Journal of Clinical Medicine

Editorial

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5 pages, 187 KiB

Open AccessEditorial

New Advances in Diagnostic Radiology for Ischemic Stroke

by Gabriel Broocks and Lukas Meyer

J. Clin. Med. 2023, 12(19), 6375; https://doi.org/10.3390/jcm12196375 - 6 Oct 2023

Viewed by 1851

Abstract

Ischemic stroke, a leading cause of disability and mortality worldwide, occurs due to the sudden interruption of blood supply to a specific region of the brain [...] Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

Research

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14 pages, 2904 KiB

Open AccessArticle

External Validation and Retraining of DeepBleed: The First Open-Source 3D Deep Learning Network for the Segmentation of Spontaneous Intracerebral and Intraventricular Hemorrhage

by Haoyin Cao, Andrea Morotti, Federico Mazzacane, Dmitriy Desser, Frieder Schlunk, Christopher Güttler, Helge Kniep, Tobias Penzkofer, Jens Fiehler, Uta Hanning, Andrea Dell’Orco and Jawed Nawabi

J. Clin. Med. 2023, 12(12), 4005; https://doi.org/10.3390/jcm12124005 - 12 Jun 2023

Cited by 3 | Viewed by 1542

Abstract

Background: The objective of this study was to assess the performance of the first publicly available automated 3D segmentation for spontaneous intracerebral hemorrhage (ICH) based on a 3D neural network before and after retraining. Methods: We performed an independent validation of this model [...] Read more.

Background: The objective of this study was to assess the performance of the first publicly available automated 3D segmentation for spontaneous intracerebral hemorrhage (ICH) based on a 3D neural network before and after retraining. Methods: We performed an independent validation of this model using a multicenter retrospective cohort. Performance metrics were evaluated using the dice score (DSC), sensitivity, and positive predictive values (PPV). We retrained the original model (OM) and assessed the performance via an external validation design. A multivariate linear regression model was used to identify independent variables associated with the model’s performance. Agreements in volumetric measurements and segmentation were evaluated using Pearson’s correlation coefficients (r) and intraclass correlation coefficients (ICC), respectively. With 1040 patients, the OM had a median DSC, sensitivity, and PPV of 0.84, 0.79, and 0.93, compared to thoseo f 0.83, 0.80, and 0.91 in the retrained model (RM). However, the median DSC for infratentorial ICH was relatively low and improved significantly after retraining, at p < 0.001. ICH volume and location were significantly associated with the DSC, at p < 0.05. The agreement between volumetric measurements (r > 0.90, p > 0.05) and segmentations (ICC ≥ 0.9, p < 0.001) was excellent. Conclusion: The model demonstrated good generalization in an external validation cohort. Location-specific variances improved significantly after retraining. External validation and retraining are important steps to consider before applying deep learning models in new clinical settings. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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10 pages, 1749 KiB

Open AccessArticle

Location of Hyperintense Vessels on FLAIR Associated with the Location of Perfusion Deficits in PWI

by Lisa D. Bunker and Argye E. Hillis

J. Clin. Med. 2023, 12(4), 1554; https://doi.org/10.3390/jcm12041554 - 16 Feb 2023

Cited by 1 | Viewed by 1743

Abstract

Perfusion imaging is preferred for identifying hypoperfusion in the management of acute ischemic stroke, but it is not always feasible/available. An alternative method for quantifying hypoperfusion, using FLAIR-hyperintense vessels (FHVs) in various vascular regions, has been proposed, with evidence of a statistical relationship [...] Read more.

Perfusion imaging is preferred for identifying hypoperfusion in the management of acute ischemic stroke, but it is not always feasible/available. An alternative method for quantifying hypoperfusion, using FLAIR-hyperintense vessels (FHVs) in various vascular regions, has been proposed, with evidence of a statistical relationship with perfusion-weighted imaging (PWI) deficits and behavior. However, additional validation is needed to confirm that areas of suspected hypoperfusion (per the location of FHVs) correspond to the location of perfusion deficits in PWI. We examined the association between the location of FHVs and perfusion deficits in PWI in 101 individuals with acute ischemic stroke, prior to the receipt of reperfusion therapies. FHVs and PWI lesions were scored as present/absent in six vascular regions (i.e., the ACA, PCA, and (four sub-regions of) the MCA territories). Chi-square analyses showed a significant relationship between the two imaging techniques for five vascular regions (the relationship in the ACA territory was underpowered). These results suggest that for most areas of the brain, the general location of FHVs corresponds to hypoperfusion in those same vascular territories in PWI. In conjunction with prior work, results support the use of estimating the amount and location of hypoperfusion using FLAIR imaging when perfusion imaging is not available. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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9 pages, 2413 KiB

