Clinically presenting acute/subacute ischemic stroke: differential diagnosis of the non-enhanced CT hypodensity by advanced neuroimaging

Misra, Vivek; Fadil, Halim; Hoque, Romy; Menon, Uma; Gonzalez‐Toledo, Eduardo; Jaffe, Stephen L.

doi:10.1179/016164109x12445505689607

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…However, in the clinical setting, old cerebral infarction (OCI) and asymmetric leukoaraiosis (LA) similarly display slightly hypodense lesions. Thus, it is sometimes challenging to distinguish AIS from these two types of lesions [ 5 ]. AIS and OCI can occur anywhere in the brain and present as solitary or multiple lesions, especially in the basal ganglia region.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of CT attenuation values in distinguishing acute ischemic stroke, old cerebral infarction and leukoaraiosis

Peng,

Luo,

Wang

et al. 2024

BMC Med Imaging

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Purpose This study aimed to investigate the feasibility of using computed tomography (CT) attenuation values to differentiate hypodense brain lesions, specifically acute ischemic stroke (AIS) from asymmetric leukoaraiosis (LA) and old cerebral infarction (OCI). Materials and methods This retrospective study included patients with indeterminate hypodense lesions identified via brain CT scans conducted between June 2019 and June 2021. All lesions were confirmed through head MRI/diffusion-weighted imaging within 48 h after CT. CT attenuation values of hypodense lesions and symmetrical control regions were measured. Additionally, CT attenuation value difference (ΔHU) and ratio (RatioHU) were calculated. One-way analysis of variance (ANOVA) was used to compare age and CT parameters (CT attenuation values, ΔHU and RatioHU) across the groups. Finally, receiver operating characteristic (ROC) analysis was performed to determine the cutoff values for distinguishing hypodense lesions. Results A total of 167 lesions from 146 patients were examined. The CT attenuation values for AIS(n = 39), LA(n = 53), and OCI(n = 75) were 18.90 ± 6.40 HU, 17.53 ± 4.67 HU, and 11.90 ± 5.92 HU, respectively. The time interval between symptom onset and CT scans for AIS group was 32.21 ± 26.85 h. ANOVA revealed significant differences among the CT parameters of the hypodense lesion groups (all P < 0.001). The AUC of CT values, ΔHU, and RatioHU for distinguishing AIS from OCI were 0.802, 0.896 and 0.878, respectively (all P < 0.001). Meanwhile, the AUC for distinguishing OCI from LA was 0.789, 0.883, and 0.857, respectively (all P < 0.001). Nevertheless, none of the parameters could distinguish AIS from LA. Conclusion CT attenuation parameters can be utilized to differentiate between AIS and OCI or OCI and LA in indeterminate hypodense lesions on CT images. However, distinguishing AIS from LA remains challenging.

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Section: Introductionmentioning

confidence: 99%

Feasibility of CT attenuation values in distinguishing acute ischemic stroke, old cerebral infarction and leukoaraiosis

Peng,

Luo,

Wang

et al. 2024

BMC Med Imaging

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“…However, the treatment of intravenous thrombolysis with recombinant tissue thrombolytic plasminogen activator (rt-PA) window-time is very narrow, usually within 3.0–4.5 h after the onset of neurologic symptoms, which delays the diagnostic time for visible neuroimaging techniques [ 5 , 6 ]. On the other hand, it is difficult to distinguish ischemic stroke subtypes from these similar focal neurological deficits, such as complex migraine, demyelinating diseases, and vascular diseases [ 7 ]. In addition, the utility of advanced MRI technology current is limited because of lacking available emergency services or vascular neurologists [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of plasma thrombin-antithrombin complex on ischemic stroke: a systematic review and meta-analysis

