Adoption of computerized tomography perfusion imaging in the diagnosis of acute cerebral infarct under optimized deconvolution algorithm

Objectives: To explore the significance of the hemodynamic parameters of Computerized Tomography Perfusion Imaging (CTPI) under the deconvolution optimization algorithm for the diagnosis and treatment of patients with acute cerebral infarct (ACI). Methods: A hundred and ten patients with ACI from December 2018 to September 2019 were selected for research, and CTPI was performed before and after Edaravone injection treatment. Then, the CTPI deconvolution algorithm based on the weighted adaptive (WA) total variation (TV) (WA-TV) optimization was constructed, which was compared with tensor total variation (TTV) and Motion-adaptive sparse parity (MASP). Brain Perfusion 4.0 was applied to obtain the relative time to peak (rTTP), the relative transit time of mean (rMTT), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) of the core infarction area (CIA) and penumbra ischemic (PI). Results: In four parameters of rTTP, rMTT, rCBV, and CBF, the peak signal to noise ratio (PSNR) of the WA-TV algorithm was higher than the MSAP and TTV algorithms, while the Mean Square Error (MSE) and Mean Absolute Error (MAE) were lower than MSAP and TTV algorithms (P<0.05); the parameters of rCBV (71.56±9.87), rCBF (43.17±7.06) of the CIA before treatment were higher than PI (23.66±7.22; 18.37±3.99), rMTT (124.83±9.73) and rTTP (122.57±7.41) were lower than the PI (183.17±10.16); 150.74±9.74) (P<0.05). After treatment, the rCBV and rCBF of PI were higher than before treatment, and rMTT and rTTP were lower than before treatment (P<0.05), and there was no obvious difference in rCBV, rCBF, rMTT, and rTTP before and after treatment in the CIA (P>0.05). Conclusion: Compared with TTV and MASP, the WA-TV algorithm performs better in noise reduction and artifact reduction. The CTPI parameters of rCBV, rCBF, rMTT, and rTTP are all important indications for the diagnosis of PI and ACI. doi: https://doi.org/10.12669/pjms.37.6-WIT.4884 How to cite this:Fang B, Zhai H. Adoption of computerized tomography perfusion imaging in the diagnosis of acute cerebral infarct under optimized deconvolution algorithm. Pak J Med Sci. 2021;37(6):1687-1692. doi: https://doi.org/10.12669/pjms.37.6-WIT.4884 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Mapping of SARS-CoV-2 Brain Invasion and Histopathology in COVID-19 Disease

ABSTRACTThe coronavirus SARS-CoV-2 (SCV2) causes acute respiratory distress, termed COVID-19 disease, with substantial morbidity and mortality. As SCV2 is related to previously-studied coronaviruses that have been shown to have the capability for brain invasion, it seems likely that SCV2 may be able to do so as well. To date, although there have been many clinical and autopsy-based reports that describe a broad range of SCV2-associated neurological conditions, it is unclear what fraction of these have been due to direct CNS invasion versus indirect effects caused by systemic reactions to critical illness. Still critically lacking is a comprehensive tissue-based survey of the CNS presence and specific neuropathology of SCV2 in humans. We conducted an extensive neuroanatomical survey of RT-PCR-detected SCV2 in 16 brain regions from 20 subjects who died of COVID-19 disease. Targeted areas were those with cranial nerve nuclei, including the olfactory bulb, medullary dorsal motor nucleus of the vagus nerve and the pontine trigeminal nerve nuclei, as well as areas possibly exposed to hematogenous entry, including the choroid plexus, leptomeninges, median eminence of the hypothalamus and area postrema of the medulla. Subjects ranged in age from 38 to 97 (mean 77) with 9 females and 11 males. Most subjects had typical age-related neuropathological findings. Two subjects had severe neuropathology, one with a large acute cerebral infarction and one with hemorrhagic encephalitis, that was unequivocally related to their COVID-19 disease while most of the 18 other subjects had non-specific histopathology including focal β-amyloid precursor protein white matter immunoreactivity and sparse perivascular mononuclear cell cuffing. Four subjects (20%) had SCV2 RNA in one or more brain regions including the olfactory bulb, amygdala, entorhinal area, temporal and frontal neocortex, dorsal medulla and leptomeninges. The subject with encephalitis was SCV2-positive in a histopathologically-affected area, the entorhinal cortex, while the subject with the large acute cerebral infarct was SCV2-negative in all brain regions. Like other human coronaviruses, SCV2 can inflict acute neuropathology in susceptible patients. Much remains to be understood, including what viral and host factors influence SCV2 brain invasion and whether it is cleared from the brain subsequent to the acute illness.