Open AccessArticle

Prospective Assessment of Cerebral Microbleeds with Low-Field Magnetic Resonance Imaging (0.55 Tesla MRI)

by Thilo Rusche, Hanns-Christian Breit, Michael Bach, Jakob Wasserthal, Julian Gehweiler, Sebastian Manneck, Johanna M. Lieb, Gian Marco De Marchis, Marios Psychogios and Peter B. Sporns

J. Clin. Med. 2023, 12(3), 1179; https://doi.org/10.3390/jcm12031179 - 2 Feb 2023

Cited by 5 | Viewed by 1953

Abstract

Purpose: Accurate detection of cerebral microbleeds (CMBs) on susceptibility-weighted (SWI) magnetic resonance imaging (MRI) is crucial for the characterization of many neurological diseases. Low-field MRI offers greater access at lower costs and lower infrastructural requirements, but also reduced susceptibility artifacts. We therefore evaluated [...] Read more.

Purpose: Accurate detection of cerebral microbleeds (CMBs) on susceptibility-weighted (SWI) magnetic resonance imaging (MRI) is crucial for the characterization of many neurological diseases. Low-field MRI offers greater access at lower costs and lower infrastructural requirements, but also reduced susceptibility artifacts. We therefore evaluated the diagnostic performance for the detection of CMBs of a whole-body low-field MRI in a prospective cohort of suspected stroke patients compared to an established 1.5 T MRI. Methods: A prospective scanner comparison was performed including 27 patients, of whom 3 patients were excluded because the time interval was >1 h between acquisition of the 1.5 T and 0.55 T MRI. All SWI sequences were assessed for the presence, number, and localization of CMBs by two neuroradiologists and additionally underwent a Likert rating with respect to image impression, resolution, noise, contrast, and diagnostic quality. Results: A total of 24 patients with a mean age of 74 years were included (11 female). Both readers detected the same number and localization of microbleeds in all 24 datasets (sensitivity and specificity 100%; interreader reliability ϰ = 1), with CMBs only being observed in 12 patients. Likert ratings of the sequences at both field strengths regarding overall image quality and diagnostic quality did not reveal significant differences between the 0.55 T and 1.5 T sequences (p = 0.942; p = 0.672). For resolution and contrast, the 0.55 T sequences were even significantly superior (p < 0.0001; p < 0.0003), whereas the 1.5 T sequences were significantly superior (p < 0.0001) regarding noise. Conclusion: Low-field MRI at 0.55 T may have similar accuracy as 1.5 T scanners for the detection of microbleeds and thus may have great potential as a resource-efficient alternative in the near future. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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15 pages, 3285 KiB

Open AccessArticle

An Intermodal Correlation Study among Imaging, Histology, Procedural and Clinical Parameters in Cerebral Thrombi Retrieved from Anterior Circulation Ischemic Stroke Patients

by Rebeka Viltužnik, Franci Bajd, Zoran Miloševič, Igor Kocijančič, Miran Jeromel, Andrej Fabjan, Eduard Kralj, Jernej Vidmar and Igor Serša

J. Clin. Med. 2022, 11(19), 5976; https://doi.org/10.3390/jcm11195976 - 10 Oct 2022

Cited by 2 | Viewed by 2020

Abstract

The precise characterization of cerebral thrombi prior to an interventional procedure can ease the procedure and increase its success. This study investigates how well cerebral thrombi can be characterized by computed tomography (CT), magnetic resonance (MR) and histology, and how parameters obtained by [...] Read more.

The precise characterization of cerebral thrombi prior to an interventional procedure can ease the procedure and increase its success. This study investigates how well cerebral thrombi can be characterized by computed tomography (CT), magnetic resonance (MR) and histology, and how parameters obtained by these methods correlate with each other as well as with the interventional procedure and clinical parameters. Cerebral thrombi of 25 patients diagnosed by CT with acute ischemic stroke were acquired by mechanical thrombectomy and, subsequently, scanned by a high spatial-resolution 3D MRI including T₁-weighted imaging, apparent diffusion coefficient (ADC), T₂ mapping and then finally analyzed by histology. Parameter pairs with Pearson correlation coefficient more than 0.5 were further considered by explaining a possible cause for the correlation and its impact on the difficulty of the interventional procedure and the treatment outcome. Significant correlations were found between the variability of ADC and the duration of the mechanical recanalization, the deviation in average Hounsfield units (HU) and the number of passes with the thrombectomy device, length of the thrombus, its RBC content and many others. This study also demonstrates the clinical potentials of high spatial resolution multiparametric MRI in characterization of thrombi and its use for interventional procedure planning. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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21 pages, 4336 KiB

