Adnan I Qureshi, Yilun Huang, Ibrahim A Bhatti, Camilo R Gomez, Daniel F Hanley, Daniel E Ford, Ameer E Hassan, Thanh N Nguyen, Alejandro M Spiotta, Erol Veznedaroglu, Ronald F Budzik, Rishi Gupta, Raul G Nogueira, Antonin Krajina, Bruno Bartolini, Joey English, Blaise Baxter, David S Liebeskind
Background and purpose: Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.
Methods: We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis.
Results: A total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .34). Among patients who received IV thrombolysis (n = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations.
Conclusions: In patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics.
背景和目的:越来越多的急性缺血性卒中患者考虑将动脉内溶栓作为机械取栓术的辅助手段,以加强再灌注。在某些患者亚群中,动脉内溶栓可能会增加血栓切除术后脑内出血(ICH)的风险:方法:我们分析了在多中心登记中接受机械溶栓治疗的急性缺血性脑卒中患者。血栓切除术后任何(无症状和有症状)ICH的发生都是根据标准定义确定的,要求在血栓切除术后48小时内进行连续的神经系统检查和计算机断层扫描。我们根据临床特征和静脉(IV)溶栓的使用情况确定了亚组的 ICH 风险:在 1953 名接受机械血栓切除术的急性缺血性脑卒中患者中,共有 146 名(7.5%)患者接受了动脉内溶栓治疗。接受和未接受动脉内溶栓治疗的患者中,发生任何 ICH 的比例分别为 26 例(17.8%)和 510 例(28.2%)(p = .006)。接受和未接受动脉内溶栓治疗的患者中,出现症状性 ICH 的比例分别为 4(2.7%)和 30(1.7%)(p = .34)。在接受静脉溶栓治疗的患者(n = 1042)中,接受和未接受动脉内溶栓治疗的患者发生任何 ICH 的比例分别为 9(16.7%)和 294(30.7%)(p = .028)。根据年龄、性别、闭塞位置、术前美国国立卫生研究院卒中量表评分、症状出现与血栓切除术之间的时间间隔、阿尔伯塔省卒中项目早期CT评分、收缩压和血清葡萄糖浓度等因素确定的分层风险没有差异:在接受机械血栓切除术的患者中,动脉内溶栓不会增加任何 ICH 和症状性 ICH 的风险,包括那些已经接受过静脉溶栓治疗的患者。
{"title":"Intracerebral hemorrhage risk after adjunct intraarterial thrombolysis in thrombectomy-treated acute ischemic stroke.","authors":"Adnan I Qureshi, Yilun Huang, Ibrahim A Bhatti, Camilo R Gomez, Daniel F Hanley, Daniel E Ford, Ameer E Hassan, Thanh N Nguyen, Alejandro M Spiotta, Erol Veznedaroglu, Ronald F Budzik, Rishi Gupta, Raul G Nogueira, Antonin Krajina, Bruno Bartolini, Joey English, Blaise Baxter, David S Liebeskind","doi":"10.1111/jon.13238","DOIUrl":"https://doi.org/10.1111/jon.13238","url":null,"abstract":"<p><strong>Background and purpose: </strong>Intraarterial thrombolysis as an adjunct to mechanical thrombectomy is increasingly being considered to enhance reperfusion in acute ischemic stroke patients. Intraarterial thrombolysis may increase the risk of post-thrombectomy intracerebral hemorrhage (ICH) in certain patient subgroups.</p><p><strong>Methods: </strong>We analyzed acute ischemic stroke patients treated with mechanical thrombectomy in a multicenter registry. The occurrence of any (asymptomatic and symptomatic) post-thrombectomy ICH was ascertained using standard definition requiring serial neurological examinations and computed tomographic scans acquired within 48 hours of the thrombectomy. We determined the risk of ICH in subgroups defined by clinical characteristics and the use of intravenous (IV) thrombolysis.</p><p><strong>Results: </strong>A total of 146 (7.5%) patients received intraarterial thrombolysis among 1953 acute ischemic stroke patients who underwent mechanical thrombectomy. The proportion of patients who developed any ICH was 26 (17.8%) and 510 (28.2%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .006). The proportion of patients who developed symptomatic ICH was 4 (2.7%) and 30 (1.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .34). Among patients who received IV thrombolysis (n = 1042), the proportion of patients who developed any ICH was 9 (16.7%) and 294 (30.7%) among patients who were and were not treated with intraarterial thrombolysis, respectively (p = .028). The risk was not different in strata defined by age, gender, location of occlusion, preprocedure National Institutes of Health Stroke Scale score, time interval between symptom onset and thrombectomy, Alberta Stroke Program Early CT Score, systolic blood pressure, and serum glucose concentrations.</p><p><strong>Conclusions: </strong>In patients undergoing mechanical thrombectomy, the risk of any ICH and symptomatic ICH was not increased with intraarterial thrombolysis, including in those who had already received IV thrombolytics.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aynur Azizova, Ivar J H G Wamelink, Yeva Prysiazhniuk, Marcus Cakmak, Elif Kaya, Jan Petr, Frederik Barkhof, Vera C Keil
Background and purpose: To develop and test a decision tree for predicting contrast enhancement quality and shape using precontrast magnetic resonance imaging (MRI) sequences in a large adult-type diffuse glioma cohort.
