Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Samaniego, Edgar A.; Boltze, Johannes; Lyden, Patrick D.; Hill, Michael D.; Campbell, Bruce C.V.; Silva, Gisele Sampaio; Sheth, Kevin N.; Fisher, Marc; Hillis, Argye E.; Nguyen, Thanh N.; Carone, Davide; Favilla, Christopher G.; Deljkich, Emir; Albers, Gregory W.; Heit, Jeremy J.; Lansberg, Maarten G.; Aksoy, Didem; Broderick, Joe; Castonguay, Alicia C.; Ghosh, Supurna; Grotta, James C.; Harston, George; Houser, Gary R.; Kuchenbecker, Kristopher; Latour, Lawrence L.; Liebeskind, David S.; Kylan Lynch, John; Maier, Carolina; Mistry, Eva; Mocco, J.; Nogueira, Raul G.; Saver, Jeffrey L.; van Vlimmeren, Marijke; Wakhloo, Ajay K.; Wechsler, Lawrence

doi:10.1161/strokeaha.123.044985

Cited by 4 publications

(1 citation statement)

References 104 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…33 Recently, the 12th Stroke Treatment Academy Industry Roundtable endorsed the use of pretreatment multimodal imaging, including CTP, as a supportive tool in stroke decision-making. 34 Hence, although not universally used, the continued use of advanced imaging in stroke diagnosis at several centers underscores the con-tinued relevance of analyses similar to ours aimed at re-examining present CTP-based thresholds for applicability in various clinical contexts.…”

Section: Limitationsmentioning

confidence: 73%

Redefining CT perfusion‐based ischemic core estimates for the ghost core in early time window stroke

Koneru,

Hoseinyazdi,

Lakhani

et al. 2023

Journal of Neuroimaging

Self Cite

View full text Add to dashboard Cite

Background and PurposeIn large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)<30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients.MethodsPatients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short‐term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long‐term outcome was 90‐day modified Rankin score. Spearman's correlations were performed. Significance was attributed to p‐value⩽.05.ResultsAmong 73 patients, median age was 66 (interquartile range 54‐76) years. Among all pretreatment imaging parameters, rCBF<30%, rCBF<34%, and rCBF<38% volumes were significantly, inversely correlated with percentage NIHSS change (p<.048). No other parameters significantly correlated with outcomes.ConclusionsOur multisite analysis shows that favorable short‐term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger‐scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.

show abstract

Section: Limitationsmentioning

confidence: 73%

Redefining CT perfusion‐based ischemic core estimates for the ghost core in early time window stroke

Koneru,

Hoseinyazdi,

Lakhani

et al. 2023

Journal of Neuroimaging

Self Cite

View full text Add to dashboard Cite

show abstract

Neurorestorative Approaches for Ischemic Stroke

Michór,

Renardson,

et al. 2024

Neuroscience

View full text Add to dashboard Cite

Assessment of automated TICI scoring during endovascular treatment in patients with an ischemic stroke

van der Sluijs,

Su,

Cornelissen

et al. 2024

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundThe extended Thrombolysis in Cerebral Infarction (eTICI) score is used in digital subtraction angiography (DSA) to quantify reperfusion grade in patients with an ischemic stroke who undergo endovascular thrombectomy (EVT). A previously developed automatic TICI score (autoTICI), which quantifies the ratio of reperfused pixels after EVT, demonstrates good correlation with eTICI.ObjectiveTo evaluate the autoTICI model in a large multicenter registry of patients with an ischemic stroke, investigate the association with visual eTICI, and compare prediction of functional outcome between autoTICI and eTICI.MethodsPatients in the MR CLEAN Registry with an internal carotid artery, M1, and M2 occlusion were selected if both anteroposterior and lateral views were present in pre- and post-EVT DSA scans. The autoTICI score was compared with eTICI in predicting favorable functional outcome (modified Rankin Scale score 0–2), using area under the receiver operating characteristics curve (AUC) with a multivariable logistic regression model including known prognostic characteristics.ResultsIn total 421 of 3637 patients were included. AutoTICI was significantly associated with eTICI non-linearly (below 70% cOR=2.3 (95% CI 2.1 to 2.5), above 70% cOR=1.6 (95% CI 1.6 to 1.7) per 10% increment). The AUC of the model predicting favorable functional outcome was similar for autoTICI and eTICI (0.86, 95% CI 0.82 to 0.92 vs 0.86, 95% CI 0.83 to 0.90, P=0.73) and was higher than for a model with prognostic patient characteristics alone (0.86 vs 0.84, P=0.01).ConclusionAutomatic quantitative assessment of reperfusion after EVT is associated with eTICI, and prediction of functional outcome is similar to that with visual eTICI. Therefore, autoTICI could be used as an alternative or additional review for visual reperfusion assessment to facilitate reproducible and uniform reporting.

show abstract

Priorities for Advancements in Neuroimaging in the Diagnostic Workup of Acute Stroke

Cited by 4 publications

References 104 publications

Redefining CT perfusion‐based ischemic core estimates for the ghost core in early time window stroke

Redefining CT perfusion‐based ischemic core estimates for the ghost core in early time window stroke

Neurorestorative Approaches for Ischemic Stroke

Assessment of automated TICI scoring during endovascular treatment in patients with an ischemic stroke

Contact Info

Product

Resources

About