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Boosted Tree Model Reforms Multimodal Magnetic Resonance Imaging Infarct Prediction in Acute Stroke Clinical Sciences
Background and Purpose—Stroke imaging is pivotal for diagnosis and stratification of patients with acute ischemic stroke to treatment. The potential of combining multimodal information into reliable estimates of outcome learning calls for robust machine learning techniques with high flexibility and accuracy. We applied the novel extreme gradient boosting algorithm for multimodal magnetic resonance imaging–based infarct prediction.Methods—In a retrospective analysis of 195 patients with acute ischemic stroke, fluid-attenuated inversion recovery, diffusion-weighted imaging, and 10 perfusion parameters were derived from...
Source: Stroke - March 26, 2018 Category: Neurology Authors: Michelle Livne, Jens K. Boldsen, Irene K. Mikkelsen, Jochen B. Fiebach, Jan Sobesky, Kim Mouridsen Tags: Magnetic Resonance Imaging (MRI), Ischemic Stroke Original Contributions Source Type: research

Prediction of Tissue Outcome and Assessment of Treatment Effect in Acute Ischemic Stroke Using Deep Learning Clinical Sciences
Background and Purpose—Treatment options for patients with acute ischemic stroke depend on the volume of salvageable tissue. This volume assessment is currently based on fixed thresholds and single imagine modalities, limiting accuracy. We wish to develop and validate a predictive model capable of automatically identifying and combining acute imaging features to accurately predict final lesion volume.Methods—Using acute magnetic resonance imaging, we developed and trained a deep convolutional neural network (CNNdeep) to predict final imaging outcome. A total of 222 patients were included, of which 187 were treated with...
Source: Stroke - May 25, 2018 Category: Neurology Authors: Anne Nielsen, Mikkel Bo Hansen, Anna Tietze, Kim Mouridsen Tags: Magnetic Resonance Imaging (MRI), Treatment, Quality and Outcomes, Statements and Guidelines, Ischemic Stroke Original Contributions Source Type: research

Initial Experience with Upfront Arterial and Perfusion Imaging among Ischemic Stroke Patients Presenting within the 4.5-hour Time Window
Conclusions: An upfront CTA/CTP protocol aided stroke team decision-making in nearly half of cases. Implementation of a CTA/CTP protocol was associated with a learning curve of 6 months before door to needle time ≤60 minutes returned to similar rates as the pre-CTA/CTP protocol.
Source: Journal of Stroke and Cerebrovascular Diseases - January 24, 2013 Category: Neurology Authors: Ali Reza Noorian, Katja Bryant, Ashley Aiken, Andrew D. Nicholson, Adam B. Edwards, Mason P. Markowski, Seena Dehkharghani, Jemisha C. Bouloute, Jacquelyn Abney, Fadi Nahab Tags: Original Articles Source Type: research

Image level detection of large vessel occlusion on 4D-CTA perfusion data using deep learning in acute stroke
Acute ischemic stroke (AIS) secondary to LVOs represent approximately 30-40% of all stroke cases and are associated with disproportionately higher morbidity and mortality.1, 2 The importance of endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS) has been well established in multiple randomized controlled trials for patients in both early and late stroke windows.3-6 A critical aspect of the patient triage is the accurate and timely detection of underlying large vessel occlusion (LVO).
Source: Journal of Stroke and Cerebrovascular Diseases - September 10, 2022 Category: Neurology Authors: Girish Bathla, Dhruba Durjoy, Sarv Priya, Edgar Samaniego, Colin P. Derdeyn Source Type: research

Collateral-Core Ratio as a Novel Predictor of Clinical Outcomes in Acute Ischemic Stroke
AbstractThe interaction effect between collateral circulation and ischemic core size on stroke outcomes has been highlighted in acute ischemic stroke (AIS). However, biomarkers that assess the magnitude of this interaction are still lacking. We aimed to present a new imaging marker, the collateral-core ratio (CCR), to quantify the interaction effect between these factors and evaluate its ability to predict functional outcomes using machine learning (ML) in AIS. Patients with AIS caused by anterior circulation large vessel occlusion (LVO) were recruited from a prospective multicenter study. CCR was calculated as collateral ...
Source: Translational Stroke Research - July 25, 2022 Category: Neurology Source Type: research

A Deep Learning-Based Automatic Collateral Assessment in Patients with Acute Ischemic Stroke
This study aimed to develop a supervised deep learning (DL) model for grading collateral status from dynamic susceptibility contrast magnetic resonance perfusion (DSC-MRP) images from patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) and compare its performance against experts ’ manual grading. Among consecutive LVO-AIS at three medical center sites, DSC-MRP data were processed to generate collateral flow maps consisting of arterial, capillary, and venous phases. With the use of expert readings as a reference, a DL model was developed to analyze collateral status with o utput classified into good and...
Source: Translational Stroke Research - May 21, 2022 Category: Neurology Source Type: research

