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P Michel - One of the best experts on this subject based on the ideXlab platform.
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Correlation between ASPECTS and Core Volume on CT Perfusion: Impact of Time since Stroke Onset and Presence of Large-Vessel Occlusion.
AJNR. American journal of neuroradiology, 2021Co-Authors: S Nannoni, F Ricciardi, D Strambo, G Sirimarco, M Wintermark, V Dunet, P MichelAbstract:Both ASPECTS and Core Volume on CTP are used to estimate infarct Volume in acute ischemic stroke. To evaluate the potential role of ASPECTS for acute endovascular treatment decisions, we studied the correlation between ASPECTS and CTP Core, depending on the timing and the presence of large-vessel occlusion. We retrospectively reviewed all MCA acute ischemic strokes with standardized reconstructions of CTP maps entered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) registry. Correlation between ASPECTS and CTP Core was determined for early (<6 hours) versus late (6-24 hours) times from stroke onset and in the presence versus absence of large-vessel occlusion. We used correlation coefficients and adjusted multiple linear regression models. We included 1046 patients with a median age of 71.4 years (interquartile range, IQR = 59.8-79.4 years), an NIHSS sCore of 12 (IQR, 6-18), an ASPECTS of 9 (IQR, 7-10), and a CTP Core of 13.6 mL (IQR, 0.6-52.8 mL). The overall correlation between ASPECTS and CTP Core was moderate (ρ = -0.49, P < .01) but significantly stronger in the late-versus-early window (ρ = -0.56 and ρ = -0.48, respectively; P = .05) and in the presence versus absence of large-vessel occlusion (ρ = -0.40 and ρ = -0.20, respectively; P < .01). In the regression model, the independent association between ASPECTS and CTP Core was confirmed and was twice as strong in late-arriving patients with large-vessel occlusion (β = -0.21 per 10 mL; 95% CI, -0.27 to -0.15; P < .01) than in the overall population (β = -0.10; 95% CI, -0.14 to -0.07; P < .01). In a large cohort of patients with acute ischemic stroke, we found a moderate correlation between ASPECTS and CTP Core. However, this was stronger in patients with large-vessel occlusion and longer delay from stroke onset. Our results could support the use of ASPECTS as a surrogate marker of CTP Core in late-arriving patients with acute ischemic stroke with large-vessel occlusion. © 2020 by American Journal of Neuroradiology.
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correlation between aspects and Core Volume on ct perfusion impact of time since stroke onset and presence of large vessel occlusion
American Journal of Neuroradiology, 2021Co-Authors: S Nannoni, F Ricciardi, D Strambo, G Sirimarco, M Wintermark, V Dunet, P MichelAbstract:BACKGROUND AND PURPOSE Both ASPECTS and Core Volume on CTP are used to estimate infarct Volume in acute ischemic stroke. To evaluate the potential role of ASPECTS for acute endovascular treatment decisions, we studied the correlation between ASPECTS and CTP Core, depending on the timing and the presence of large-vessel occlusion. MATERIALS AND METHODS We retrospectively reviewed all MCA acute ischemic strokes with standardized reconstructions of CTP maps entered in the Acute STroke Registry and Analysis of Lausanne (ASTRAL) registry. Correlation between ASPECTS and CTP Core was determined for early (<6 hours) versus late (6-24 hours) times from stroke onset and in the presence versus absence of large-vessel occlusion. We used correlation coefficients and adjusted multiple linear regression models. RESULTS We included 1046 patients with a median age of 71.4 years (interquartile range, IQR = 59.8-79.4 years), an NIHSS sCore of 12 (IQR, 6-18), an ASPECTS of 9 (IQR, 7-10), and a CTP Core of 13.6 mL (IQR, 0.6-52.8 mL). The overall correlation between ASPECTS and CTP Core was moderate (ρ = -0.49, P < .01) but significantly stronger in the late-versus-early window (ρ = -0.56 and ρ = -0.48, respectively; P = .05) and in the presence versus absence of large-vessel occlusion (ρ = -0.40 and ρ = -0.20, respectively; P < .01). In the regression model, the independent association between ASPECTS and CTP Core was confirmed and was twice as strong in late-arriving patients with large-vessel occlusion (β = -0.21 per 10 mL; 95% CI, -0.27 to -0.15; P < .01) than in the overall population (β = -0.10; 95% CI, -0.14 to -0.07; P < .01). CONCLUSIONS In a large cohort of patients with acute ischemic stroke, we found a moderate correlation between ASPECTS and CTP Core. However, this was stronger in patients with large-vessel occlusion and longer delay from stroke onset. Our results could support the use of ASPECTS as a surrogate marker of CTP Core in late-arriving patients with acute ischemic stroke with large-vessel occlusion.