Open AccessArticle

A Focus on the Role of DSC-PWI Dynamic Radiomics Features in Diagnosis and Outcome Prediction of Ischemic Stroke

by Yingwei Guo, Yingjian Yang, Fengqiu Cao, Mingming Wang, Yu Luo, Jia Guo, Yang Liu, Xueqiang Zeng, Xiaoqiang Miu, Asim Zaman, Jiaxi Lu and Yan Kang

J. Clin. Med. 2022, 11(18), 5364; https://doi.org/10.3390/jcm11185364 - 13 Sep 2022

Cited by 11 | Viewed by 2199

Abstract

Background: The ability to accurately detect ischemic stroke and predict its neurological recovery is of great clinical value. This study intended to evaluate the performance of whole-brain dynamic radiomics features (DRF) for ischemic stroke detection, neurological impairment assessment, and outcome prediction. Methods: The [...] Read more.

Background: The ability to accurately detect ischemic stroke and predict its neurological recovery is of great clinical value. This study intended to evaluate the performance of whole-brain dynamic radiomics features (DRF) for ischemic stroke detection, neurological impairment assessment, and outcome prediction. Methods: The supervised feature selection (Lasso) and unsupervised feature-selection methods (five-feature dimension-reduction algorithms) were used to generate four experimental groups with DRF in different combinations. Ten machine learning models were used to evaluate their performance by ten-fold cross-validation. Results: In experimental group_A, the best AUCs (0.873 for stroke detection, 0.795 for NIHSS assessment, and 0.818 for outcome prediction) were obtained by outstanding DRF selected by Lasso, and the performance of significant DRF was better than the five-feature dimension-reduction algorithms. The selected outstanding dimension-reduction DRF in experimental group_C obtained a better AUC than dimension-reduction DRF in experimental group_A but were inferior to the outstanding DRF in experimental group_A. When combining the outstanding DRF with each dimension-reduction DRF (experimental group_B), the performance can be improved in ischemic stroke detection (best AUC = 0.899) and NIHSS assessment (best AUC = 0.835) but failed in outcome prediction (best AUC = 0.806). The performance can be further improved when combining outstanding DRF with outstanding dimension-reduction DRF (experimental group_D), achieving the highest AUC scores in all three evaluation items (0.925 for stroke detection, 0.853 for NIHSS assessment, and 0.828 for outcome prediction). By the method in this study, comparing the best AUC of F_t_-test in experimental group_A and the best_AUC in experimental group_D, the AUC in stroke detection increased by 19.4% (from 0.731 to 0.925), the AUC in NIHSS assessment increased by 20.1% (from 0.652 to 0.853), and the AUC in prognosis prediction increased by 14.9% (from 0.679 to 0.828). This study provided a potential clinical tool for detailed clinical diagnosis and outcome prediction before treatment. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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13 pages, 8997 KiB

Open AccessArticle

Potential of Stroke Imaging Using a New Prototype of Low-Field MRI: A Prospective Direct 0.55 T/1.5 T Scanner Comparison

by Thilo Rusche, Hanns-Christian Breit, Michael Bach, Jakob Wasserthal, Julian Gehweiler, Sebastian Manneck, Johanna Maria Lieb, Gian Marco De Marchis, Marios Nikos Psychogios and Peter B. Sporns

J. Clin. Med. 2022, 11(10), 2798; https://doi.org/10.3390/jcm11102798 - 16 May 2022

Cited by 19 | Viewed by 2963

Abstract

Objectives: Ischemic stroke is a leading cause of mortality and acquired disability worldwide and thus plays an enormous health-economic role. Imaging of choice is computed-tomographic (CT) or magnetic resonance imaging (MRI), especially diffusion-weighted (DW) sequences. However, MR imaging is associated with high costs [...] Read more.

Objectives: Ischemic stroke is a leading cause of mortality and acquired disability worldwide and thus plays an enormous health-economic role. Imaging of choice is computed-tomographic (CT) or magnetic resonance imaging (MRI), especially diffusion-weighted (DW) sequences. However, MR imaging is associated with high costs and therefore has a limited availability leading to low-field-MRI techniques increasingly coming into focus. Thus, the aim of our study was to assess the potential of stroke imaging with low-field MRI. Material and Methods: A scanner comparison was performed including 27 patients (17 stroke cohort, 10 control group). For each patient, a brain scan was performed first with a 1.5T scanner and afterwards with a 0.55T scanner. Scan protocols were as identical as possible and optimized. Data analysis was performed in three steps: All DWI/ADC (apparent diffusion coefficient) and FLAIR (fluid attenuated inversion recovery) sequences underwent Likert rating with respect to image impression, resolution, noise, contrast, and diagnostic quality and were evaluated by two radiologists regarding number and localization of DWI and FLAIR lesions in a blinded fashion. Then segmentation of lesion volumes was performed by two other radiologists on DWI/ADC and FLAIR. Results: DWI/ADC lesions could be diagnosed with the same reliability by the most experienced reader in the 0.55T and 1.5T sequences (specificity 100% and sensitivity 92.9%, respectively). False positive findings did not occur. Detection of number/location of FLAIR lesions was mostly equivalent between 0.55T and 1.5T sequences. No significant difference (p = 0.789–0.104) for FLAIR resolution and contrast was observed regarding Likert scaling. For DWI/ADC noise, the 0.55T sequences were significantly superior (p < 0.026). Otherwise, the 1.5T sequences were significantly superior (p < 0.029). There was no significant difference in infarct volume and volume of infarct demarcation between the 0.55T and 1.5T sequences, when detectable. Conclusions: Low-field MRI stroke imaging at 0.55T may not be inferior to scanners with higher field strengths and thus has great potential as a low-cost alternative in future stroke diagnostics. However, there are limitations in the detection of very small infarcts. Further technical developments with follow-up studies must show whether this problem can be solved. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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10 pages, 1859 KiB