Endovascular Treatment of Acute Ischemic Stroke
This article reviews the actual indications for mechanical thrombectomy in patients with acute ischemic stroke and how the opportunities for endovascular therapy can be expanded by using the concept of clinical-imaging or perfusion-imaging mismatch (as a surrogate for salvageable tissue) rather than time of ischemia. RECENT FINDINGS Six randomized controlled trials undoubtedly confirmed the benefits of using endovascular thrombectomy on the clinical outcome of patients with stroke with large vessel occlusion within 6 hours from symptom onset compared with those receiving only standard medical care. In a meta-analysis of...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Neuroimaging in Acute Stroke
This article describes how imaging can be used by physicians in diagnosing, determining prognosis, and making appropriate treatment decisions in a timely manner in patients with acute stroke. RECENT FINDINGS Advances in acute stroke treatment, including the use of endovascular thrombectomy in patients with large vessel occlusion and, more recently, of IV thrombolysis in an extended time window, have resulted in a paradigm shift in how imaging is used in patients with acute stroke. This paradigm shift, combined with the understanding that “time is brain,” means that imaging must be fast, reliable, and available aroun...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Effects of Repetitive Peripheral Sensory Stimulation in the Subacute and Chronic Phases After Stroke: Study Protocol for a Pilot Randomized Trial
DiscussionThe results of this study are relevant to inform future clinical trials to tailor RPSS to patients more likely to benefit from this intervention.Trial RegistrationNCT03956407.
Source: Frontiers in Neurology - February 16, 2022 Category: Neurology Source Type: research

Endovascular Stroke Therapy Results Improve over Time: The ‘Learning Curve' at a New Comprehensive Stoke Center
Conclusions: At a new community-based CSC, improved outcome occurred from year 1 to year 2, and trends towards decreased mortality, fewer complications, and improved revascularization were observed. Furthermore, the data shows that improvement in NIHSS score after EST is associated with decreased mortality following stroke in this setting, implying a net benefit.Cerebrovasc Dis Extra 2014;4:235-242
Source: Cerebrovascular Diseases Extra - January 13, 2015 Category: Neurology Source Type: research

Update on Treatment of Acute Ischemic Stroke
This article provides an update on the state of the art of the treatment of acute ischemic stroke with particular emphasis on the indications for reperfusion therapy. RECENT FINDINGS In addition to the previously established indications for intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of stroke symptom onset and endovascular therapy with mechanical thrombectomy for patients with large artery occlusion who can be treated within 6 hours of symptom onset, recent randomized controlled trials have now established new indications for emergency reperfusion in patients with ...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

The three-phase enriched environment paradigm promotes neurovascular restorative and prevents learning impairment after ischemic stroke in rats.
Abstract Enriched environment (EE) with a complex combination of sensorimotor, cognitive and social stimulations has been shown to enhance brain plasticity and improve recovery of functions in animal models of stroke. The present study extended these findings by assessing whether the three-phase EE intervention paradigm would improve neurovascular remodeling following ischemic stroke. Male Sprague-Dawley rats were subjected to permanent middle cerebral artery occlusion (MCAO). A three-phase EE intervention paradigm was designed in terms of the different periods of cerebral ischemia by periodically rearranging the ...
Source: Neurobiology of Disease - September 22, 2020 Category: Neurology Authors: Zhan Y, Li MZ, Yang L, Feng XF, Lei JF, Zhang N, Zhao YY, Zhao H Tags: Neurobiol Dis Source Type: research

Machine Learning-Based Prediction of Brain Tissue Infarction in Patients With Acute Ischemic Stroke Treated With Theophylline as an Add-On to Thrombolytic Therapy: A Randomized Clinical Trial Subgroup Analysis
Conclusions: The predicted follow-up brain lesions for each patient were not significantly different for patients virtually treated with theophylline or placebo, as an add-on to thrombolytic therapy. Thus, this study confirmed the lack of neuroprotective effect of theophylline shown in the main clinical trial and is contrary to the results from preclinical stroke models.
Source: Frontiers in Neurology - May 21, 2021 Category: Neurology Source Type: research

Assessing the Relative Value of CT Perfusion Compared to Non-contrast CT and CT Angiography in Prognosticating Reperfusion-Eligible Acute Ischemic Stroke Patients
In the present study we sought to measure the relative statistical value of various multimodal CT protocols at identifying treatment responsiveness in patients being considered for thrombolysis. We used a prospectively collected cohort of acute ischemic stroke patients being assessed for IV-alteplase, who had CT-perfusion (CTP) and CT-angiography (CTA) before a treatment decision. Linear regression and receiver operator characteristic curve analysis were performed to measure the prognostic value of models incorporating each imaging modality. One thousand five hundred and sixty-two sub-4.5 h ischemic stroke patients were in...
Source: Frontiers in Neurology - September 9, 2021 Category: Neurology Source Type: research

A deep learning approach to predict collateral flow in stroke patients using radiomic features from perfusion images
We present a multi-stage deep learning approach to predict collateral flow grading in stroke patients based on radiomic features extracted from MR perfusion data. First, we formulate a region of interest detection task as a reinforcement learning problem and train a deep learning network to automatically detect the occluded region within the 3D MR perfusion volumes. Second, we extract radiomic features from the obtained region of interest through local image descriptors and denoising auto-encoders. Finally, we apply a convolutional neural network and other machine learning classifiers to the extracted radiomic features to ...
Source: Frontiers in Neurology - February 21, 2023 Category: Neurology Source Type: research

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