Mark W. Parsons - One of the best experts on this subject based on the ideXlab platform.
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Absent Contrast Filling of Ipsilateral Superficial Middle Cerebral Vein Predicts Midline Shift in Acute Middle Cerebral Artery Occlusion.
Frontiers in neurology, 2020Co-Authors: Sheng Zhang, Mark W. Parsons, Longting Lin, Ruiting Zhang, Meiping Wang, Zongjie Shi, Yu GengAbstract:Background and purpose: Midline shift is a life-threatening complication of acute large artery occlusion (LAO). The value of superficial middle cerebral vein (SMCV) for predicting midline shift is currently unclear for patients with acute LAO. Methods: Consecutive acute LAO (middle cerebral artery M1 ± intracranial internal carotid artery) patients between March 2018 and May 2019 were included. Absent filling of ipsilateral cortical vein (marked as SMCV-) was defined as no contrast filling into the vein across the whole venous phase of four-dimensional computed tomography (CT) angiography derived from CT perfusion in the ischemic hemisphere. Results: In the total of 81 patients, 31 (38.4%) were identified as SMCV-. SMCV- independently predicted midline shift, with sensitivity of 87.5% and specificity of 82.5%. Receiver operating characteristic analysis showed that including SMCV- as a predictor in addition to baseline ischemic Core Volume significantly increased the area under the curve in predicting midline shift (SMCV- with baseline ischemic Core Volume vs. baseline ischemic Core Volume: AUC = 0.903 vs. 0.841, Z = 2.451, P = 0.014). Conclusion: In acute LAO patients, the presence of SMCV- was a sensitive and specific imaging marker for midline shift. SMCV- had supplementary value to baseline ischemic Core Volume in predicting midline shift.
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Exploring the relationship between ischemic Core Volume and clinical outcomes after thrombectomy or thrombolysis
Neurology, 2019Co-Authors: Chushuang Chen, Mark W. Parsons, Christopher R. Levi, Longting Lin, Xin Cheng, Min Lou, Timothy J. Kleinig, Neil J. Spratt, Ferdinand Miteff, Kenneth ButcherAbstract:Objective To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO). Methods EVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion Volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic Core and penumbral Volumes. Results From INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline Core p p = 0.01). In patients with a baseline ischemic Core Volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0–1 odds ratio 1.61, p 30 mL (20% vs 3% in EVT-R, p = 0.008). Conclusion From this observational cohort, LVO patients with larger baseline ischemic Cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic Cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.
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Author response: Evaluation of hyperacute infarct Volume using ASPECTS and brain CT perfusion Core Volume.
Neurology, 2017Co-Authors: Christopher R. Levi, Jelle Demeestere, Carlos Garcia-esperon, Pablo García-bermejo, Fouke Ombelet, Patrick Mcelduff, Andrew Bivard, Mark W. ParsonsAbstract:Demeestere et al.1 compared hyperacute infarct Volume using the Alberta Stroke Program Early CT SCore (ASPECTS) and brain CT perfusion and found no significant difference. ASPECTS and CT perfusion-based studies have already established their critical role in selecting patients for thrombolysis and mechanical recanalization.2,3 In this study, ASPECTS or CT perfusion Core Volume was compared with MRI diffusion-weighted imaging (DWI) lesion Volume.1 However, MRI was performed within 100 minutes (median 60 minutes) of CT perfusion and 49% of patients received thrombolysis before MRI.
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Influence of Penumbral Reperfusion on Clinical Outcome Depends on Baseline Ischemic Core Volume.