Effects of Arteriovenous Thrombolysis Combined with Mechanical Thrombectomy on Efficacy and Neurological Function of Acute Cerebral Infarct Patients

Objective. To investigate the effects of arteriovenous thrombolysis combined with mechanical thrombectomy on clinical efficacy, neurological function, and the changes of nerve injury markers of acute cerebral infarct (ACI) patients. Methods. A total of 143 cases with ACI admitted to our hospital from June 2017 to June 2019 were elected as research subjects. Among them, 69 cases of patients who received treatment of arteriovenous thrombolysis were considered as group A, and 74 cases of patients who received treatment of arteriovenous thrombolysis combined with mechanical thrombectomy were considered as group B. NIHSS score, clinical efficacy, vascular recanalization, adverse reactions, hemodynamics, neurological injury indexes, duration of coma, length of hospital stay, and prognosis of patients in the two groups were compared. Results. After treatment, the NIHSS score of group A was higher than that of group B (P<0.05), the clinical efficacy of group B was better than that of group A, and the incidence of adverse reactions was lower than that of group A (P<0.05). There was no difference in vascular recanalization rate, duration of coma, and prognosis between the two groups (P>0.05). Length of hospital stay, maximum peak velocity after treatment (Vs), and mean flow rate (Vm) of group A were lower than those of group B, while vascular resistance index (RI), pulsatility index (PI), serum glutamic acid (Glu), neuron-specific enolase (NES), and S100β protein detected by enzyme-linked immunosorbent assay (ELISA) of group A were higher than those of group B (P<0.05). Conclusion. Arteriovenous thrombolysis combined with mechanical thrombectomy has a significant effect on ACI, with high safety and quick effect. In addition, it has a stronger effect on improving and protecting the neurological function of patients, which is worth promoting in clinical practice.

Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories

Background and Purpose— Patients with acute cerebral infarcts in multiple arterial territories (MACI) represent a substantial portion of the stroke population. There are no data on short-term outcome and in-hospital complications in patients with MACI. We compared patients with MACI with patients having acute cerebral infarct(s) in a single arterial territory. Methods— We analyzed 3343 patients with diffusion-weighted imaging-confirmed acute cerebral infarcts. MACI was defined as at least 2 acute cerebral ischemic lesions in at least 2 arterial cerebral territories. Patients with MACI were compared with patients with acute cerebral infarct(s) in a single arterial territory for relevant in-hospital complications and short-term outcome, namely National Institutes of Health Stroke Scale and modified Rankin Scale at day 7 after admission or at discharge when earlier. Results— A total of 311 patients (9.3%) met the definition of MACI. Both median National Institutes of Health Stroke Scale (2 [1–7] versus 1 [0–4]) and modified Rankin Scale (3 [1–4] versus 2 [1–3]) were higher in patients with MACI. MACI was independently associated with higher National Institutes of Health Stroke Scale and modified Rankin Scale. Deep venous thrombosis, myocardial infarction, and any complications were more frequent in patients with MACI. Conclusions— In-hospital complications were more frequent in patients with MACI, which may adversely affect short-term clinical and functional outcome. Closer follow-up of patients with MACI during hospitalization may prevent such events and negative progression.