Neuroimaging in Randomized, Multi-Center Clinical Trials of Endovascular Treatment for Acute Ischemic Stroke: A Systematic Review

Abstract

Appropriate use and analysis of neuroimaging techniques is an inevitable aspect of clinical trials for patients with acute ischemic stroke. Neuroimaging examinations were recently used to define the core eligibility criteria and outcomes in acute ischemic stroke research. Recent clinical trials for endovascular treatment in acute ischemic stroke have also demonstrated the efficacy or safety of endovascular treatment using various imaging modalities as well as clinical indices. Furthermore, independent imaging reviews and imaging core laboratory assessments are essential to manage and analyze imaging data in order to enhance the reliability of the outcomes. Therefore, we systematically reviewed the use of neuroimaging in recent randomized clinical trials for endovascular treatment of acute ischemic stroke in order to provide a thorough summary, which would serve as a resource guiding the use of appropriate imaging protocols and analyses in future clinical trials for acute ischemic stroke. This review will help researchers select appropriate imaging biomarkers among the various imaging protocols available and apply the selected type of imaging examination for each study in accordance with the academic purpose.

Quality Reporting of Systematic Review and Meta-Analysis According to PRISMA 2020 Guidelines: Results from Recently Published Papers in the Korean Journal of Radiology

“…Briefly, 18 studies (14 univariate and four bivariate) were systematic reviews with meta-analyses [ 14 15 19 20 21 22 23 24 25 26 27 28 29 31 32 33 34 35 ] and six studies were systematic reviews without meta-analyses [ 16 17 18 30 36 37 ]. In terms of the type of data used for analyses, 13 studies used dichotomous data to measure the following outcomes: 1) efficacy or safety of an intervention (proportion of tumor response, recurrence, or treatment-related complications), 2) efficacy of a diagnostic test (proportion of technical failure and unreliable measurement), 3) imaging features in a certain disease (proportion of specific imaging findings), 4) evaluation of study quality or reporting quality (proportion of studies that met the specific criteria), and 5) diagnostic yield [ 14 15 18 19 22 23 24 28 32 33 34 35 36 ]; six studies used time-to-event data to calculate the efficacy of a new intervention or the reliability between overall survival and imaging surrogate markers [ 15 22 31 32 33 34 ]; six studies used diagnostic test data to pool the diagnostic performance of index tests [ 16 25 26 27 29 37 ]; two studies used continuous data to evaluate the agreement and reliability of measurements between imaging methods [ 20 21 ]; one study used descriptive data from imaging protocols in randomized controlled trials of acute ischemic stroke [ 30 ]; and one study used qualitative and quantitative data to assess the health-related quality-of-life in patients with hepatocellular carcinoma [ 17 ]. The number of included studies ranged from 4 to 516, with the majority (83%, 20 out of 24) of the articles including more than 10 studies.…”

“…Seven articles [ 16 24 27 30 31 32 36 ] did not report how many reviewers participated in the evaluation of study eligibility or whether they worked independently (item #8). Eighteen articles [ 16 17 18 19 20 21 22 23 24 25 26 27 28 29 32 34 36 37 ] did not cite the studies that seemed to meet the inclusion criteria, but were excluded in the final stage or did not explain the reason for exclusion (item #16b).…”

“…Finally, 24 publications were included in our analysis ( Fig. 1 ) [ 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 ].…”

Rare Neurovascular Diseases in Korea: Classification and Related Genetic Variants

“…Since RNVD is rare, obtaining the diagnosis based on imaging studies can often be difficult, and knowing which diseases can involve the neurovascular system can be of great help in the diagnosis. Advanced neuroimaging techniques, which are useful in diagnosing various neurologic diseases, are also expected to play an essential role in the evaluation of RNVDs [ 104 105 106 ]. For example, four-dimensional magnetic resonance angiography and arterial spin labeling are useful non-invasive imaging modalities in the detection, evaluation, and follow-up of intracranial shunt diseases ( Figs.…”

Genetic Aspects of Inflammation and Immune Response in Stroke

“…This disability is presented with wide variability among individuals in post-stroke period. Early diagnostics with adequate triage and implementation of innovative treatment protocols are considered to be very important in early recognition and controlling the progress and dynamics of tissue damage in affected areas of the brain [ 24 , 25 , 26 , 27 ]. Once the disability is present, post-stroke survivors are included in rehabilitation treatment for optimal functional improvements and prevention of further functional decline [ 28 , 29 ].…”