Prediction of hemorrhagic transformation after experimental ischemic stroke using MRI-based algorithms

Bouts, Mark J. R. J.; Tiebosch, Ivo A C W; Rudrapatna, Umesh; Toorn, Annette van der; Wu, Ona; Dijkhuizen, Rick M.

doi:10.1177/0271678x16683692

Cited by 8 publications

(7 citation statements)

References 37 publications

(77 reference statements)

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“…upregulated cell adhesion molecules with MRI [28], or multimodal SPECT/CT [125], have shown promise in assessment of (neuro) inflammation associated with stroke and BBB injury. Furthermore, prediction of ischaemic tissue fate has been shown to improve by including multiple imaging-based measures of ischaemia–reperfusion injury [15, 86]. The ongoing advances in imaging technologies will continue to enable original translational studies in experimental and clinical settings that will increase our understanding of the critical role of the BBB in stroke pathology and recovery, ultimately contributing to improved patient care.…”

Section: Microscopic Imaging Of Bbb Dysfunctionmentioning

confidence: 99%

Functional morphology of the blood–brain barrier in health and disease

et al. 2018

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The adult quiescent blood-brain barrier (BBB), a structure organised by endothelial cells through interactions with pericytes, astrocytes, neurons and microglia in the neurovascular unit, is highly regulated but fragile at the same time. In the past decade, there has been considerable progress in understanding not only the molecular pathways involved in BBB development, but also BBB breakdown in neurological diseases. Specifically, the Wnt/β-catenin, retinoic acid and sonic hedgehog pathways moved into the focus of BBB research. Moreover, angiopoietin/Tie2 signalling that is linked to angiogenic processes has gained attention in the BBB field. Blood vessels play an essential role in initiation and progression of many diseases, including inflammation outside the central nervous system (CNS). Therefore, the potential influence of CNS blood vessels in neurological diseases associated with BBB alterations or neuroinflammation has become a major focus of current research to understand their contribution to pathogenesis. Moreover, the BBB remains a major obstacle to pharmaceutical intervention in the CNS. The complications may either be expressed by inadequate therapeutic delivery like in brain tumours, or by poor delivery of the drug across the BBB and ineffective bioavailability. In this review, we initially describe the cellular and molecular components that contribute to the steady state of the healthy BBB. We then discuss BBB alterations in ischaemic stroke, primary and metastatic brain tumour, chronic inflammation and Alzheimer's disease. Throughout the review, we highlight common mechanisms of BBB abnormalities among these diseases, in particular the contribution of neuroinflammation to BBB dysfunction and disease progression, and emphasise unique aspects of BBB alteration in certain diseases such as brain tumours. Moreover, this review highlights novel strategies to monitor BBB function by non-invasive imaging techniques focussing on ischaemic stroke, as well as novel ways to modulate BBB permeability and function to promote treatment of brain tumours, inflammation and Alzheimer's disease. In conclusion, a deep understanding of signals that maintain the healthy BBB and promote fluctuations in BBB permeability in disease states will be key to elucidate disease mechanisms and to identify potential targets for diagnostics and therapeutic modulation of the BBB.

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Section: Microscopic Imaging Of Bbb Dysfunctionmentioning

confidence: 99%

Functional morphology of the blood–brain barrier in health and disease

et al. 2018

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“…Recently, several studies have used ML to predict HT in AIS patients [ 26 , 27 , 28 , 29 ]. However, the diagnostic performance of multiparameter MRI using DL for the prediction of HT in AIS has not yet been systematically evaluated.…”

Section: Discussionmentioning

confidence: 99%

A deep learning‐based model for prediction of hemorrhagic transformation after stroke