Stroke, 2017Co-Authors: Chushuang Chen, Mark W. Parsons, Matthew Clapham, Christopher Oldmeadow, Christopher R. Levi, Longting Lin, Xin Cheng, Min Lou, Timothy J. Kleinig, Kenneth ButcherAbstract:Background and Purpose— In alteplase-treated patients with acute ischemic stroke, we investigated the relationship between penumbral reperfusion at 24 hours and clinical outcomes, with and without adjustment for baseline ischemic Core Volume. Methods— Data were collected from consecutive acute ischemic stroke patients with baseline and follow-up perfusion imaging presenting to hospital within 4.5 hours of symptom onset at 7 hospitals. Logistic regression models were used for predicting the effect of the reperfused penumbral Volume on the dichotomized modified Rankin Scale (mRS) at 90 days and improvement of National Institutes of Health Stroke Scale at 24 hours, both adjusted for baseline ischemic Core Volume. Results— This study included 1507 patients. Reperfused penumbral Volume had moderate ability to predict 90-day mRS 0 to 1 (area under the curve, 0.77; R 2 , 0.28; P R 2 , 0.55; P R 2 , 0.31; P R 2 , 0.41; P Conclusions— In patients treated with alteplase, the extent of the penumbra that is reperfused is a powerful predictor of early and late clinical outcomes, particularly when baseline ischemic Core is taken into account.
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Evaluation of hyperacute infarct Volume using ASPECTS and brain CT perfusion Core Volume.
Neurology, 2017Co-Authors: Jelle Demeestere, Mark W. Parsons, Carlos Garcia-esperon, Pablo García-bermejo, Fouke Ombelet, Patrick Mcelduff, Andrew Bivard, Christopher R. LeviAbstract:Objective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography SCore (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. Methods: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS sCores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion Core Volume to detect an acute MRI diffusion lesion of ≥70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J. Results: Median ASPECTS sCore was 8 (interquartile range [IQR] 5–9). Median CT perfusion Core Volume was 22 mL (IQR 10.4–71.9). Median MRI diffusion lesion Volume was 24.5 mL (IQR 10–63.9). No significant difference was found between the accuracy of CT perfusion and ASPECTS (c statistic 0.95 vs 0.87, p value for difference = 0.17). The optimum ASPECTS cutoff sCore to detect a diffusion-weighted imaging lesion ≥70 mL was Conclusions: We found no significant difference between the accuracy of CT perfusion and ASPECTS to predict hyperacute MRI lesion Volume in ischemic stroke.
Christopher R. Levi - One of the best experts on this subject based on the ideXlab platform.
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Exploring the relationship between ischemic Core Volume and clinical outcomes after thrombectomy or thrombolysis
Neurology, 2019Co-Authors: Chushuang Chen, Mark W. Parsons, Christopher R. Levi, Longting Lin, Xin Cheng, Min Lou, Timothy J. Kleinig, Neil J. Spratt, Ferdinand Miteff, Kenneth ButcherAbstract:Objective To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO). Methods EVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion Volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic Core and penumbral Volumes. Results From INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline Core p p = 0.01). In patients with a baseline ischemic Core Volume >30 mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0–1 odds ratio 1.61, p 30 mL (20% vs 3% in EVT-R, p = 0.008). Conclusion From this observational cohort, LVO patients with larger baseline ischemic Cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic Cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.
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Author response: Evaluation of hyperacute infarct Volume using ASPECTS and brain CT perfusion Core Volume.
Neurology, 2017Co-Authors: Christopher R. Levi, Jelle Demeestere, Carlos Garcia-esperon, Pablo García-bermejo, Fouke Ombelet, Patrick Mcelduff, Andrew Bivard, Mark W. ParsonsAbstract:Demeestere et al.1 compared hyperacute infarct Volume using the Alberta Stroke Program Early CT SCore (ASPECTS) and brain CT perfusion and found no significant difference. ASPECTS and CT perfusion-based studies have already established their critical role in selecting patients for thrombolysis and mechanical recanalization.2,3 In this study, ASPECTS or CT perfusion Core Volume was compared with MRI diffusion-weighted imaging (DWI) lesion Volume.1 However, MRI was performed within 100 minutes (median 60 minutes) of CT perfusion and 49% of patients received thrombolysis before MRI.
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Influence of Penumbral Reperfusion on Clinical Outcome Depends on Baseline Ischemic Core Volume.
