Perfusion computed tomography (PCT) shows promise in acute stroke assessment. However, the accuracy of CT perfusion thresholds in defining the acute infarct core remains uncertain.
Concurrent PCT and ...MRI-DWI performed 3-6 h after symptoms onset were assessed in 57 ischemic stroke patients. PCT was compared to DWI images to define the infarct core using a pixel-based receiver operating characteristic curve analysis to calculate the area under the curve (AUC) for thresholds from PCT maps that were co-registered with the DWI slice location.
A relative cerebral blood flow (CBF) of 45% of the contralateral hemisphere was found to be the most accurate threshold for describing the infarct core (AUC 0.788), and it was also by far the most frequent threshold with the highest AUC across patients.
CBF thresholds on PCT define the acute infarct core more accurately than do other PCT thresholds, including a cerebral blood volume of 2 ml/100 g.
This study aimed to compare the performance of the Bayesian probabilistic method, circular Singular Value Decomposition (cSVD), and oscillation index Singular Value Decomposition (oSVD) algorithms in ...Olea Sphere for predicting infarct volume in patients with acute ischemic stroke (AIS). Eighty-seven patients suffering from AIS with large vessel occlusion were divided into improvement and progression groups. The improvement group included patients with successful recanalization (TICI 2b-3) after thrombectomy or whose clinical symptoms improved after thrombolysis. The progression group consisted of patients whose clinical symptoms did not improve or even got worse. The infarct core volume from the Olea Sphere software was used as the predicted infarct volume (PIV) in the improvement group, whereas the hypoperfusion volume was used as the PIV in the progression group. We defined predicted difference (PD) as PIV minus final infarct volume (FIV) measured at follow-up imaging. Differences among the three algorithms were assessed by the Friedman test. Spearman correlation analysis was used to verify the correlation between PIV and FIV. In addition, we performed a subgroup analysis of the progression group based on collateral circulation status. The median interquartile range (IQR) of the PD and Spearman correlation coefficients (SCCs) between PIV and FIV for the improvement group (n = 22) were: Bayesian = 6.99 (-14.72, 18.99), 0.500; oSVD = -12.74 (-41.06, -3.46), 0.423; cSVD = -15.38 (-38.92, -4.68), 0.586. For the progression group (n = 65), the median (IQR) of PD and SCCs were: Bayesian = 1.00 (-34.07, 49.37), 0.748; oSVD = -0.17 (-53.42, 29.73), 0.712; cSVD = 66.55 (7.94, 106.32), 0.674. The Bayesian algorithm in the Olea Sphere software predicted infarct volumes with better accuracy and stability than the other two algorithms in both the progression and improvement groups.
Quantification of myocardial infarction on late Gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) images into heterogeneous infarct periphery (or gray zone) and infarct core plays an ...important role in cardiac diagnosis, especially in identifying patients at high risk of cardiovascular mortality. However, quantification task is challenging due to noise corrupted in cardiac MR images, the contrast variation, and limited resolution of images. In this study, we propose a novel approach for automatic myocardial infarction quantification, termed DEMPOT, which consists of three key parts: Decomposition of image into intrinsic modes, monogenic phase performing on combined dominant modes, and multilevel Otsu thresholding on the phase. In particular, inspired by the Hilbert-Huang transform, we perform the multidimensional ensemble empirical mode decomposition and 2-D generalization of the Hilbert transform known as the Riesz transform on the MR image to obtain the monogenic phase that is robust to noise and contrast variation. Then, a two-stage algorithm using multilevel Otsu thresholding is accomplished on the monogenic phase to automatically quantify the myocardium into healthy, gray zone, and infarct core regions. Experiments on LGE-CMR images with myocardial infarction from 82 patients show the superior performance of the proposed approach in terms of reproducibility, robustness, and effectiveness.
The majority of patients receiving implantable cardioverter-defibrillator (ICD) implantation under current guidelines never develop sustained ventricular arrhythmia; therefore, better markers of risk ...for sustained ventricular tachycardia and/or ventricular fibrillation are needed.
The purpose of this study was to identify cardiac magnetic resonance arrhythmic risk predictors of ischemic cardiomyopathy before ICD implantation.
Forty-three subjects (mean age, 64.5 ± 11.9 years) with previous myocardial infarction who were referred for ICD implantation were evaluated by cardiac magnetic resonance imaging (MRI). The MRI protocol included left ventricular functional parameter assessment using steady-state free precession and late gadolinium enhancement MRI using inversion recovery fast gradient echo. Left ventricular functional parameters were measured using cardiac magnetic resonance software. Subjects were followed up for 6-46 months, and the events of appropriate ICD treatments (shocks and antitachycardia pacing) were recorded.
Twenty-eight patients experienced 46 spontaneous episodes during a median follow-up duration of 30 months. The total myocardial infarct (MI) size (18.05 ± 11.44 g vs 38.83 ± 19.87 g; P = .0006), MI core (11.63 ± 7.14 g vs 24.12 ± 12.73 g; P = .0002), and infarct gray zone (6.43 ± 4.64 g vs 14.71 ± 7.65 g; P = .0004) were significantly larger in subjects who received appropriate ICD therapy than in those who did not experience an episode of ventricular tachycardia and/or ventricular fibrillation. Multivariate regression analyses for the infarct gray zone and MI core adjusted for New York Heart Association class, diabetes, and etiology (primary or secondary prevention) revealed that the gray zone and MI core were predictors of appropriate ICD therapies (P = .0018 and P = .007, respectively).