Methods: Preoperative MRI scans (development/optimization/test sets: n = 31/38/303, male = 17/22/189, mean age = 52/59/56.7 years, high-grade glioma = 22/33/249) were retrospectively evaluated, including pre- and postcontrast T1-weighted, T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences. Enhancement prediction decision tree (EPDT) was developed using development and optimization sets, incorporating four imaging features: necrosis, diffusion restriction, T2 inhomogeneity, and nonenhancing tumor margins. EPDT accuracy was assessed on a test set by three raters of variable experience. True enhancement features (gold standard) were evaluated using pre- and postcontrast T1-weighted images. Statistical analysis used confusion matrices, Cohen's/Fleiss' kappa, and Kendall's W. Significance threshold was p < .05.
Results: Raters 1, 2, and 3 achieved overall accuracies of .86 (95% confidence interval [CI]: .81-.90), .89 (95% CI: .85-.92), and .92 (95% CI: .89-.95), respectively, in predicting enhancement quality (marked, mild, or no enhancement). Regarding shape, defined as the thickness of enhancing margin (solid, rim, or no enhancement), accuracies were .84 (95% CI: .79-.88), .88 (95% CI: .84-.92), and .89 (95% CI: .85-.92). Intrarater intergroup agreement comparing predicted and true enhancement features consistently reached substantial levels (≥.68 [95% CI: .61-.75]). Interrater comparison showed at least moderate agreement (group: ≥.42 [95% CI: .36-.48], pairwise: ≥.61 [95% CI: .50-.72]). Among the imaging features in the EPDT, necrosis assessment displayed the highest intra- and interrater consistency (≥.80 [95% CI: .73-.88]).
Conclusion: The proposed EPDT has high accuracy in predicting enhancement patterns of gliomas irrespective of rater experience.
{"title":"Human performance in predicting enhancement quality of gliomas using gadolinium-free MRI sequences.","authors":"Aynur Azizova, Ivar J H G Wamelink, Yeva Prysiazhniuk, Marcus Cakmak, Elif Kaya, Jan Petr, Frederik Barkhof, Vera C Keil","doi":"10.1111/jon.13233","DOIUrl":"https://doi.org/10.1111/jon.13233","url":null,"abstract":"<p><strong>Background and purpose: </strong>To develop and test a decision tree for predicting contrast enhancement quality and shape using precontrast magnetic resonance imaging (MRI) sequences in a large adult-type diffuse glioma cohort.</p><p><strong>Methods: </strong>Preoperative MRI scans (development/optimization/test sets: n = 31/38/303, male = 17/22/189, mean age = 52/59/56.7 years, high-grade glioma = 22/33/249) were retrospectively evaluated, including pre- and postcontrast T1-weighted, T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences. Enhancement prediction decision tree (EPDT) was developed using development and optimization sets, incorporating four imaging features: necrosis, diffusion restriction, T2 inhomogeneity, and nonenhancing tumor margins. EPDT accuracy was assessed on a test set by three raters of variable experience. True enhancement features (gold standard) were evaluated using pre- and postcontrast T1-weighted images. Statistical analysis used confusion matrices, Cohen's/Fleiss' kappa, and Kendall's W. Significance threshold was p < .05.</p><p><strong>Results: </strong>Raters 1, 2, and 3 achieved overall accuracies of .86 (95% confidence interval [CI]: .81-.90), .89 (95% CI: .85-.92), and .92 (95% CI: .89-.95), respectively, in predicting enhancement quality (marked, mild, or no enhancement). Regarding shape, defined as the thickness of enhancing margin (solid, rim, or no enhancement), accuracies were .84 (95% CI: .79-.88), .88 (95% CI: .84-.92), and .89 (95% CI: .85-.92). Intrarater intergroup agreement comparing predicted and true enhancement features consistently reached substantial levels (≥.68 [95% CI: .61-.75]). Interrater comparison showed at least moderate agreement (group: ≥.42 [95% CI: .36-.48], pairwise: ≥.61 [95% CI: .50-.72]). Among the imaging features in the EPDT, necrosis assessment displayed the highest intra- and interrater consistency (≥.80 [95% CI: .73-.88]).</p><p><strong>Conclusion: </strong>The proposed EPDT has high accuracy in predicting enhancement patterns of gliomas irrespective of rater experience.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Omid Shoraka, Mashaal Syed, Shreya Mandloi, Sara Thalheimer, Sara Naghizadeh Kashani, Joshua E. Heller, Feroze B. Mohamed, Ashwini D. Sharan, Kiran S. Talekar, Caio M. Matias, James S. Harrop, Laura Krisa, Mahdi Alizadeh