Stroke, 2017Co-Authors: Chushuang Chen, Mark W. Parsons, Matthew Clapham, Christopher Oldmeadow, Christopher R. Levi, Longting Lin, Xin Cheng, Min Lou, Timothy J. Kleinig, Kenneth ButcherAbstract:Background and Purpose— In alteplase-treated patients with acute ischemic stroke, we investigated the relationship between penumbral reperfusion at 24 hours and clinical outcomes, with and without adjustment for baseline ischemic Core Volume. Methods— Data were collected from consecutive acute ischemic stroke patients with baseline and follow-up perfusion imaging presenting to hospital within 4.5 hours of symptom onset at 7 hospitals. Logistic regression models were used for predicting the effect of the reperfused penumbral Volume on the dichotomized modified Rankin Scale (mRS) at 90 days and improvement of National Institutes of Health Stroke Scale at 24 hours, both adjusted for baseline ischemic Core Volume. Results— This study included 1507 patients. Reperfused penumbral Volume had moderate ability to predict 90-day mRS 0 to 1 (area under the curve, 0.77; R 2 , 0.28; P R 2 , 0.55; P R 2 , 0.31; P R 2 , 0.41; P Conclusions— In patients treated with alteplase, the extent of the penumbra that is reperfused is a powerful predictor of early and late clinical outcomes, particularly when baseline ischemic Core is taken into account.
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Evaluation of hyperacute infarct Volume using ASPECTS and brain CT perfusion Core Volume.
Neurology, 2017Co-Authors: Jelle Demeestere, Mark W. Parsons, Carlos Garcia-esperon, Pablo García-bermejo, Fouke Ombelet, Patrick Mcelduff, Andrew Bivard, Christopher R. LeviAbstract:Objective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography SCore (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. Methods: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS sCores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion Core Volume to detect an acute MRI diffusion lesion of ≥70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J. Results: Median ASPECTS sCore was 8 (interquartile range [IQR] 5–9). Median CT perfusion Core Volume was 22 mL (IQR 10.4–71.9). Median MRI diffusion lesion Volume was 24.5 mL (IQR 10–63.9). No significant difference was found between the accuracy of CT perfusion and ASPECTS (c statistic 0.95 vs 0.87, p value for difference = 0.17). The optimum ASPECTS cutoff sCore to detect a diffusion-weighted imaging lesion ≥70 mL was Conclusions: We found no significant difference between the accuracy of CT perfusion and ASPECTS to predict hyperacute MRI lesion Volume in ischemic stroke.
Nawaf Yassi - One of the best experts on this subject based on the ideXlab platform.
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penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy a meta analysis of individual patient level data
Lancet Neurology, 2019Co-Authors: Bruce C V Campbell, Charles B L M Majoie, Nawaf Yassi, Gagan Sharma, Gregory W Albers, Bijoy K Menon, Wim H Van Zwam, Robert J Van Oostenbrugge, Andrew M DemchukAbstract:Summary Background CT perfusion (CTP) and diffusion or perfusion MRI might assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of irreversibly injured ischaemic Core and potentially salvageable penumbra Volumes were associated with functional outcome and whether they interacted with the treatment effect of endovascular thrombectomy on functional outcome. Methods In this systematic review and meta-analysis, the HERMES collaboration pooled patient-level data from all randomised controlled trials that compared endovascular thrombectomy (predominantly using stent retrievers) with standard medical therapy in patients with anterior circulation ischaemic stroke, published in PubMed from Jan 1, 2010, to May 31, 2017. The primary endpoint was functional outcome, assessed by the modified Rankin Scale (mRS) at 90 days after stroke. Ischaemic Core was estimated, before treatment with either endovascular thrombectomy or standard medical therapy, by CTP as relative cerebral blood flow less than 30% of normal brain blood flow or by MRI as an apparent diffusion coefficient less than 620 μm 2 /s. Critically hypoperfused tissue was estimated as the Volume of tissue with a CTP time to maximum longer than 6 s. Mismatch Volume (ie, the estimated penumbral Volume) was calculated as critically hypoperfused tissue Volume minus ischaemic Core Volume. The association of ischaemic Core and penumbral Volumes with 90-day mRS sCore was analysed with multivariable logistic regression (functional independence, defined as mRS sCore 0–2) and ordinal logistic regression (functional improvement by at least one mRS category) in all patients and in a subset of those with more than 50% endovascular reperfusion, adjusted for baseline prognostic variables. The meta-analysis was prospectively designed by the HERMES executive committee, but not registered. Findings We identified seven studies with 1764 patients, all of which were included in the meta-analysis. CTP was available and assessable for 591 (34%) patients and diffusion MRI for 309 (18%) patients. Functional independence was worse in patients who had CTP versus those who had diffusion MRI, after adjustment for ischaemic Core Volume (odds ratio [OR] 0·47 [95% CI 0·30–0·72], p=0·0007), so the imaging modalities were not pooled. Increasing ischaemic Core Volume was associated with reduced likelihood of functional independence (CTP OR 0·77 [0·69–0·86] per 10 mL, p interaction =0·29; diffusion MRI OR 0·87 [0·81–0·94] per 10 mL, p interaction =0·94). Mismatch Volume, examined only in the CTP group because of the small numbers of patients who had perfusion MRI, was not associated with either functional independence or functional improvement. In patients with CTP with more than 50% endovascular reperfusion (n=186), age, ischaemic Core Volume, and imaging-to-reperfusion time were independently associated with functional improvement. Risk of bias between studies was generally low. Interpretation Estimated ischaemic Core Volume was independently associated with functional independence and functional improvement but did not modify the treatment benefit of endovascular thrombectomy over standard medical therapy for improved functional outcome. Combining ischaemic Core Volume with age and expected imaging-to-reperfusion time will improve assessment of prognosis and might inform endovascular thrombectomy treatment decisions. Funding Medtronic.