The extent of MI scar may predict which patients would benefit most from ICD implantation.
Intravenous thrombolysis (IVT) is the method of choice in reperfusion treatment of patients with signs and symptoms of acute ischemic stroke (AIS) lasting less than 4.5 hours. Hemorrhagic ...transformation (HT) of acute ischemic stroke is a serious complication of IVT and occurs in 4.5-68.0% of clinical cases. The aim of our study was to determine the infarct core CT perfusion parameter (CTPP) most predictive of HT.
Seventy-five patients with AIS who had undergone CT perfusion (CTP) imaging and were treated with IVT were enrolled in this retrospective study. Patients with and without HT after IVT were defined as cases and controls, respectively. Controls were found by matching for time from AIS symptom onset to IVT ± 0.5 h. The following CTPPs were measured: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), relative CBF (rCBF) and relative CBV (rCBV). Receiver operating characteristic analysis curves of significant CTPPs determined cut-off values that best predict HT.
There was a significant difference between cases and controls for CBF (p = 0.004), CBV (p = 0.009), rCBF (p < 0.001) and rCBV (p = 0.001). Receiver operating characteristic analysis revealed that rCBF < 4.5% of the contralateral mean (area under the curve = 0.736) allowed prediction of HT with a sensitivity of 71.0% and specificity of 52.5%.
CTP imaging has a considerable role in HT prediction, assisting in selection of patients that are likely to benefit from IVT. rCBF proved to have the highest HT predictive value.
The novel estrogen receptor, G protein-coupled estrogen receptor (GPER, previously named GPR30), is widely distributed throughout the male and female brain and, thus, could potentially play a role in ...estrogen-mediated neuroprotective effects in diseases such as stroke. We hypothesized that GPER distribution and expression in the brain of male, intact female, and ovariectomized (OVX) mice is increased after 0.5 h middle cerebral artery occlusion. Using immunohistochemistry, we found that ischemia reperfusion increased GPER distribution in the peri-infarct brain regions of male mice, but surprisingly not in intact females or OVX mice. Similar differences were observed in the male and female human brain after stroke. In contrast, GPER distribution was decreased in the infarct core of all mice examined. Furthermore, GPER immunofluorescence was co-localized with the endothelial cell marker, von Willebrand factor, and the neuronal marker, NeuN. Consistent with the immunohistochemical findings, Western blot analysis showed GPER expression is only elevated in the ischemic hemisphere of male mice. Moreover, GPER mRNA expression in males was elevated at 4 h but had returned to baseline by 24 h. In conclusion, these findings indicate that GPER may be a potential therapeutic target after stroke, especially in males, in whom estrogen therapy is not feasible.
Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy ...of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.
We investigated the practical clinical utility of the CT perfusion (CTP) cerebral blood volume (CBV) parameter for differentiating salvageable from non-salvageable tissue in acute ischemic stroke ...(AIS). Fifty-five patients with AIS were imaged within 6 h from onset using CTP. Admission CBV defect (CBV
D
) volume was outlined using previously established gray and white matter CBV thresholds for infarct core. Admission cerebral blood flow (CBF) hypoperfusion and CBF/CBV mismatch were visually evaluated. Truncation of the ischemic time–density curve (ITDC) and hypervolemia status at admission, recanalization at 24-h CT angiography, hemorrhagic transformation (HT) at 24 h and/or 7-day non-contrast CT (NCCT), final infarct volume as indicated by 3-month NCCT defect (NCCT
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) and 3-month modified Rankin Score were determined. Patients with recanalization and no truncation had the highest correlation (
R
= 0.81) and regression slope (0.80) between CBV
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and NCCT
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. Regression slopes were close to zero for patients with admission hypervolemia with/without recanalization. Hypervolemia underestimated (
p
= 0.02), while recanalization and ITDC truncation overestimated (
p
= 0.03) the NCCT
D
. Among patients with confirmed recanalization at 24 h, 38 % patients had an admission CBF/CBV mismatch within normal appearing areas on respective NCCT. 83 % of these patients developed infarction in admission hypervolemic CBF/CBV mismatch tissue. A reduction in CBV is a valuable predictor of infarct core when the acquisition of ITDC data is complete and hypervolemia is absent within the tissue destined to infarct. Raised or normal CBV is not always indicative of salvageable tissue, contrary to the current definition of penumbra.
Embolic stroke is thought to cause irreparable damage in the brain immediately adjacent to the region of reduced blood perfusion. Therefore, much of the current research focuses on treatments such as ...anti-inflammatory, neuroprotective, and cell replacement strategies to minimize behavioral and physiological consequences. In the present study, intravenous delivery of human umbilical cord blood cells (HUCBC) 48 h after a middle cerebral artery occlusion (MCAo) in a rat resulted in both behavioral and physiological recovery. Nissl and TUNEL staining demonstrated that many of the neurons in the core were rescued, indicating that while both necrotic and apoptotic cell death occur in ischemia, it is clear that apoptosis plays a larger role than first anticipated. Further, immunohistochemical and histochemical analysis showed a diminished and/or lack of granulocyte and monocyte infiltration and astrocytic and microglial activation in the parenchyma in animals treated with HUCBC 48 h poststroke. Successful treatment at this time point should offer encouragement to clinicians that a therapy with a broader window of efficacy may soon be available to treat stroke.
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