Background and PurposeNeuropathic pain (NP) is a debilitating condition following spinal cord injury (SCI). The role of periaqueductal gray (PAG) in NP development following SCI remains underexplored. Using resting‐state functional MRI (rsfMRI), our study aimed to demonstrate the alterations in functional connectivity (FC) of PAG in NP following SCI.MethodsTen SCI patients (SCI + NP, n = 7, and SCI − NP, n = 3), alongside 10 healthy controls (HCs), were enrolled. rsfMRI was conducted followed by seed‐to‐voxel analysis using PAG as the seed region and then group‐based analysis comprising three groups (SCI + NP, SCI − NP, and HC). Age and gender were considered as confounding variables.ResultsCompared to HCs, SCI + NP demonstrated decreased FC between PAG and right insula, right frontal orbital cortex, right pallidum, dorsal raphe nucleus (DRN), red nuclei (RN), substantia nigra (SN), and ventral posterolateral (VPL) thalamic nuclei. Compared to SCI − NP, SCI + NP demonstrated increased FC between PAG and posterior cingulate cortex (PCC), hippocampus, cerebellar vermis lobules IV and V, and thalamic structures (posterior and lateral pulvinar, the mediodorsal nuclei, and the ventral lateral nuclei). Additionally, decreased FC between the PAG and VPL, geniculate bodies, intralaminar nuclei of thalamus, DRN, RN, SN, and prefrontal cortex was observed in this comparison.ConclusionsAltered FC between PAG and right anterior insula, VPL, DRN, RN, SN, cerebellar vermis lobules IV and V, frontal cortex, and PCC was associated with NP sequelae of SCI. Additionally, SCI was independently associated with decreased FC between PAG and right posterior insula, cerebellar lobules IV and V, and cerebellar vermis lobules III, IV, and V.
{"title":"Periaqueductal gray connectivity in spinal cord injury‐induced neuropathic pain","authors":"Omid Shoraka, Mashaal Syed, Shreya Mandloi, Sara Thalheimer, Sara Naghizadeh Kashani, Joshua E. Heller, Feroze B. Mohamed, Ashwini D. Sharan, Kiran S. Talekar, Caio M. Matias, James S. Harrop, Laura Krisa, Mahdi Alizadeh","doi":"10.1111/jon.13237","DOIUrl":"https://doi.org/10.1111/jon.13237","url":null,"abstract":"Background and PurposeNeuropathic pain (NP) is a debilitating condition following spinal cord injury (SCI). The role of periaqueductal gray (PAG) in NP development following SCI remains underexplored. Using resting‐state functional MRI (rsfMRI), our study aimed to demonstrate the alterations in functional connectivity (FC) of PAG in NP following SCI.MethodsTen SCI patients (SCI + NP, <jats:italic>n</jats:italic> = 7, and SCI − NP, <jats:italic>n</jats:italic> = 3), alongside 10 healthy controls (HCs), were enrolled. rsfMRI was conducted followed by seed‐to‐voxel analysis using PAG as the seed region and then group‐based analysis comprising three groups (SCI + NP, SCI − NP, and HC). Age and gender were considered as confounding variables.ResultsCompared to HCs, SCI + NP demonstrated decreased FC between PAG and right insula, right frontal orbital cortex, right pallidum, dorsal raphe nucleus (DRN), red nuclei (RN), substantia nigra (SN), and ventral posterolateral (VPL) thalamic nuclei. Compared to SCI − NP, SCI + NP demonstrated increased FC between PAG and posterior cingulate cortex (PCC), hippocampus, cerebellar vermis lobules IV and V, and thalamic structures (posterior and lateral pulvinar, the mediodorsal nuclei, and the ventral lateral nuclei). Additionally, decreased FC between the PAG and VPL, geniculate bodies, intralaminar nuclei of thalamus, DRN, RN, SN, and prefrontal cortex was observed in this comparison.ConclusionsAltered FC between PAG and right anterior insula, VPL, DRN, RN, SN, cerebellar vermis lobules IV and V, frontal cortex, and PCC was associated with NP sequelae of SCI. Additionally, SCI was independently associated with decreased FC between PAG and right posterior insula, cerebellar lobules IV and V, and cerebellar vermis lobules III, IV, and V.","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roger Mateu-Estivill, Ana Adan, Sergi Grau, Xavier Rifà-Ros, Xavier Caldú, Núria Bargalló, Josep M Serra-Grabulosa
