Use of neuroimaging to guide the treatment of patients beyond the 8-hour time window

Janjua, Nazli

doi:10.1212/wnl.0b013e3182695826

Cited by 9 publications

(4 citation statements)

References 39 publications

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“…However, only 1.6% of stroke patients receive tissue plasminogen activator (rtPA) therapy in China 1 despite proven effectiveness in reducing disability. By identifying the tissue at risk (penumbra) and the tissue that is irreversibly injured (ischemic core) for those patients who arrive at hospital outside the time window or with unknown onset time, perfusion imaging may increase the rate of thrombolytic therapy 2 . The presence of a “mismatch” between a small core and large penumbra may indicate the potential for such patients to benefit from off-label reperfusion therapies.…”

mentioning

confidence: 99%

Defining Core and Penumbra in Ischemic Stroke: A Voxel- and Volume-Based Analysis of Whole Brain CT Perfusion

Han

Ding

et al. 2016

Sci Rep

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Whole brain computed tomography perfusion (CTP) has the potential to select eligible patients for reperfusion therapy. We aimed to find the optimal thresholds on baseline CTP for ischemic core and penumbra in acute ischemic stroke. We reviewed patients with acute ischemic stroke in the anterior circulation, who underwent baseline whole brain CTP, followed by intravenous thrombolysis and perfusion imaging at 24 hours. Patients were divided into those with major reperfusion (to define the ischemic core) and minimal reperfusion (to define the extent of penumbra). Receiver operating characteristic (ROC) analysis and volumetric consistency analysis were performed separately to determine the optimal threshold by Youden’s Index and mean magnitude of volume difference, respectively. From a series of 103 patients, 22 patients with minimal-reperfusion and 47 with major reperfusion were included. Analysis revealed delay time ≥ 3 s most accurately defined penumbra (AUC = 0.813; 95% CI, 0.812-0.814, mean magnitude of volume difference = 29.1 ml). The optimal threshold for ischemic core was rCBF ≤ 30% within delay time ≥ 3 s (AUC = 0.758; 95% CI, 0.757-0.760, mean magnitude of volume difference = 10.8 ml). In conclusion, delay time ≥ 3 s and rCBF ≤ 30% within delay time ≥ 3 s are the optimal thresholds for penumbra and core, respectively. These results may allow the application of the mismatch on CTP to reperfusion therapy.

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confidence: 99%

Defining Core and Penumbra in Ischemic Stroke: A Voxel- and Volume-Based Analysis of Whole Brain CT Perfusion

Han

Ding

et al. 2016

Sci Rep

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“…Revascularization time windows for mechanical thrombectomy are generally restricted to 8 h, 31 since stunned or hibernating myocardium can be saved from infarction if it is reperfused promptly by unblocking the occluded vessel, thereby increasing blood flow to the reversible dysfunctional myocardium. This study demonstrated that 131 I-HDA could guide the use of interventions for myocardial salvage through early imaging of necrotic myocardium to assess myocardial viability.…”

Section: Molecular Pharmaceuticsmentioning

confidence: 99%

Synthesis and Preclinical Evaluation of Radioiodinated Hypericin Dicarboxylic Acid as a Necrosis Avid Agent in Rat Models of Induced Hepatic, Muscular, and Myocardial Necroses

Zhang

Yang

et al. 2015

Mol. Pharmaceutics

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ABSTRACT:Myocardial infarction (MI) leads to substantial morbidity and mortality around the world.Accurate assessment of myocardial viability is essential to assist therapies and improve patient outcomes. 131 I-hypericin dicarboxylic acid ( 131 I-HDA) was synthesized and evaluated as a potential diagnostic agent for earlier assessment of myocardium viability compared to its preceding counterpart 131 I-hypericin ( 131 I-Hyp) with strong hydrophobic property, long plasma half-life and high uptake in mononuclear phagocyte system (MPS). Herein, HDA was synthesized and characterized, and self-aggregation constant K α was analyzed by spectrophotometry. Plasma half-life was determined in healthy rats by γ-counting. 131 I-HDA and 131 I-Hyp were prepared with iodogen as oxidant. In vitro necrosis avidity of 131 I-HDA and 131 I-Hyp was evaluated in necrotic cells induced by hyperthermia. Biodistribution was determined in rat models of induced necrosis using γ-counting, autoradiography, and histopathology. Earlier imaging of necrotic myocardium to assess myocardial viability was performed in rat models of reperfused myocardium infarction using single photon emission computed tomography/computed tomography (SPECT/CT). As a result, the self-aggregation

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“…Stroke is the most common and well known clinical application of DWI, where the images allow the non-invasive detection of ischemia within minutes of onset and are sensitive and relatively specific in detecting changes triggered by strokes [22]. The technique has also allowed deeper insights into the pathogenesis of Alzheimer’s disease, Parkinson disease, autism spectrum disorder, schizophrenia, and many other psychiatric and non-psychiatric brain diseases.…”

Section: Viewpoints From Science To Applicationmentioning

confidence: 99%

Viewpoints on Medical Image Processing: From Science to Application

Tm¹,

Handels²,

Kh³

et al. 2013

CMIR

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Medical image processing provides core innovation for medical imaging. This paper is focused on recent developments from science to applications analyzing the past fifteen years of history of the proceedings of the German annual meeting on medical image processing (BVM). Furthermore, some members of the program committee present their personal points of views: (i) multi-modality for imaging and diagnosis, (ii) analysis of diffusion-weighted imaging, (iii) model-based image analysis, (iv) registration of section images, (v) from images to information in digital endoscopy, and (vi) virtual reality and robotics. Medical imaging and medical image computing is seen as field of rapid development with clear trends to integrated applications in diagnostics, treatment planning and treatment.

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Use of neuroimaging to guide the treatment of patients beyond the 8-hour time window

Cited by 9 publications

References 39 publications

Defining Core and Penumbra in Ischemic Stroke: A Voxel- and Volume-Based Analysis of Whole Brain CT Perfusion

Defining Core and Penumbra in Ischemic Stroke: A Voxel- and Volume-Based Analysis of Whole Brain CT Perfusion

Synthesis and Preclinical Evaluation of Radioiodinated Hypericin Dicarboxylic Acid as a Necrosis Avid Agent in Rat Models of Induced Hepatic, Muscular, and Myocardial Necroses

Viewpoints on Medical Image Processing: From Science to Application

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