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Volumetric and spatial accuracy of computed tomography perfusion estimated ischemic Core Volume in patients with acute ischemic stroke
Stroke, 2018Co-Authors: Jan W Hoving, Henk A Marquering, Charles B L M Majoie, Nawaf Yassi, Gagan Sharma, David S Liebeskind, Aad Van Der Lugt, Yvo B W E M RoosAbstract:Background and Purpose- The Volume of estimated ischemic Core using computed tomography perfusion (CTP) imaging can identify ischemic stroke patients who are likely to benefit from reperfusion, particularly beyond standard time windows. We assessed the accuracy of pretreatment CTP estimated ischemic Core in patients with successful endovascular reperfusion. Methods- Patients from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) and EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) databases who had pretreatment CTP, >50% angiographic reperfusion, and follow-up magnetic resonance imaging at 24 hours were included. Ischemic Core Volume on baseline CTP data was estimated using relative cerebral blood flow <30% (RAPID, iSchemaView). Follow-up diffusion magnetic resonance imaging was registered to CTP, and the diffusion lesion was outlined using a semiautomated algorithm. Volumetric and spatial agreement (using Dice similarity coefficient, average Hausdorff distance, and precision) was assessed, and expert visual assessment of quality was performed. Results- In 120 patients, median CTP estimated ischemic Core Volume was 7.8 mL (IQR, 1.8-19.9 mL), and median diffusion lesion Volume at 24 hours was 30.8 mL (IQR, 14.9-67.6 mL). Median Volumetric difference was 4.4 mL (IQR, 1.2-12.0 mL). Dice similarity coefficient was low (median, 0.24; IQR, 0.15-0.37). The median precision (positive predictive value) of 0.68 (IQR, 0.40-0.88) and average Hausdorff distance (median, 3.1; IQR, 1.8-5.7 mm) indicated reasonable spatial agreement for regions estimated as ischemic Core at baseline. Overestimation of total ischemic Core Volume by CTP was uncommon. Expert visual review revealed overestimation predominantly in white matter regions. Conclusions- CTP estimated ischemic Core Volumes were substantially smaller than follow-up diffusion-weighted imaging lesions at 24 hours despite endovascular reperfusion within 2 hours of imaging. This may be partly because of infarct growth. Volumetric CTP Core overestimation was uncommon and not related to imaging-to-reperfusion time. Core overestimation in white matter should be a focus of future efforts to improve CTP accuracy.
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Volumetric and Spatial Accuracy of Computed Tomography Perfusion Estimated Ischemic Core Volume in Patients With Acute Ischemic Stroke.
Stroke, 2018Co-Authors: Jan W Hoving, Henk A Marquering, Charles B L M Majoie, Nawaf Yassi, Gagan Sharma, David S Liebeskind, Aad Van Der Lugt, Yvo B W E M Roos, Wim H. Van Zwam, Robert J. Van OostenbruggeAbstract:Background and Purpose- The Volume of estimated ischemic Core using computed tomography perfusion (CTP) imaging can identify ischemic stroke patients who are likely to benefit from reperfusion, particularly beyond standard time windows. We assessed the accuracy of pretreatment CTP estimated ischemic Core in patients with successful endovascular reperfusion. Methods- Patients from the HERMES (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) and EXTEND-IA TNK (Tenecteplase Versus Alteplase Before Endovascular Therapy for Ischemic Stroke) databases who had pretreatment CTP, >50% angiographic reperfusion, and follow-up magnetic resonance imaging at 24 hours were included. Ischemic Core Volume on baseline CTP data was estimated using relative cerebral blood flow
Jelle Demeestere - One of the best experts on this subject based on the ideXlab platform.