Background and purpose: In recent years, there has been a growing interest in the study of resting neural networks in different neurological and mental disorders. While previous studies suggest that the default mode network (DMN) may be altered in dyscalculia, the study of resting-state networks in the development of numerical skills, especially in children with developmental dyscalculia (DD), is scarce and relatively recent. Based on this, this study examines differences in resting-state functional connectivity (rs-FC) data of children with DD using functional connectivity multivariate pattern analysis (fc-MVPA), a data-driven methodology that summarizes properties of the entire connectome.
Methods: We performed fc-MVPA on resting-state images of a sample composed of a group of children with DD (n = 19, 8.06 ± 0.87 years) and an age- and sex-matched control group of typically developing children (n = 23, 7.76 ± 0.46 years).
Results: Analysis of fc-MVPA showed significant differences between group connectivity profiles in two clusters allocated in both the right and left medial temporal gyrus. Post hoc effect size results revealed a decreased rs-FC between each temporal pole and the DMN in children with DD and an increased rs-FC between each temporal pole and the sensorimotor network.
Conclusions: Our results suggest an aberrant information flow between resting-state networks in children with DD, demonstrating the importance of these networks for arithmetic development.
{"title":"Alterations in functional brain connectivity associated with developmental dyscalculia.","authors":"Roger Mateu-Estivill, Ana Adan, Sergi Grau, Xavier Rifà-Ros, Xavier Caldú, Núria Bargalló, Josep M Serra-Grabulosa","doi":"10.1111/jon.13236","DOIUrl":"https://doi.org/10.1111/jon.13236","url":null,"abstract":"<p><strong>Background and purpose: </strong>In recent years, there has been a growing interest in the study of resting neural networks in different neurological and mental disorders. While previous studies suggest that the default mode network (DMN) may be altered in dyscalculia, the study of resting-state networks in the development of numerical skills, especially in children with developmental dyscalculia (DD), is scarce and relatively recent. Based on this, this study examines differences in resting-state functional connectivity (rs-FC) data of children with DD using functional connectivity multivariate pattern analysis (fc-MVPA), a data-driven methodology that summarizes properties of the entire connectome.</p><p><strong>Methods: </strong>We performed fc-MVPA on resting-state images of a sample composed of a group of children with DD (n = 19, 8.06 ± 0.87 years) and an age- and sex-matched control group of typically developing children (n = 23, 7.76 ± 0.46 years).</p><p><strong>Results: </strong>Analysis of fc-MVPA showed significant differences between group connectivity profiles in two clusters allocated in both the right and left medial temporal gyrus. Post hoc effect size results revealed a decreased rs-FC between each temporal pole and the DMN in children with DD and an increased rs-FC between each temporal pole and the sensorimotor network.</p><p><strong>Conclusions: </strong>Our results suggest an aberrant information flow between resting-state networks in children with DD, demonstrating the importance of these networks for arithmetic development.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142140344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adnan I Qureshi, Ibrahim A Bhatti, Syed A Gillani, Jonathan Beall, Christy N Cassarly, Byron Gajewski, Renee H Martin, Jose I Suarez, Chun Shing Kwok
Background and purpose: Cerebral infarction remains an important cause of death or disability in patients with aneurysmal subarachnoid hemorrhage (SAH). The prevalence, trends, and outcomes of cerebral infarction in patients with aneurysmal SAH at a national level are not known.
