Computed Tomography–Based Imaging of Voxel-Wise Lesion Water Uptake in Ischemic Brain

Broocks, Gabriel; Flottmann, Fabian; Ernst, Marielle; Faizy, Tobias D.; Minnerup, Jens; Siemonsen, Susanne; Fiehler, Jens; Kemmling, André

doi:10.1097/rli.0000000000000430

Cited by 92 publications

(142 citation statements)

References 18 publications

Supporting

Mentioning

141

Contrasting

Order By: Relevance

“…It is based on the physical relationship between tissue hypoattenuation and volumetric change due to edematous water uptake over time. 10,[16][17][18][19] This method is in accordance with previous independent data and can be directly related to histopathological measurements of volume of water uptake. 20 In brief, the ischemic core lesion was operationally defined using a CTP-based ROI (CBV lesion), which was segmented manually and co-registered to the corresponding NECT image, with subsequent manual correction, if necessary.…”

Section: Ct Image Analysissupporting

confidence: 66%

Lesion Age Imaging in Acute Stroke: Water Uptake in CT Versus DWI‐FLAIR Mismatch

Broocks

Leischner

Hanning

et al. 2020

Annals of Neurology

Self Cite

View full text Add to dashboard Cite

In acute ischemic stroke with unknown time of onset, magnetic resonance (MR)-based diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) estimates lesion age to guide intravenous thrombolysis. Computed tomography (CT)-based quantitative net water uptake (NWU) may be a potential alternative. The purpose of this study was to directly compare CT-based NWU to magnetic resonance imaging (MRI) at identifying patients with lesion age < 4.5 hours from symptom onset. Methods: Fifty patients with acute anterior circulation stroke were analyzed with both imaging modalities at admission between 0.5 and 8.0 hours after known symptom onset. DWI-FLAIR lesion mismatch was rated and NWU was measured in admission CT. An established NWU threshold (11.5%) was used to classify patients within and beyond 4.5 hours. Multiparametric MRI signal was compared with NWU using logistic regression analyses. The empirical distribution of NWU was analyzed in a consecutive cohort of patients with wake-up stroke. Results: The median time between CT and MRI was 35 minutes (interquartile range [IQR] = 24-50). The accuracy of DWI-FLAIR mismatch was 68.8% (95% confidence interval [CI] = 53.7-81.3%) with a sensitivity of 58% and specificity of 82%. The accuracy of NWU threshold was 86.0% (95% CI = 73.3-94.2%) with a sensitivity of 91% and specificity of 78%. The area under the curve (AUC) of multiparametric MRI signal to classify lesion age <4.5 hours was 0.86 (95% CI = 0.64-0.97), and the AUC of quantitative NWU was 0.91 (95% CI = 0.78-0.98). Among 87 patients with wake-up stroke, 46 patients (53%) showed low NWU (< 11.5%). Conclusion: The predictive power of CT-based lesion water imaging to identify patients within the time window of thrombolysis was comparable to multiparametric DWI-FLAIR MRI. A significant proportion of patients with wake-up stroke exhibit low NWU and may therefore be potentially suitable for thrombolysis.

show abstract

Section: Ct Image Analysissupporting

confidence: 66%

Lesion Age Imaging in Acute Stroke: Water Uptake in CT Versus DWI‐FLAIR Mismatch

Broocks

Leischner

Hanning

et al. 2020

Annals of Neurology

Self Cite

View full text Add to dashboard Cite

show abstract

“…As for the accuracy of CT-based NWU measurements, ROIs were drawn by a quantitative edge-detection tool and boundaries adjusted manually if necessary. However, semiautomatic methods of Hounsfield Unit value thresholding have been used in previous studies and partially mitigate a method bias (22, 32). Another point of criticism is the strict inclusion of patients with terminal ICA and MCA occlusion to obtain a homogenous patient cohort and to avoid bias.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhage After Endovascular Recanalization in Acute Stroke: Lesion Extent, Collaterals and Degree of Ischemic Water Uptake Mediate Tissue Vulnerability

