scholarly journals Response by Zhang and Xie to Letter Regarding Article, “Spotty Calcium on Cervicocerebral Computed Tomography Angiography Associates With Increased Risk of Ischemic Stroke”

Stroke ◽  
2019 ◽  
Vol 50 (8) ◽  
Author(s):  
Fan Zhang ◽  
Yibin Xie
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Increased Risk

scholarly journals Spotty Calcium on Cervicocerebral Computed Tomography Angiography Associates With Increased Risk of Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 859-866 ◽  
Author(s):  
Fan Zhang ◽  
Li Yang ◽  
Lu Gan ◽  
Zhaoyang Fan ◽  
Bill Zhou ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Spatial Pattern ◽  
Computed Tomography Angiography ◽  
Lateral Side ◽  
Operating Characteristics ◽  
Increased Risk ◽  
Bilateral Carotid ◽  
Spotty Calcification ◽  
Stroke Group

Background and Purpose— Cervicocerebral vascular calcification on computed tomography angiography is a known sign of advanced atherosclerosis. However, the clinical significance of calcification pattern remains unclear. In this study, we aimed to investigate the potential association between spotty calcium and acute ischemic stroke. Methods— This study included patients with first-time nonlacunar ischemic stroke (N=50) confirmed by brain magnetic resonance imaging or nonenhanced head computed tomography, as well as control subjects with asymptomatic carotid atherosclerosis (N=50) confirmed by carotid ultrasonography. Subjects in both groups underwent contrast-enhanced cervicocerebral computed tomography angiography within a week after the initial imaging examination. Spotty calcification was evaluated at 11 arterial segments commonly affected by atherosclerosis along the carotid and vertebrobasilar circulation. Statistical analysis was performed comparing the frequency and spatial pattern of spotty calcification between the 2 groups. Results— Spotty calcification in the Stroke group was markedly more prevalent than that in the Control group (total SC count: 8.74±4.96 versus 1.84±1.82, P <0.001). The odds ratio (95% CI) for stroke was 2.49 (1.55–4.00) for spotty calcification at bilateral carotid bifurcation, 1.52 (1.13–2.04) at carotid siphon, and 1.98 (1.45–2.69) at all evaluated locations. A total number of 3 spotty calcifications were determined as the optimal cutoff threshold for increased risk of stroke. Spotty calcium showed significantly greater area under the receiver operating characteristics curve than total calcium volume irrespective of size (0.88 versus 0.77). Within the Stroke group, ipsilateral lateral side showed significantly more spotty calcium than the contralateral side (5.18±3.05 versus 3.56±2.67, P <0.001). Conclusions— Nonlacunar ischemia stroke was associated with markedly increased incidence of spotty calcification with a distinct spatial pattern on cervicocerebral computed tomography compared with subclinical atherosclerosis, suggesting the potential role of spotty calcification for improving the risk stratification for ischemic stroke.

Contrast-Induced Nephropathy in Ischemic Stroke Patients Undergoing Computed Tomography Angiography: CINISter Study

2019 ◽  
Vol 28 (3) ◽  
pp. 649-654 ◽  
Author(s):  
Anthony Shaun Rowe ◽  
Brandon Hawkins ◽  
Leslie A. Hamilton ◽  
Andrew Ferrell ◽  
Jennifer Henry ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Stroke Patients ◽  
Contrast Induced Nephropathy

scholarly journals Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3765-3769
Author(s):  
Charles Esenwa ◽  
Ji-Ae Lee ◽  
Taha Nisar ◽  
Anna Shmukler ◽  
Inessa Goldman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Positive Predictive Value ◽  
Diagnostic Accuracy ◽  
Computed Tomography Angiography ◽  
Predictive Value ◽  
Screening Tool ◽  
Clinical Symptoms ◽  
Shortness Of Breath ◽  
Patient Reported

Background and Purpose: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19). Methods: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19–specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm. Results: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83. Conclusions: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.

