Computed tomography–based quantification of lesion water uptake identifies patients within 4.5 hours of stroke onset: A multicenter observational study

Minnerup, Jens; Broocks, Gabriel; Kalkoffen, Judith; Langner, Soenke; Knauth, Michael; Psychogios, Marios; Wersching, Heike; Teuber, Anja; Heindel, Walter; Eckert, Bernd; Wiendl, Heinz; Schramm, Peter; Fiehler, Jens; Kemmling, André

doi:10.1002/ana.24818

Cited by 104 publications

(153 citation statements)

References 25 publications

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“…Consequently, the use of NCCT is intrinsically a quantitative and standardized process for infarct brain tissues. The previous literature suggested that since inherent anatomical structures in the human brain are symmetric, ischemic tissues can be highlighted by comparing the left and right sides of a brain [18,19].…”

Section: Asymmetric Interpretationmentioning

confidence: 99%

Computer-Aided Detection of Hyperacute Stroke Based on Relative Radiomic Patterns in Computed Tomography

Hung

Hsieh

2019

Applied Sciences

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Ischemic stroke is one of the leading causes of disability and death. To achieve timely assessments, a computer-aided diagnosis (CAD) system was proposed to perform early recognition of hyperacute ischemic stroke based on non-contrast computed tomography (NCCT). In total, 26 patients with hyperacute ischemic stroke (with onset <6 h previous) and 56 normal controls composed the image database. For each NCCT slice, textural features were extracted from Ranklet-transformed images which had enhanced local contrast. Textural differences between the two sides of an image were calculated and combined in a machine learning classifier to detect stroke areas. The proposed CAD system using Ranklet features achieved significantly higher accuracy (81% vs. 71%), specificity (90% vs. 79%), and area under the curve (Az) (0.81 vs. 0.73) than conventional textural features. Diagnostic suggestions provided by the CAD system are fast and promising and could be useful in the pipeline of hyperacute ischemic stroke assessments.

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Section: Asymmetric Interpretationmentioning

confidence: 99%

Computer-Aided Detection of Hyperacute Stroke Based on Relative Radiomic Patterns in Computed Tomography

Hung

Hsieh

2019

Applied Sciences

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“…Furthermore, data from primate stroke show that water uptake by white matter (WM) is less severe than that by gray matter (GM) 2 . Taking into account the water data above and the fact that the ischaemic core is effectively without blood supply, it is difficult to appreciate the water uptake values reported by Minnerup et al 1 . One potential reason for high water uptake estimate by Minnerup et al 1 could be the use of aqueous HU calibration instead of measurements of HUs against water content in the brain tissue 4 .…”

Section: Computed Tomography-based Acute Stroke Lesion Timing and Patmentioning

confidence: 99%

“…Minnerup and co-workers proposed a computed tomography (CT) -based procedure to determine age of acute/hyperacute stroke to aid patient stratification for reperfusion therapy 1 . The CT procedure converts Hounsfield Units (HU) determined in the stroke lesion into net water uptake due to ischaemia.…”

Section: Computed Tomography-based Acute Stroke Lesion Timing and Patmentioning

confidence: 99%

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Computed tomography–based acute stroke lesion timing and patient stratification

Kauppinen

Knight

2017

Annals of Neurology

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“…The estimated optimal threshold for procalcitonin in this analysis was 1.2 ng/ml. Such an approach to the problem of multiple diagnostic thresholds appears to be a most promising initiative and has been implemented in at least one independent study [31]. …”

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confidence: 99%

Procalcitonin as a Biomarker for Infection and Sepsis: Yet Again

Moran¹,

Solomon²

2017

Pulm Crit Care Med

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Biomarkers may be characterized as diagnostic, distinguishing between two states (say, infected or non-infected); prognostic, informing of a likely outcome (say, mortality); or predictive, if a treatment effect is differential between biomarker positivity and negativity [1]. One of the most discussed biomarkers in the infectious diseases and critical care literature is procalcitonin [2][3][4], a polypeptide that serves as the precursor for calcitonin in thyroid gland C cells and is released in response to microbial toxins and pro-inflammatory mediators [5]. Procalcitonin qualifies as both a diagnostic (an infection or sepsis marker) and predictive (a guide to antimicrobial therapy) biomarker. This being said, procalcitonin biomarker performance has been subjected to a large number of meta-analyses [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], suggesting a degree of disquiet regarding the actual level of evidence for procalcitonin utility.We first summarize certain key parameters of procalcitonin performance as a diagnostic biomarker in 6 meta-analyses, conducted between the years of 2004-2015; author sub-group analyses are not considered (Table 1) [11,14,[16][17][18][19]. Where reported, heterogeneity was a marked feature, even when restricted to a more circumscribed population of the "critically ill"; the components of heterogeneity presumably reflecting such factors as different procalcitonin assays and threshold levels, patient subgroups, endpoint prevalence, primary study inclusions and exclusions, and study quality / bias [5]. Analytic methods reflected year of publication, with the earlier studies [16][17][18][19] using the linear regression model of Moses et al, as opposed to the mixed-effects bivariate approach of the two more recent studies [11,14]; a point of importance for Wacker and co-authors [14]. Overall, the diagnostic performance could at best be described as modest, a point conceded by some of the authors [11,16,18] and reiterated by Afshari and Harbath [22], commenting upon the somewhat fulsome conclusions of Wacker et al. [14]. The former noted that the sensitivity of 77% corresponded to 23% of patients not receiving adequate therapy and a specificity of 79% corresponded to 21% being unnecessarily treated (Table 1); similarly, a positive likelihood ratio of 3.67 and a negative likelihood ratio of 0.29, being small and containing no information, were "… of little use for guiding initial treatment decisions", especially in the critically ill with a high pre-test sepsis probability [22]. As diagnostic meta-analyses have had a history of poor reporting [23] compared with meta-analyses reporting treatment effects of randomized controlled trials, the attendant vigorous correspondence [22,[24][25][26][27][28][29] to some of the above meta-analyses is perhaps not surprising.One outstanding feature of these diagnostic meta-analyses was the variable cut-point procalcitonin thresholds used in the primary studies. Again in a response to the meta-analysis of Wacker et al. [14], Ruecker and Sch...

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Computed tomography–based quantification of lesion water uptake identifies patients within 4.5 hours of stroke onset: A multicenter observational study

Abstract: Quantification of brain water uptake identifies stroke patients with symptom onset within 4.5 hours with high accuracy and may guide the decision to use thrombolysis in patients with unknown time of stroke onset. Ann Neurol 2016;80:924-934.

Cited by 104 publications

References 25 publications

Computer-Aided Detection of Hyperacute Stroke Based on Relative Radiomic Patterns in Computed Tomography

Computer-Aided Detection of Hyperacute Stroke Based on Relative Radiomic Patterns in Computed Tomography

Computed tomography–based acute stroke lesion timing and patient stratification

Procalcitonin as a Biomarker for Infection and Sepsis: Yet Again

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