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background and Purpose: Intracranial hemorrhage (ICH) remains a major complication of endovascular treatment (ET) in acute stroke. The aim of this study was to identify clinical and imaging predictors for ICH in patients with acute ischemic stroke undergoing successful ET. Methods: We performed a retrospective analysis of patients with large vessel occlusion in the anterior circulation who underwent successful ET at our university medical center between 2015 and 2018. ICH was diagnosed on non-enhanced CT and a binary outcome was defined: ICH occurrence in the immediate post-interventional phase within 12–36 h (yes/no). The impacts of clinical, radiological, and interventional parameters on outcome were assessed in logistic regression models. Results: One hundred and seven patients fulfilled the inclusion criteria. 37 (34.6%) showed an ICH of which 7 (6.5%) patients were diagnosed as symptomatic and 30 (28.04%) as asymptomatic. Multivariable regression analyses identified a lower ASPECTS (adjusted odds ratio (OR) 1.95, 95%CI: 1.4–3.63, P = 0.037), low collateral score (adjusted OR 0.12, 95%CI: 0.03–0.49, P = 0.003) and high Net Water Uptake (NWU) (adjusted OR 1.56, 95%CI: 2.34–1.03, P = 0.007) as independent predictors of ICH after successful ET. Conclusions: CT-based quantitative NWU, ASPECTS, and collateral score mediate tissue vulnerability and are reliable independent predictors of a bleeding event after successful ET. This imaging-based prediction model might be useful for early stratification of patients at high risk of a bleeding event after ET, especially with low ASPECTS.

show abstract

“…The ASPECTS rating itself is based on detecting visually evident hypoattenuation, although the degree of hypoattenuation is not encoded. Any hypoattenuated ischemic lesion is physically equivalent to early infarct with vasogenic edema which can be quantified by NWU 20 26. Thus, two patients may show the same ASPECTS with comparable lesion extent but a significantly different degree of hypoattenuation—that is, different lesion water uptake.…”

Section: Discussionmentioning

confidence: 99%

“…shows an example of two low ASPECTS patients with good versus poor collaterals. We determined net water uptake (NWU) within early infarct as the imaging biomarker to quantify cerebral ischemic edema in the admission CT before treatment and in FCT after treatment with a standardized procedure, as reported elsewhere 19–22…”

Section: Methodsmentioning

confidence: 99%

Patients with low Alberta Stroke Program Early CT Score (ASPECTS) but good collaterals benefit from endovascular recanalization

Broocks

Kniep

Schramm

et al. 2019

J NeuroIntervent Surg

Self Cite

View full text Add to dashboard Cite

BackgroundBenefit of thrombectomy in patients with a low initial Alberta Stroke Program Early CT Score (ASPECTS) is still uncertain. We hypothesized that, despite low ASPECTS, patients may benefit from endovascular recanalization if good collaterals are present.MethodsIschemic stroke patients with large vessel occlusion in the anterior circulation and an ASPECTS of ≤5 were analyzed. Collateral status (CS) was assessed using a 5-point-scoring system in CT angiography with poor CS defined as CS=0–1. Clinical outcome was determined using the modified Rankin Scale (mRS) score after 90 days. Edema formation was measured in admission and follow-up CT by net water uptake.Results27/100 (27%) patients exhibited a CS of 2–4. 50 patients underwent successful vessel recanalization and 50 patients had a persistent vessel occlusion. In multivariable logistic regression analysis, collateral status (OR 3.0; p=0.003) and vessel recanalization (OR 12.2; p=0.009) significantly increased the likelihood of a good outcome (mRS 0–3). A 1-point increase in CS was associated with 1.9% (95% CI 0.2% to 3.7%) lowered lesion water uptake in follow-up CT .ConclusionEndovascular recanalization in patients with ASPECTS of ≤5 but good collaterals was linked to improved clinical outcome and attenuated edema formation. Collateral status may serve as selection criterion for thrombectomy in low ASPECTS patients.

show abstract

Computed Tomography–Based Imaging of Voxel-Wise Lesion Water Uptake in Ischemic Brain

Abstract: Volume of water uptake in infarct lesions can be calculated quantitatively by relative CT density measurements. Voxel-wise imaging of water uptake depicts lesion pathophysiology and could serve as a quantitative imaging biomarker of acute infarct lesions.

Cited by 92 publications

References 18 publications

Lesion Age Imaging in Acute Stroke: Water Uptake in CT Versus DWI‐FLAIR Mismatch

Lesion Age Imaging in Acute Stroke: Water Uptake in CT Versus DWI‐FLAIR Mismatch

Hemorrhage After Endovascular Recanalization in Acute Stroke: Lesion Extent, Collaterals and Degree of Ischemic Water Uptake Mediate Tissue Vulnerability

Patients with low Alberta Stroke Program Early CT Score (ASPECTS) but good collaterals benefit from endovascular recanalization

Contact Info

Product

Resources

About