Orbit image analysis machine learning software can be used for the histological quantification of acute ischemic stroke blood clots

Fitzgerald, Seán; Wang, Shunli; Dai, Daying; Murphree, Dennis H.; Pandit, Abhay; Douglas, Andrew; Rizvi, Asim; Kadirvel, Ramanathan; Gilvarry, Michael; McCarthy, Ray; Stritt, Manuel; Gounis, Matthew J.; Brinjikji, Waleed; Kallmes, David F.; Doyle, Karen M.

doi:10.1371/journal.pone.0225841

Cited by 62 publications

(53 citation statements)

References 27 publications

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“…6 Recent studies have shown large-scale heterogeneity in the composition of retrieved clots, in terms of the percentage of fibrin/platelet aggregates (FP), red blood cell (RBC), and white blood cells (WBC). 7 Differences in clot composition have been associated with stroke etiology and MT treatment outcomes. In several studies, FP-rich clots have been found to be cardioembolic in origin [8][9][10] and less responsive to revascularization attempts.…”

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Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin/Platelet-Rich Clots

Patel

Fricano

Waqas

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Clot perviousness in acute ischemic stroke is a potential CT imaging biomarker for mechanical thrombectomy efficacy. We investigated the association among perviousness, clot cellular composition, and first-pass effect. MATERIALS AND METHODS: In 40 mechanical thrombectomy-treated cases of acute ischemic stroke, we calculated perviousness as the difference in clot density on CT angiography and noncontrast CT. We assessed the proportion of fibrin/platelet aggregates, red blood cells, and white blood cells on clot histopathology. We tested for linear correlation between histologic components and perviousness, differences in components between "high" and "low" pervious clots defined by median perviousness, and differences in perviousness/composition between cases that did and did not achieve a first-pass effect. RESULTS: Perviousness significantly positively and negatively correlated with the percentage of fibrin/platelet aggregates (P ¼ .001) and the percentage of red blood cells (P ¼ .001), respectively. Higher pervious clots had significantly greater fibrin/platelet aggregate content (P ¼ .042). Cases that achieved a first-pass effect (n ¼ 14) had lower perviousness, though not significantly (P ¼ .055). The percentage of red blood cells was significantly higher (P ¼ .028) and the percentage of fibrin/platelet aggregates was significantly lower (P ¼ .016) in cases with a first-pass effect. There was no association between clot density on NCCT and clot composition or first-pass effect. Receiver operating characteristic analysis indicated that clot composition was the best predictor of firstpass effect (area under receiver operating characteristic curve: percentage of fibrin/platelet aggregates ¼ 0.731, percentage of red blood cells ¼ 0.706, perviousness ¼ 0.668). CONCLUSIONS: Clot perviousness on CT is associated with a higher percentage of fibrin/platelet aggregate content. Histologic data and, to a lesser degree, perviousness may have value in predicting first-pass outcome. Imaging metrics that more strongly reflect clot biology than perviousness may be needed to predict a first-pass effect with high accuracy. ABBREVIATIONS: AIS ¼ acute ischemic stroke; AUC ¼ area under the curve; CV ¼ coefficient of variation; FP ¼ fibrin/platelet aggregates; FPE ¼ first-pass effect; MMI ¼ Mattes mutual information; MT ¼ mechanical thrombectomy; mTICI ¼ modified TICI; RBC ¼ red blood cells; ROC ¼ receiver operating characteristic; WBC ¼ white blood cells C T is the most common imaging technique used to evaluate patients with acute ischemic stroke (AIS). Together, NCCT and CTA can provide valuable information about the occlusive clot, such as its location, length, and density. 1-3 One parameter derived from these images is clot permeability, or perviousness, which indicates the amount of contrast that diffuses through the clot tissue. 1,4 Several clinical studies have claimed that perviousness may be an important indicator of how easily occlusive clots can be treated by tPA or mechanical thrombectomy (MT). 1...

