Virtual Diffusion Weighted Imaging for Assessing Acute Ischemic Stroke from Computed Tomography Angiography Via Deep Learning

2021 ◽  
Author(s):  
Xiaoer Wei ◽  
Chi-Cheng Fu ◽  
Feng Wang ◽  
Kai Shang ◽  
Xinyu Song ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Deep Learning ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted

scholarly journals Incidence of New Diffusion-Weighted Imaging Lesions Outside the Area of Initial Hypoperfusion Within 1 Week After Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 2654-2658 ◽  
Author(s):  
Tatiana Usnich ◽  
Fredrik N. Albach ◽  
Peter Brunecker ◽  
Jochen B. Fiebach ◽  
Christian H. Nolte
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Diffusion Weighted Imaging ◽  
Diffusion Weighted

Reversible diffusion-weighted imaging lesions in acute ischemic stroke

Neurology ◽  
2020 ◽  
Vol 94 (13) ◽  
pp. 571-587 ◽  
Author(s):  
Nandakumar Nagaraja ◽  
John R. Forder ◽  
Steven Warach ◽  
Jośe G. Merino
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Diffusion Weighted Imaging ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Nihss Score ◽  
Diffusion Weighted ◽  
Ischemic Tissue ◽  
Fluid Attenuated Inversion Recovery

ObjectivesTo systematically review the literature for reversible diffusion-weighted imaging (DWIR) lesions and to describe its prevalence, predictors, and clinical significance.MethodsStudies were included if the first DWI MRI was performed within 24 hours of stroke onset and follow-up DWI or fluid-attenuated inversion recovery (FLAIR)/T2 was performed within 7 or 90 days, respectively, to measure DWIR. We abstracted clinical, imaging, and outcomes data.ResultsTwenty-three studies met the study criteria. The prevalence of DWIR was 26.5% in DWI-based studies and 6% in FLAIR/T2-based studies. DWIR was associated with recanalization or reperfusion of the ischemic tissue with or without the use of tissue plasminogen activator (t-PA) or endovascular therapy, earlier treatment with t-PA, shorter time to endovascular therapy after MRI, and absent or less severe perfusion deficit within the DWI lesion. DWIR was associated with early neurologic improvement in 5 of 6 studies (defined as improvement in the NIH Stroke Scale (NIHSS) score by 4 or 8 points from baseline or NIHSS score 0 to 2 at 24 hours after treatment or at discharge or median NIHSS score at 7 days) and long-term outcome in 6 of 7 studies (defined as NIHSS score ≤1, improvement in the NIHSS score ≥8 points, or modified Rankin Scale score up to ≤2 at 30 or 90 days) likely due to reperfusion.ConclusionsDWIR is seen in up to a quarter of patients with acute ischemic stroke, and it is associated with good clinical outcome following reperfusion. Our findings highlight the pitfalls of DWI to define ischemic core in the early hours of stroke.

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.

scholarly journals Clinical and Imaging Determinants of Collateral Status in Patients With Acute Ischemic Stroke in MR CLEAN Trial and Registry

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1493-1502
Author(s):  
Eveline J.A. Wiegers ◽  
Maxim J.H.L. Mulder ◽  
Ivo G.H. Jansen ◽  
Esmee Venema ◽  
Kars C.J. Compagne ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Computed Tomography Angiography ◽  
Odds Ratio ◽  
Internal Carotid ◽  
Common Odds Ratio ◽  
Mr Clean

Background and Purpose— Collateral circulation status at baseline is associated with functional outcome after ischemic stroke and effect of endovascular treatment. We aimed to identify clinical and imaging determinants that are associated with collateral grade on baseline computed tomography angiography in patients with acute ischemic stroke due to an anterior circulation large vessel occlusion. Methods— Patients included in the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; n=500) and MR CLEAN Registry (n=1488) were studied. Collateral status on baseline computed tomography angiography was scored from 0 (absent) to 3 (good). Multivariable ordinal logistic regression analyses were used to test the association of selected determinants with collateral status. Results— In total, 1988 patients were analyzed. Distribution of the collateral status was as follows: absent (7%, n=123), poor (32%, n=596), moderate (39%, n=735), and good (23%, n=422). Associations for a poor collateral status in a multivariable model existed for age (adjusted common odds ratio, 0.92 per 10 years [95% CI, 0.886–0.98]), male (adjusted common odds ratio, 0.64 [95% CI, 0.53–0.76]), blood glucose level (adjusted common odds ratio, 0.97 [95% CI, 0.95–1.00]), and occlusion of the intracranial segment of the internal carotid artery with occlusion of the terminus (adjusted common odds ratio 0.50 [95% CI, 0.41–0.61]). In contrast to previous studies, we did not find an association between cardiovascular risk factors and collateral status. Conclusions— Older age, male sex, high glucose levels, and intracranial internal carotid artery with occlusion of the terminus occlusions are associated with poor computed tomography angiography collateral grades in patients with acute ischemic stroke eligible for endovascular treatment.

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