Methods: We identified the proportion of patients who develop cerebral infarction (ascertained using validated methodology) among patients with aneurysmal SAH and annual trends using the Nationwide Inpatient Sample (NIS) from 2016 to 2021. We analyzed the effect of cerebral infarction on in-hospital mortality, routine discharge without palliative care (based on discharge disposition), poor outcome defined by the NIS SAH outcome measure, and length and costs of hospitalization after adjusting for potential confounders.
Results: A total of 35,305 (53.6%) patients developed cerebral infarction among 65,840 patients with aneurysmal SAH over a 6-year period. There was a trend toward an increase in the proportion of patients who developed cerebral infarction from 51.5% in 2016 to 56.1% in 2021 (p trend p<.001). Routine discharge was significantly lower (30.5% vs. 37.8%, odds ratio [OR] 0.82, 95% confidence interval [CI] 0.75-0.89, p<.001), and poor outcome defined by NIS-SAH outcome measure was significantly higher among patients with cerebral infarction compared with those without cerebral infarction (67.4% vs. 59.3%, OR 1.29, 95% CI 1.18-1.40, p<.001). There was no difference in in-hospital mortality (13.0% vs. 13.6%, OR 0.94, 95% CI 0.85-1.05, p = .30). The length of stay (median 18 days [interquartile range [IQR] 13-25] vs. 14 days [IQR 9-20]), coefficient 3.04, 95% CI 2.44-3.52 and hospitalization cost (median $96,823 vs. $71,311, coefficient 22,320, 95% CI 20,053-24,587) were significantly higher among patients who developed cerebral infarction compared with those who did not develop cerebral infarction.
Conclusions: Cerebral infarction was seen in 54% of the patients with a trend toward an increase in the affected proportion of patients with aneurysmal SAH. Patients with cerebral infarction had higher rates of adverse outcomes and required higher resources during hospitalization.
{"title":"Prevalence, trends, and outcomes of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage in the USA.","authors":"Adnan I Qureshi, Ibrahim A Bhatti, Syed A Gillani, Jonathan Beall, Christy N Cassarly, Byron Gajewski, Renee H Martin, Jose I Suarez, Chun Shing Kwok","doi":"10.1111/jon.13229","DOIUrl":"https://doi.org/10.1111/jon.13229","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cerebral infarction remains an important cause of death or disability in patients with aneurysmal subarachnoid hemorrhage (SAH). The prevalence, trends, and outcomes of cerebral infarction in patients with aneurysmal SAH at a national level are not known.</p><p><strong>Methods: </strong>We identified the proportion of patients who develop cerebral infarction (ascertained using validated methodology) among patients with aneurysmal SAH and annual trends using the Nationwide Inpatient Sample (NIS) from 2016 to 2021. We analyzed the effect of cerebral infarction on in-hospital mortality, routine discharge without palliative care (based on discharge disposition), poor outcome defined by the NIS SAH outcome measure, and length and costs of hospitalization after adjusting for potential confounders.</p><p><strong>Results: </strong>A total of 35,305 (53.6%) patients developed cerebral infarction among 65,840 patients with aneurysmal SAH over a 6-year period. There was a trend toward an increase in the proportion of patients who developed cerebral infarction from 51.5% in 2016 to 56.1% in 2021 (p trend p<.001). Routine discharge was significantly lower (30.5% vs. 37.8%, odds ratio [OR] 0.82, 95% confidence interval [CI] 0.75-0.89, p<.001), and poor outcome defined by NIS-SAH outcome measure was significantly higher among patients with cerebral infarction compared with those without cerebral infarction (67.4% vs. 59.3%, OR 1.29, 95% CI 1.18-1.40, p<.001). There was no difference in in-hospital mortality (13.0% vs. 13.6%, OR 0.94, 95% CI 0.85-1.05, p = .30). The length of stay (median 18 days [interquartile range [IQR] 13-25] vs. 14 days [IQR 9-20]), coefficient 3.04, 95% CI 2.44-3.52 and hospitalization cost (median $96,823 vs. $71,311, coefficient 22,320, 95% CI 20,053-24,587) were significantly higher among patients who developed cerebral infarction compared with those who did not develop cerebral infarction.</p><p><strong>Conclusions: </strong>Cerebral infarction was seen in 54% of the patients with a trend toward an increase in the affected proportion of patients with aneurysmal SAH. Patients with cerebral infarction had higher rates of adverse outcomes and required higher resources during hospitalization.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hamza Adel Salim, Shenwen Huang, Dhairya A Lakhani, Janet Mei, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Mona Bahouth, Adam A Dmytriw, Adrien Guenego, Gregory W Albers's, Hanzhang Lu, Victor C Urrutia, Kambiz Nael, Elisabeth B Marsh, Argye E Hillis, Raf Llinas, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Vivek Yedavalli
Background and purpose: Ischemic strokes due to isolated posterior cerebral artery (PCA) occlusions represent 5% of all strokes but have significant impacts on patients' quality of life, primarily due to visual deficits and thalamic involvement. Current guidelines for acute PCA occlusion management are sparse, and the prognostic value of perfusion imaging parameters remains underexplored.