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Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin/Platelet-Rich Clots

Patel

Fricano

Waqas

et al. 2020

AJNR Am J Neuroradiol

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“…Slides were then scanned and quantified using Orbit Image Analysis software. Our quantification method has been published in detail [ 5 ]. In each prepared slide, the percentage of components including RBC and fibrin/platelet was calculated.…”

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confidence: 99%

Assessment of Blood Clot Composition by Spectral Optical Coherence Tomography: An In Vitro Study

et al. 2021

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Purpose: Optical coherence tomography (OCT) has the potential for <i>in vivo</i> clot composition characterization in difficult mechanical embolectomy cases. We performed an <i>in vitro</i> study to determine the OCT characteristics of red blood cells (RBCs) and fibrin rich clots.Materials and Methods: Analogues of 5 compositions of clots (5% to 95% RBCs from Group A to E) were created from human blood. The blood mixture was injected into the bifurcation of a 3D printed bifurcated silicone tube. The OPTISTM Integrated System (St. Jude Medical Inc.) was used to identify the magnitude of OCT signals from different compositions of clots. Martius Scarlett Blue trichrome (MSB) staining was performed to confirm the composition of RBCs and fibrin in each clot.Results: Group A and B showed less signal attenuation (less than 30%) from its surface to the inside, which indicated high penetration (low-back scattering). Group C indicated intermediate signal attenuation (60%) from its surface to inside the clots, in which signals were found even at the periphery of the clot. Group D and E were superficially signal rich with more signal attenuation (more than 80%) from its surface to the inside indicating low penetration (high-back scattering). Signal-free shadowing was shown in 3 clots in Group E. MSB staining indicated color change (from red in fibrin-rich clots to yellow in RBC-rich clots).Conclusion: Different compositions of clots can be assessed using OCT. Fibrin-rich clots have homogeneous signals with high penetration, while RBC-rich clots can be recognized as superficially signal rich with low penetration.

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“…Formalin fixed paraffin embedded analogues were sectioned into 3 μm slices and then a representative slide of each analogue was stained with MSB. Histological quantification was performed using Orbit Image Analysis software (https://www.orbit.bio/, licensed under GPLv3) [47]. The percentage of components including RBC and fibrin was determined (Table 1).…”

Section: Methodsmentioning

confidence: 99%

Characterizing thrombus with multiple red blood cell compositions by optical coherence tomography attenuation coefficient

Liu

Abbasi

Ding

et al. 2020

Journal of Biophotonics

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Embolectomy is one of the emergency procedures performed to remove emboli. Assessing the composition of human blood clots is an important diagnostic factor and could provide guidance for an appropriate treatment strategy for interventional physicians. Immunostaining has been used to identity compositions of clots as a gold‐standard procedure, but it is time‐consuming and cannot be performed in situ. Here, we proposed that the optical attenuation coefficient of optical coherence tomography (OCT) can be a reliable indicator as a new imaging modality to differentiate clot compositions. Fifteen human blood clots with multiple red blood cell (RBC) compositions from 21% to 95% were prepared using healthy human whole blood. A homogeneous gelatin phantom experiment and numerical simulation based on the Lambert–Beer's law were examined to verify the validity of the attenuation coefficient estimation. The results displayed that optical attenuation coefficients were strongly correlated with RBC compositions. We reported that attenuation coefficients could be a promising biomarker to guide the choice of an appropriate interventional device in a clinical setting and assist in characterizing blood clots.

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Orbit image analysis machine learning software can be used for the histological quantification of acute ischemic stroke blood clots

Cited by 62 publications

References 27 publications

Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin/Platelet-Rich Clots

Increased Perviousness on CT for Acute Ischemic Stroke is Associated with Fibrin/Platelet-Rich Clots

Assessment of Blood Clot Composition by Spectral Optical Coherence Tomography: An In Vitro Study

Characterizing thrombus with multiple red blood cell compositions by optical coherence tomography attenuation coefficient

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