Perfusion-Weighted Imaging–Derived Collateral Flow Index is a Predictor of MCA M1 Recanalization after IV Thrombolysis

Nicoli, F.; Micheaux, Pierre Lafaye de; Girard, Nadine

doi:10.3174/ajnr.a3174

Cited by 34 publications

(36 citation statements)

References 26 publications

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“…Biases in patient selection for MRI were limited, since patients received protocolised serial MRI. Additionally, lesion volume and final infarct size (corresponding lesion volume on follow-up FLAIR imaging) were volumetrically characterised by blinded reviewers using standardised software 23. This study is also the first to look at risk factors for early MRI ischaemia.…”

Section: Discussionmentioning

confidence: 99%

“…Shine-through DWI positive, FLAIR bright lesions that were not dark on ADC were excluded. The volumes of these selected ADC dark lesions were measured by two investigators (WA, VZ), blinded to the patient's clinical condition and outcome using Neuroscape software (Olea, La Ciotat, France) 23. Lesions were considered to be distinct if they were separated by 5 mm.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Acute ischaemia after subarachnoid haemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study

Frontera

Ahmed

Zach

et al. 2014

J Neurol Neurosurg Psychiatry

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Acute ischaemia after subarachnoid haemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study

Frontera

Ahmed

Zach

et al. 2014

J Neurol Neurosurg Psychiatry

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show abstract

“…It is also important to note that although there is general agreement that the size of the core infarct is an important factor in patient outcomes, it has been suggested that there may be better predictors of outcomes such as certain perfusion measurements. [26][27][28][29] Currently, intravenous thrombolytic therapy is administered in only 1% to 7% of cases (high performing centers approach 15%-20%), with most patients ineligible because they present outside the 3-to 4.5-hour treatment window. [30][31][32][33] Proximal anterior circulation artery occlusions may respond well to intra-arterial thrombolysis and mechanical thrombectomy; however, these treatments are also typically restricted by adherence to time windows of 6 and 8 hours, respectively, from the time of stroke onset.…”

Section: Strokementioning

confidence: 99%

Time and Diffusion Lesion Size in Major Anterior Circulation Ischemic Strokes

Hakimelahi

Vachha

Copen

et al. 2014

Stroke

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Background and Purpose-Major anterior circulation ischemic strokes caused by occlusion of the distal internal carotid artery or proximal middle cerebral artery or both account for about one third of ischemic strokes with mostly poor outcomes. These strokes are treatable by intravenous tissue-type plasminogen activator and endovascular methods. However, dynamics of infarct growth in these strokes are poorly documented. The purpose was to help understand infarct growth dynamics by measuring acute infarct size with diffusion-weighted imaging (DWI) at known times after stroke onset in patients with documented internal carotid artery/middle cerebral artery occlusions. Methods-Retrospectively, we included 47 consecutive patients with documented internal carotid artery/middle cerebral artery occlusions who underwent DWI within 30 hours of stroke onset. Prospectively, 139 patients were identified using the same inclusion criteria. DWI lesion volumes were measured and correlated to time since stroke onset. Perfusion data were reviewed in those who underwent perfusion imaging. Results-Acute infarct volumes ranged from 0.41 to 318.3 mL. Infarct size and time did not correlate (R 2 =0.001). The majority of patients had DWI lesions that were <25% the territory at risk (<70 mL) whether they were imaged <8 or >8 hours after stroke onset. DWI lesions corresponded to areas of greatly reduced perfusion. Conclusions-Poor

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“…A recent study suggested that a normalized index derived from Tmax maps calculated from MR-PWI data might be a predictor of full MCA-M1 recanalization in patients treated with IV thrombolysis. 24 Nevertheless, PET studies have shown that there are differences regarding the stages of compensation throughout the whole area that is generally defined as ischemic penumbra by the PWI-DWI mismatch criterion. 25 Until now, these regional differences are not taken into account in most studies when analyzing the penumbra and only minor attention has been devoted to the distribution of perfusion impairment rather than to the mere severity measured by absolute or relative values in perfusion parameter maps.…”

Section: Discussionmentioning

confidence: 99%

Spatial Distribution of Perfusion Abnormality in Acute MCA Occlusion is Associated with Likelihood of Later Recanalization

Siemonsen

Forkert

Hansen

et al. 2014

J Cereb Blood Flow Metab

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The aim of this study is to investigate whether different spatial perfusion-deficit patterns, which indicate differing compensatory mechanisms, can be recognized and used to predict recanalization success of intravenous fibrinolytic therapy in acute stroke patients. Twenty-seven acute stroke data sets acquired within 6 hours from symptom onset including diffusion-(DWI) and perfusion-weighted magnetic resonance (MR) imaging (PWI) were analyzed and dichotomized regarding recanalization outcome using time-of-flight follow-up data sets. The DWI data sets were used for calculation of apparent diffusion coefficient (ADC) maps and subsequent infarct core segmentation. A patient-individual three-dimensional (3D) shell model was generated based on the segmentation and used for spatial analysis of the ADC as well as cerebral blood volume (CBV), cerebral blood flow, time to peak (TTP), and mean transit time (MTT) parameters derived from PWI. Skewness, kurtosis, area under the curve, and slope were calculated for each parameter curve and used for classification (recanalized/nonrecanalized) using a LogitBoost Alternating Decision Tree (LAD Tree). The LAD tree optimization revealed that only ADC skewness, CBV kurtosis, and MTT kurtosis are required for best possible prediction of recanalization success with a precision of 85%. Our results suggest that the propensity for macrovascular recanalization after intravenous fibrinolytic therapy depends not only on clot properties but also on distal microvascular bed perfusion. The 3D approach for characterization of perfusion parameters seems promising for further research.

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Perfusion-Weighted Imaging–Derived Collateral Flow Index is a Predictor of MCA M1 Recanalization after IV Thrombolysis

Cited by 34 publications

References 26 publications

Acute ischaemia after subarachnoid haemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study

Acute ischaemia after subarachnoid haemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study

Time and Diffusion Lesion Size in Major Anterior Circulation Ischemic Strokes

Spatial Distribution of Perfusion Abnormality in Acute MCA Occlusion is Associated with Likelihood of Later Recanalization

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