Song

Xie

et al. 2023

Syst Rev

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Background and objective Thrombin-antithrombin complex (TAT) is a prethrombotic marker, and its application in ischemic stroke is still uncertain. The purpose of this systematic review and meta-analysis is to evaluate the relationship between plasma TAT and ischemic stroke base on the current evidence. Methods A systematic literature search was conducted for searching the relative studies that investigated the association of TAT and ischemic stroke in PubMed, EMBASE, and Cochrane library databases. Mean difference and 95% confidence interval as the effect sizes were synthesized by random effects model in Review Manager (RevMan) Version 5.4. The heterogeneity was investigated using the chi-square test and the possible sources of heterogeneity were explored by sensitivity analysis and meta-regression. The publication bias was estimated by Egger’s tests. Results A total of 12 eligible studies were included involving 1431 stroke cases and 532 healthy controls, of which six studies were eventually included in the meta-analysis. Plasma TAT in patients with ischemic stroke was significantly higher than that in healthy controls (MD 5.31, 95% CI = 4.12–6.51, P < 0.0001, I2 = 97.8%). There is a difference of TAT level in the same period among cardioembolic, lacunar, and atherothrombotic stroke (all P < 0.0001), in which the cardioembolic stroke with the highest level. Meanwhile, it is significant of TAT levels among various phases of cardioembolic stroke and the acute phase are markedly elevated (MD 7.75, 95CI%, 6.07–9.43, P < 0.001). However, no difference was found in the atherothrombotic (P = 0.13) and lacunar stroke (P = 0.34). Besides, the higher TAT level is closely related to the poor prognosis of patients with ischemic stroke, including higher recurrence, mortality, unfavorable recovery (modified Rankin scale > 2), and poor revascularization. Conclusions This study suggested that plasma TAT levels are different in ischemic stroke subtypes, which are closely associated with the progression and might have an effect on the prognosis. Systematic review registration PROSPERO CRD: 42021248787

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“…However, the treatment of intravenous thrombolysis with recombinant tissue thrombolytic plasminogen activator (rt-PA) window-time is very narrow, usually within 3.0-4.5 hours after the onset of neurologic symptoms, which delays the diagnostic time for visible neuroimaging techniques [5,6]. On the other hand, it is di cult to distinguish ischemic stroke subtypes from these similar focal neurological de cits, such as complex migraine, demyelinating diseases, metabolic and vascular diseases [7]. In addition, the utility of advanced MRI technology current is limited because of lacking available emergency services or vascular neurologists [8].…”

Section: Introductionmentioning

confidence: 99%

Association of Plasma Thrombin-Antithrombin Complex and Ischemic Stroke: A Systematic Review and Meta-analysis

Song

Xie

et al. 2021

Preprint

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Background and objectiveThrombin-antithrombin complex (TAT) is a prethrombotic marker, and its application in ischemic stroke is still uncertain. The purpose of this systematic review and meta-analysis is to evaluate the relationship between plasma TAT and ischemic stroke base on the current evidence.MethodsA systematic literature search was conducted for searching the relative studies that investigated the association of TAT and ischemic stroke in PubMed, EMBASE, and Cochrane library databases. Mean difference and 95% confidence interval as the effect sizes were synthesized by random effects model in Review Manager (RevMan) Version 5.4. Then, the heterogeneity was investigated using the Chi-square test and the possible sources of heterogeneity were explored by sensitivity analysis. The publication bias was estimated through Begg’s and Egger’s tests.ResultsA total of 12 eligible studies were included involving 1431 stroke cases and 532 healthy controls, of which six studies were eventually included in the meta-analysis. Plasma TAT in patients with ischemic stroke was significantly higher than that in healthy controls (MD 5.31, 95% CI =4.12-6.51, P<0.0001, I2=97.8 %). There is a difference of TAT level in the same period among cardioembolic, lacunar and atherothrombotic stroke (all P<0.0001), in which the cardioembolic stroke with the highest level. Meanwhile, it is significant of TAT levels among various phases of cardioembolic stroke and the acute phase are markedly elevated (MD 7.75, 95CI%, 6.07-9.43, P<0.001). However, no difference was found in the atherothrombotic (P=0.13) and lacunar stroke (P=0.34). Besides, the higher TAT level is closely related to the poor prognosis of patients with ischemic stroke, including higher recurrence, mortality, unfavorable recovery (modified Rankin scale >2), and poor revascularization.ConclusionsThis study suggested that plasma TAT levels are different in ischemic stroke subtypes, which are closely associated with the progression and might have an effect on the prognosis. PROSPERO CRD: 42021248787

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Clinically presenting acute/subacute ischemic stroke: differential diagnosis of the non-enhanced CT hypodensity by advanced neuroimaging

Abstract: As presented in this review, although several diseases initially present a diagnostic dilemma upon presentation because of their clinical and non-enhanced CT similarities to cerebral infarction, advanced diagnostic neuroimaging readily establishes their unique pathologies.

Cited by 6 publications

References 15 publications

Feasibility of CT attenuation values in distinguishing acute ischemic stroke, old cerebral infarction and leukoaraiosis

Feasibility of CT attenuation values in distinguishing acute ischemic stroke, old cerebral infarction and leukoaraiosis

Effect of plasma thrombin-antithrombin complex on ischemic stroke: a systematic review and meta-analysis

Association of Plasma Thrombin-Antithrombin Complex and Ischemic Stroke: A Systematic Review and Meta-analysis

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