scholarly journals Signs of Pulmonary Infection on Admission Chest Computed Tomography Are Associated With Pneumonia or Death in Patients With Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1690-1695
Author(s):  
Jeroen C. de Jonge ◽  
Richard A.P. Takx ◽  
Frans Kauw ◽  
Pim A. de Jong ◽  
Jan W. Dankbaar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Pulmonary Infection ◽  
Stroke Onset ◽  
Odds Ratios ◽  
Chest Computed Tomography ◽  
Risk Of Death ◽  
Increased Risk

Background and Purpose— In patients with acute stroke, the occurrence of pneumonia has been associated with poor functional outcomes and an increased risk of death. We assessed the presence and consequences of signs of pulmonary infection on chest computed tomography (CT) before the development of clinically overt pneumonia. Methods— In 200 consecutive patients with acute ischemic stroke who had CT angiography from skull to diaphragm (including CT of the chest) within 24 hours of symptom onset, we assessed the presence of consolidation, ground-glass-opacity and the tree-in-bud sign as CT signs of pulmonary infection and assessed the association with the development of clinically overt pneumonia and death in the first 7 days and functional outcome after 90 days with logistic regression. Results— The median time from stroke onset to CT was 151 minutes (interquartile range, 84–372). Thirty patients (15%) had radiological signs of infection on admission, and 22 (11.0%) had a clinical diagnosis of pneumonia in the first 7 days. Patients with radiological signs of infection had a higher risk of developing clinically overt pneumonia (30% versus 7.6%; adjusted odds ratios, 4.2 [95% CI, 1.5–11.7]; P =0.006) and had a higher risk of death at 7 days (adjusted odds ratios, 3.7 [95% CI, 1.2–11.6]; P =0.02), but not at 90 days. Conclusions— About 1 in 7 patients with acute ischemic stroke had radiological signs of pulmonary infection within hours of stroke onset. These patients had a higher risk of clinically overt pneumonia or death. Early administration of antibiotics in these patients may lead to better outcomes.

scholarly journals Multiphasic Computed Tomography Angiography Findings for Identifying Pseudo-Occlusion of the Internal Carotid Artery

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2558-2562
Author(s):  
Jai Ho Choi ◽  
Jinhee Jang ◽  
Jaseong Koo ◽  
Kook-Jin Ahn ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Internal Carotid ◽  
Diagnostic Value ◽  
Fisher Exact Test ◽  
Anterior Circulation

Background and Purpose: Differentiation between pseudo-occlusion and true occlusion of internal carotid artery (ICA) is important in treatment planning for acute ischemic stroke patients. We compared the findings of multiphasic computed tomography angiography between cervical ICA pseudo-occlusion and true occlusion at the cervical ICA in patients with anterior circulation acute ischemic stroke to determine their diagnostic value. Methods: Thirty patients with nonvisualization of the proximal ICA were included. Diagnosis of pseudo- or true occlusion of the ICA was made based on digital subtraction angiography. Diagnostic performances of multiphasic computed tomography angiography findings—(1) a flame-shaped stump and (2) delayed contrast filling at the cervical ICA— were evaluated and compared. The Fisher exact test, χ 2 test, or Wilcoxon rank-sum test and McNemar test were used in the data analysis. Results: Twelve patients had true proximal ICA occlusion and 18 had pseudo-occlusion. Delayed contrast filling at the cervical ICA on multiphasic computed tomography angiography was found in all patients with pseudo-occlusion of the ICA, while 1 case of true occlusion showed delayed contrast filling ( P <0.001). The presence of a flame-shaped stump was not significantly different between the pseudo- and true occlusion groups. The sensitivity of delayed contrast filling (0.94 [95% CI, 0.73–1]) was significantly higher than that of flame-shaped stump (0.75 [95% CI, 0.36–0.83]). Conclusions: We demonstrated that the delayed filling sign on multiphasic computed tomography angiography could be a useful and readily available finding for differentiating proximal ICA pseudo-occlusion from true occlusion.

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