Methods: We conducted a retrospective analysis of 32 patients with isolated PCA occlusions treated at Johns Hopkins Medical Institutions between January 2017 and March 2023. Patients underwent pretreatment perfusion imaging, with perfusion parameters analyzed using RAPID software. The primary outcome was short-term clinical outcome as measured by the National Institutes of Health Stroke Scale (NIHSS) at discharge.
Results: The median age of the cohort was 70 years, with 34% female and 66% male. Significant correlations were found between NIHSS at discharge and various perfusion parameters, including time-to-maximum (Tmax) >6 seconds (ρ = .55, p = .004), Tmax >8 seconds (ρ = .59, p = .002), Tmax >10 seconds (ρ = .6, p = .001), mismatch volume (ρ = .51, p = .008), and cerebral blood volume (CBV) < 34% (ρ = .59, p = .002).
Conclusions: Tmax and CBV volumes significantly correlated with discharge NIHSS with marginal superiority of Tmax >10 seconds and CBV <42% volumes. These findings suggest that CT and MR perfusion imaging can play a crucial role in the acute management of PCA strokes, though larger, standardized studies are needed to validate these results and refine imaging thresholds specific to posterior circulation infarcts.
{"title":"Perfusion imaging predicts short-term clinical outcome in isolated posterior cerebral artery occlusion stroke.","authors":"Hamza Adel Salim, Shenwen Huang, Dhairya A Lakhani, Janet Mei, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Mona Bahouth, Adam A Dmytriw, Adrien Guenego, Gregory W Albers's, Hanzhang Lu, Victor C Urrutia, Kambiz Nael, Elisabeth B Marsh, Argye E Hillis, Raf Llinas, Max Wintermark, Jeremy J Heit, Tobias D Faizy, Vivek Yedavalli","doi":"10.1111/jon.13235","DOIUrl":"https://doi.org/10.1111/jon.13235","url":null,"abstract":"<p><strong>Background and purpose: </strong>Ischemic strokes due to isolated posterior cerebral artery (PCA) occlusions represent 5% of all strokes but have significant impacts on patients' quality of life, primarily due to visual deficits and thalamic involvement. Current guidelines for acute PCA occlusion management are sparse, and the prognostic value of perfusion imaging parameters remains underexplored.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 32 patients with isolated PCA occlusions treated at Johns Hopkins Medical Institutions between January 2017 and March 2023. Patients underwent pretreatment perfusion imaging, with perfusion parameters analyzed using RAPID software. The primary outcome was short-term clinical outcome as measured by the National Institutes of Health Stroke Scale (NIHSS) at discharge.</p><p><strong>Results: </strong>The median age of the cohort was 70 years, with 34% female and 66% male. Significant correlations were found between NIHSS at discharge and various perfusion parameters, including time-to-maximum (Tmax) >6 seconds (ρ = .55, p = .004), Tmax >8 seconds (ρ = .59, p = .002), Tmax >10 seconds (ρ = .6, p = .001), mismatch volume (ρ = .51, p = .008), and cerebral blood volume (CBV) < 34% (ρ = .59, p = .002).</p><p><strong>Conclusions: </strong>Tmax and CBV volumes significantly correlated with discharge NIHSS with marginal superiority of Tmax >10 seconds and CBV <42% volumes. These findings suggest that CT and MR perfusion imaging can play a crucial role in the acute management of PCA strokes, though larger, standardized studies are needed to validate these results and refine imaging thresholds specific to posterior circulation infarcts.</p>","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Agnese Pirozzi, Antonietta Canna, Federica Di Nardo, Mario Sansone, Francesca Trojsi, Mario Cirillo, Fabrizio Esposito