et al. 2021

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Hemorrhagic transformation (HT) is one of the most serious complications after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) patients. The purpose of this study is to develop and validate deep‐learning (DL) models based on multiparametric magnetic resonance imaging (MRI) to automatically predict HT in AIS patients. Multiparametric MRI and clinical data of AIS patients with EVT from two centers (data set 1 for training and testing: n = 338; data set 2 for validating: n = 54) were used in the DL models. The acute infarction area of diffusion‐weighted imaging (DWI) and hypoperfusion of perfusion‐weighted imaging (PWI) was labeled manually. Two forms of data sets (volume of interest [VOI] data sets and slice data sets) were analyzed, respectively. The models based on single parameter and multiparameter models were developed and validated to predict HT in AIS patients after EVT. Performance was evaluated by area under the receiver‐operating characteristic curve (AUC), accuracy (ACC), sensitivity, specificity, negative predictive value, and positive predictive value. The results showed that the performance of single parameter model based on MTT (VOI data set: AUC = 0.933, ACC = 0.843; slice data set: AUC = 0.945, ACC = 0.833) and TTP (VOI data set: AUC = 0.916, ACC = 0.873; slice data set: AUC = 0.889, ACC = 0.818) were better than the other single parameter model. The multiparameter model based on DWI & MTT & TTP & Clinical (DMTC) had the best performance for predicting HT (VOI data set: AUC = 0.948, ACC = 0.892; slice data set: AUC = 0.932, ACC = 0.873). The DMTC model in the external validation set achieved similar performance with the testing set (VOI data set: AUC = 0.939, ACC = 0.884; slice data set: AUC = 0.927, ACC = 0.871) (p > 0.05). The proposed clinical, DWI, and PWI multiparameter DL model has great potential for assisting the periprocedural management in the early prediction HT of the AIS patients with EVT.

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“…The latest guideline of acute stroke treatment still recommends tPA as the first‐line of effective thrombolytic treatment to achieve early reperfusion of the ischemic brain . However, the current therapeutic window of 4.5 hours after the onset of stroke remarkably limits the clinical use of tPA thrombolysis . BBB disruption is a fundamental pathological feature of intracerebral HT induced by tPA thrombolysis .…”

Section: Discussionmentioning

confidence: 99%

“…2,3,30 However, the current therapeutic window of 4.5 hours after the onset of stroke remarkably limits the clinical use of tPA thrombolysis. [31][32][33] BBB disruption is a fundamental pathological feature of intracerebral HT induced by tPA thrombolysis. 34,35 Loss of BBB integrity results in increased vascular permeability and is associated with reduced cerebral blood flow and impaired hemodynamic responses.…”

Section: Discussionmentioning

confidence: 99%

Rosiglitazone ameliorates tissue plasminogen activator‐induced brain hemorrhage after stroke

Zhu

et al. 2019

CNS Neurosci Ther

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Objective Delayed thrombolytic therapy with recombinant tissue plasminogen activator (tPA) may exacerbate blood‐brain barrier (BBB) breakdown after ischemic stroke and lead to catastrophic hemorrhagic transformation (HT). Rosiglitazone(RSG), a widely used antidiabetic drug that activates peroxisome proliferator‐activated receptor‐γ (PPAR‐γ), has been shown to protect against cerebral ischemia through promoting poststroke microglial polarization toward the beneficial anti‐inflammatory phenotype. However, whether RSG can alleviate HT after delayed tPA treatment remains unknown. In this study, we sort to examine the role of RSG on tPA‐induced HT after stroke. Methods and results We used the murine suture middle cerebral artery occlusion (MCAO) models of stroke followed by delayed administration of tPA (10 mg/kg, 2 hours after suture occlusion) to investigate the therapeutic potential of RSG against tPA‐induced HT. When RSG(6 mg/kg) was intraperitoneally administered 1 hour before MCAO in tPA‐treated MCAO mice, HT in the ischemic territory was significantly attenuated 1 day after stroke. In the tPA‐treated MCAO mice, we found RSG significantly mitigated BBB disruption and hemorrhage development compared to tPA‐alone‐treated stroke mice. Using flow cytometry and immunostaining, we confirmed that the expression of CD206 was significantly upregulated while the expression of iNOS was down‐regulated in microglia of the RSG‐treated mice. We further found that the expression of Arg‐1 was also upregulated in those tPA and RSG‐treated stroke mice and the protection against tPA‐induced HT and BBB disruption in these mice were abolished in the presence of PPAR‐γ antagonist GW9662 (4 mg/kg, 1 hour before dMCAO through intraperitoneal injection). Conclusions RSG treatment protects against BBB damage and ameliorates HT in delayed tPA‐treated stroke mice by activating PPAR‐γ and favoring microglial polarization toward anti‐inflammatory phenotype.

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Prediction of hemorrhagic transformation after experimental ischemic stroke using MRI-based algorithms

Cited by 8 publications

References 37 publications

Functional morphology of the blood–brain barrier in health and disease

Functional morphology of the blood–brain barrier in health and disease

A deep learning‐based model for prediction of hemorrhagic transformation after stroke

Rosiglitazone ameliorates tissue plasminogen activator‐induced brain hemorrhage after stroke

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