with acute cerebral infarction caused by middle cerebral artery M1 segment occlusion were retrospectively included based on angiographic findings to distinguish ICAS from embolic occlusion. Patients were divided into two groups based on the location of the infarct core on DWI: in the deep part of the brain (basal ganglia or semiovoid region) or more superficially (i.e., cortex).Results: In 16 patients, the infarct core was mainly in the deep part of the brain on DWI [14 of 16 patients in the ICAS group and only 2 in the non-ICAS group (93.3 vs. 6.7%, respectively; P < 0.001)]. The diagnostic sensitivity of DWI for ICAS was 93.3%, with a specificity of 87.5%, a Positive predictive value (PPV) of 87.5%, and an Negative predictive value (NPV) of 93.3%, the accuracy was 88.5%.Conclusion: Intracranial atherosclerotic disease-related acute MCAO can be predicted using DWI.

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Section: Discussionmentioning

confidence: 99%

Intracranial Atherosclerotic Disease-Related Acute Middle Cerebral Artery Occlusion Can Be Predicted by Diffusion-Weighted Imaging

et al. 2019

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“…36,37 By overcoming these barriers, several institutions use MRI as their primary neuroimaging selection tool in AIS, which can be particularly useful in patients presenting late or with an unknown time of onset. 10,[38][39][40][41] Acute Therapy…”

Section: Stroke Scales and Neuroimagingmentioning

confidence: 99%

Acute Ischemic Stroke: Acute Management and Selection for Endovascular Therapy

Dhand

O’Connor

Hughes

et al. 2020

Semin intervent Radiol

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Stroke is a medical emergency and expeditious treatment is critical to reducing permanent disability or death. Acute management of patients suffering from acute ischemic stroke (AIS) requires early recognition of symptoms, rapid assessment and stabilization (hyperacute workup), and appropriate selection of patients for reperfusion with intravenous alteplase and/or mechanical thrombectomy. Established stroke protocols which involve both prehospital emergency medical services and in-hospital multidisciplinary stroke teams have been shown to be crucial to reducing the long term, devastating effects of stroke.

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“…Measurement of ischemic core and penumbra volumes in acute ischemic stroke provides clinicians with important clues for predicting clinical response after successful recanalization (SR) and selecting patients for treatments, such as intravenous thrombolysis and endovascular therapy (EVT) [1][2][3]. Diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) in magnetic resonance imaging (MRI) are neuroimaging modalities that can visualize the location and extent of ischemic stroke lesions with high sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Novel Estimation of Penumbra Zone Based on Infarct Growth Using Machine Learning Techniques in Acute Ischemic Stroke

Kim

Chung

et al. 2020

JCM

Self Cite

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While the penumbra zone is traditionally assessed based on perfusion–diffusion mismatch, it can be assessed based on machine learning (ML) prediction of infarct growth. The purpose of this work was to develop and validate an ML method for the prediction of infarct growth distribution and volume, in cases of successful (SR) and unsuccessful recanalization (UR). Pre-treatment perfusion-weighted, diffusion-weighted imaging (DWI) data, and final infarct lesions annotated from day-7 DWI from patients with middle cerebral artery occlusion were utilized to develop and validate two ML models for prediction of tissue fate. SR and UR models were developed from data in patients with modified treatment in cerebral infarction (mTICI) scores of 2b–3 and 0–2a, respectively. When compared to manual infarct annotation, ML-based infarct volume predictions resulted in an intraclass correlation coefficient (ICC) of 0.73 (95% CI = 0.31–0.91, p < 0.01) for UR, and an ICC of 0.87 (95% CI = 0.73–0.94, p < 0.001) for SR. Favorable outcomes for mismatch presence and absence in SR were 50% and 36%, respectively, while they were 61%, 56%, and 25%, respectively, for the low, intermediate, and high infarct growth groups. The presented method can offer novel and alternative insights into selecting patients for recanalization therapy and predicting functional outcome.

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Multimodal MRI-Based Triage for Acute Stroke Therapy: Challenges and Progress

Cited by 19 publications

References 74 publications

Intracranial Atherosclerotic Disease-Related Acute Middle Cerebral Artery Occlusion Can Be Predicted by Diffusion-Weighted Imaging

Intracranial Atherosclerotic Disease-Related Acute Middle Cerebral Artery Occlusion Can Be Predicted by Diffusion-Weighted Imaging

Acute Ischemic Stroke: Acute Management and Selection for Endovascular Therapy

Novel Estimation of Penumbra Zone Based on Infarct Growth Using Machine Learning Techniques in Acute Ischemic Stroke

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