<p><strong>Background and purpose: </strong>Susceptibility estimates derived from quantitative susceptibility mapping (QSM) images for the cerebral cortex and major subcortical structures are variably reported in brain magnetic resonance imaging (MRI) studies, as average of all ( <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> ), absolute ( <math> <semantics><msub><mi>μ</mi> <mi>abs</mi></msub> <annotation>${{{{mu}}}_{{mathrm{abs}}}}$</annotation></semantics> </math> ), or positive- ( <math> <semantics><msub><mi>μ</mi> <mi>p</mi></msub> <annotation>${{{{mu}}}_{mathrm{p}}}$</annotation></semantics> </math> ) and negative-only ( <math> <semantics><msub><mi>μ</mi> <mi>n</mi></msub> <annotation>${{{{mu}}}_{mathrm{n}}}$</annotation></semantics> </math> ) susceptibility values using a region of interest (ROI) approach. This pilot study presents a reliability analysis of currently used ROI-QSM metrics and an alternative ROI-based approach to obtain voxel-weighted ROI-QSM metrics ( <math> <semantics><msub><mi>μ</mi> <mi>wp</mi></msub> <annotation>${{{{mu}}}_{{mathrm{wp}}}}$</annotation></semantics> </math> and <math> <semantics><msub><mi>μ</mi> <mi>wn</mi></msub> <annotation>${{{{mu}}}_{{mathrm{wn}}}}$</annotation></semantics> </math> ).</p><p><strong>Methods: </strong>Ten healthy subjects underwent repeated (test-retest) 3-dimensional multi-echo gradient-echo (3DMEGE) 3 Tesla MRI measurements. Complex-valued 3DMEGE images were acquired and reconstructed with slice thicknesses of 1 and 2 mm (3DMEGE1, 3DMEGE2) along with 3DT1-weighted isometric (voxel 1 mm<sup>3</sup>) images for independent registration and ROI segmentation. Agreement, consistency, and reproducibility of ROI-QSM metrics were assessed through Bland-Altman analysis, intraclass correlation coefficient, and interscan and intersubject coefficient of variation (CoV).</p><p><strong>Results: </strong>All ROI-QSM metrics exhibited good to excellent consistency and test-retest agreement with no proportional bias. Interscan CoV was higher for <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> in comparison to the other metrics where it was below 15%, in both 3DMEGE1 and 3DMEGE2 datasets. Intersubject CoV for <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> and <math> <semantics><msub><mi>μ</mi> <mi>abs</mi></msub> <annotation>${{{{mu}}}_{{mathrm{abs}}}}$</annotation></semantics> </math> exceeded 50% in all ROIs.</p><p><strong>Conclusions: </strong>Among the evaluated ROI-QSM metrics, <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> and <math> <semantics><msub><mi>μ</mi> <mi>abs</mi></msub> <annotation>${{{{mu}}}_{{mathrm{abs}}}}$</annotation></semantics> </math> estimates were less rel
背景和目的:在脑磁共振成像(MRI)研究中,根据定量易感度图(QSM)图像得出的大脑皮层和主要皮层下结构的易感度估计值被不同程度地报告为所有的平均值(μ all ${{{{mu}}}_{mathrm{all}}}}$ )、绝对值(μ abs ${{{{mu}}}_{mathrm{abs}}}}$ ),或使用感兴趣区(ROI)方法的正感(μ p ${{{{mu}}}_{mathrm{p}}$ )和负感(μ n ${{{{mu}}}_{mathrm{n}}$ )。本试验研究对目前使用的ROI-QSM指标和另一种基于ROI的方法进行了可靠性分析,以获得体素加权的ROI-QSM指标(μ wp ${{{{mu}}}_{{mathrm{wp}}}}$ 和 μ wn ${{{{mu}}}_{mathrm{wn}}}}$ )。方法:十名健康受试者接受了重复(测试-再测试)三维多回波梯度回波(3DMEGE)3 特斯拉磁共振成像测量。采集并重建了切片厚度为 1 毫米和 2 毫米的复值 3DMEGE 图像(3DMEGE1、3DMEGE2)以及 3DT1 加权等距(体素 1 mm3)图像,用于独立配准和 ROI 分割。通过Bland-Altman分析、类内相关系数、扫描间和受试者间变异系数(CoV)评估了ROI-QSM指标的一致性、再现性和可重复性:结果:所有 ROI-QSM 指标都表现出良好到卓越的一致性和测试-再测试一致性,没有比例偏差。在3DMEGE1和3DMEGE2数据集中,μ all ${{{{mu}}}_{mathrm{all}}}}$的扫描间变异系数高于其他指标,后者低于15%。在所有ROI中,μ all ${{{{mu}}_{mathrm{all}}}}$ 和 μ abs ${{{{mu}}_{mathrm{abs}}}}$ 的受试者间CoV都超过了50%.结论:在所评估的 ROI-QSM 指标中,μ all ${{{{mu}}_{{mathrm{all}}}}$ 和 μ abs ${{{{mu}}_{{mathrm{abs}}}}$ 估计值的可靠性较低,而正负值分离(使用 μ p , μ n , μ wp 、 μ wn ${{{{mu}}}_{mathrm{p}}}, {{{{mu}}}_{mathrm{n}}}, {{{{mu}}}_{mathrm{wp}}}}, {{{{mu}}}_{mathrm{wn}}}}$ )提高了受试者内部的可重复性和受试者之间的可比性,即使在减少切片厚度的情况下也是如此。这些初步研究结果可能会为未来临床磁共振成像研究中不同患者群和成像环境下的ROI-QSM指标标准化提供有价值的见解。