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Alberta Stroke Program Early CT SCore Versus Computed Tomographic Perfusion to Predict Functional Outcome After Successful Reperfusion in Acute Ischemic Stroke.
Stroke, 2018Co-Authors: Jelle Demeestere, Gregory W Albers, Soren Christensen, Michael Mlynash, Lauranne Scheldeman, Sandra Cornelissen, Sam Heye, Anke Wouters, Patrick Dupont, Maarten G. LansbergAbstract:Background and Purpose- We aimed to compare the ability of conventional Alberta Stroke Program Early CT SCore (ASPECTS), automated ASPECTS, and ischemic Core Volume on computed tomographic perfusion to predict clinical outcome in ischemic stroke because of large vessel occlusion ≤18 hours after symptom onset. Methods- We selected patients with acute ischemic stroke from the CRISP study (Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke Project) with successful reperfusion (modified treatment in cerebral ischemia sCore 2b or 3). We used e-ASPECTS software to calculate automated ASPECTS and RAPID software to estimate ischemic Core Volumes. We studied associations between these imaging characteristics and good outcome (modified Rankin Scale sCore, 0-2) or poor outcome (modified Rankin Scale sCore, 4-6) in univariable and multivariable analysis, after adjustment for relevant clinical confounders. Results- We included 156 patients. Conventional and automated ASPECTS was not associated with good or poor outcome in univariable analysis ( P=nonsignificant for all). Automated ASPECTS was associated with good outcome in multivariable analysis ( P=0.02) but not with poor outcome. Ischemic Core Volume was associated with good ( P
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Author response: Evaluation of hyperacute infarct Volume using ASPECTS and brain CT perfusion Core Volume.
Neurology, 2017Co-Authors: Christopher R. Levi, Jelle Demeestere, Carlos Garcia-esperon, Pablo García-bermejo, Fouke Ombelet, Patrick Mcelduff, Andrew Bivard, Mark W. ParsonsAbstract:Demeestere et al.1 compared hyperacute infarct Volume using the Alberta Stroke Program Early CT SCore (ASPECTS) and brain CT perfusion and found no significant difference. ASPECTS and CT perfusion-based studies have already established their critical role in selecting patients for thrombolysis and mechanical recanalization.2,3 In this study, ASPECTS or CT perfusion Core Volume was compared with MRI diffusion-weighted imaging (DWI) lesion Volume.1 However, MRI was performed within 100 minutes (median 60 minutes) of CT perfusion and 49% of patients received thrombolysis before MRI.
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Evaluation of hyperacute infarct Volume using ASPECTS and brain CT perfusion Core Volume.
Neurology, 2017Co-Authors: Jelle Demeestere, Mark W. Parsons, Carlos Garcia-esperon, Pablo García-bermejo, Fouke Ombelet, Patrick Mcelduff, Andrew Bivard, Christopher R. LeviAbstract:Objective: To compare the accuracy of Alberta Stroke Program Early Computed Tomography SCore (ASPECTS) and CT perfusion to detect established infarction in acute anterior circulation stroke. Methods: We performed an observational study in 59 acute anterior circulation ischemic stroke patients who underwent brain noncontrast CT, CT perfusion, and MRI within 100 minutes from CT imaging. ASPECTS sCores were calculated by 4 blinded vascular neurologists. The accuracy of ASPECTS and CT perfusion Core Volume to detect an acute MRI diffusion lesion of ≥70 mL was evaluated using receiver operating characteristics analysis and optimum cutoff values were calculated using Youden J. Results: Median ASPECTS sCore was 8 (interquartile range [IQR] 5–9). Median CT perfusion Core Volume was 22 mL (IQR 10.4–71.9). Median MRI diffusion lesion Volume was 24.5 mL (IQR 10–63.9). No significant difference was found between the accuracy of CT perfusion and ASPECTS (c statistic 0.95 vs 0.87, p value for difference = 0.17). The optimum ASPECTS cutoff sCore to detect a diffusion-weighted imaging lesion ≥70 mL was Conclusions: We found no significant difference between the accuracy of CT perfusion and ASPECTS to predict hyperacute MRI lesion Volume in ischemic stroke.