{"title":"Reliability of quantitative magnetic susceptibility imaging metrics for cerebral cortex and major subcortical structures.","authors":"Maria Agnese Pirozzi, Antonietta Canna, Federica Di Nardo, Mario Sansone, Francesca Trojsi, Mario Cirillo, Fabrizio Esposito","doi":"10.1111/jon.13234","DOIUrl":"https://doi.org/10.1111/jon.13234","url":null,"abstract":"<p><strong>Background and purpose: </strong>Susceptibility estimates derived from quantitative susceptibility mapping (QSM) images for the cerebral cortex and major subcortical structures are variably reported in brain magnetic resonance imaging (MRI) studies, as average of all ( <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> ), absolute ( <math> <semantics><msub><mi>μ</mi> <mi>abs</mi></msub> <annotation>${{{{mu}}}_{{mathrm{abs}}}}$</annotation></semantics> </math> ), or positive- ( <math> <semantics><msub><mi>μ</mi> <mi>p</mi></msub> <annotation>${{{{mu}}}_{mathrm{p}}}$</annotation></semantics> </math> ) and negative-only ( <math> <semantics><msub><mi>μ</mi> <mi>n</mi></msub> <annotation>${{{{mu}}}_{mathrm{n}}}$</annotation></semantics> </math> ) susceptibility values using a region of interest (ROI) approach. This pilot study presents a reliability analysis of currently used ROI-QSM metrics and an alternative ROI-based approach to obtain voxel-weighted ROI-QSM metrics ( <math> <semantics><msub><mi>μ</mi> <mi>wp</mi></msub> <annotation>${{{{mu}}}_{{mathrm{wp}}}}$</annotation></semantics> </math> and <math> <semantics><msub><mi>μ</mi> <mi>wn</mi></msub> <annotation>${{{{mu}}}_{{mathrm{wn}}}}$</annotation></semantics> </math> ).</p><p><strong>Methods: </strong>Ten healthy subjects underwent repeated (test-retest) 3-dimensional multi-echo gradient-echo (3DMEGE) 3 Tesla MRI measurements. Complex-valued 3DMEGE images were acquired and reconstructed with slice thicknesses of 1 and 2 mm (3DMEGE1, 3DMEGE2) along with 3DT1-weighted isometric (voxel 1 mm<sup>3</sup>) images for independent registration and ROI segmentation. Agreement, consistency, and reproducibility of ROI-QSM metrics were assessed through Bland-Altman analysis, intraclass correlation coefficient, and interscan and intersubject coefficient of variation (CoV).</p><p><strong>Results: </strong>All ROI-QSM metrics exhibited good to excellent consistency and test-retest agreement with no proportional bias. Interscan CoV was higher for <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> in comparison to the other metrics where it was below 15%, in both 3DMEGE1 and 3DMEGE2 datasets. Intersubject CoV for <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> and <math> <semantics><msub><mi>μ</mi> <mi>abs</mi></msub> <annotation>${{{{mu}}}_{{mathrm{abs}}}}$</annotation></semantics> </math> exceeded 50% in all ROIs.</p><p><strong>Conclusions: </strong>Among the evaluated ROI-QSM metrics, <math> <semantics><msub><mi>μ</mi> <mi>all</mi></msub> <annotation>${{{{mu}}}_{{mathrm{all}}}}$</annotation></semantics> </math> and <math> <semantics><msub><mi>μ</mi> <mi>abs</mi></msub> <annotation>${{{{mu}}}_{{mathrm{abs}}}}$</annotation></semantics> </math> estimates were less rel","PeriodicalId":16399,"journal":{"name":"Journal of Neuroimaging","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}