Open AccessArticle

Cerebral Hypoperfusion Intensity Ratio Is Linked to Progressive Early Edema Formation

by Noel van Horn, Gabriel Broocks, Reza Kabiri, Michel C. Kraemer, Soren Christensen, Michael Mlynash, Lukas Meyer, Maarten G. Lansberg, Gregory W. Albers, Peter Sporns, Adrien Guenego, Jens Fiehler, Max Wintermark, Jeremy J. Heit and Tobias D. Faizy

J. Clin. Med. 2022, 11(9), 2373; https://doi.org/10.3390/jcm11092373 - 23 Apr 2022

Cited by 18 | Viewed by 3173

Abstract

The hypoperfusion intensity ratio (HIR) is associated with collateral status and reflects the impaired microperfusion of brain tissue in patients with acute ischemic stroke and large vessel occlusion (AIS-LVO). As a deterioration in cerebral blood flow is associated with brain edema, we aimed [...] Read more.

The hypoperfusion intensity ratio (HIR) is associated with collateral status and reflects the impaired microperfusion of brain tissue in patients with acute ischemic stroke and large vessel occlusion (AIS-LVO). As a deterioration in cerebral blood flow is associated with brain edema, we aimed to investigate whether HIR is correlated with the early edema progression rate (EPR) determined by the ischemic net water uptake (NWU) in a multicenter retrospective analysis of AIS-LVO patients anticipated for thrombectomy treatment. HIR was automatically calculated as the ratio of time-to-maximum (TMax) > 10 s/(TMax) > 6 s. HIRs < 0.4 were regarded as favorable (HIR+) and ≥0.4 as unfavorable (HIR−). Quantitative ischemic lesion NWU was delineated on baseline NCCT images and EPR was calculated as the ratio of NWU/time from symptom onset to imaging. Multivariable regression analysis was used to assess the association of HIR with EPR. This study included 731 patients. HIR+ patients exhibited a reduced median NWU upon admission CT (4% (IQR: 2.1–7.6) versus 8.2% (6–10.4); p < 0.001) and less median EPR (0.016%/h (IQR: 0.007–0.04) versus 0.044%/h (IQR: 0.021–0.089; p < 0.001) compared to HIR− patients. Multivariable regression showed that HIR+ (β: 0.53, SE: 0.02; p = 0.003) and presentation of the National Institutes of Health Stroke Scale (β: 0.2, SE: 0.0006; p = 0.001) were independently associated with EPR. In conclusion, favorable HIR was associated with lower early edema progression and decreased ischemic edema formation on baseline NCCT. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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12 pages, 2642 KiB

Open AccessArticle

Effect of Intravenous Alteplase on Functional Outcome and Secondary Injury Volumes in Stroke Patients with Complete Endovascular Recanalization

by Gabriel Broocks, Lukas Meyer, Celine Ruppert, Wolfgang Haupt, Tobias D. Faizy, Noel Van Horn, Matthias Bechstein, Helge Kniep, Sarah Elsayed, Andre Kemmling, Ewgenia Barow, Jens Fiehler and Uta Hanning

J. Clin. Med. 2022, 11(6), 1565; https://doi.org/10.3390/jcm11061565 - 12 Mar 2022

Cited by 1 | Viewed by 3363

Abstract

Intravenous thrombolytic therapy with alteplase (IVT) is a standard of care in ischemic stroke, while recent trials investigating direct endovascular thrombectomy (EVT) approaches showed conflicting results. Yet, the effect of IVT on secondary injury volumes in patients with complete recanalization has not been [...] Read more.

Intravenous thrombolytic therapy with alteplase (IVT) is a standard of care in ischemic stroke, while recent trials investigating direct endovascular thrombectomy (EVT) approaches showed conflicting results. Yet, the effect of IVT on secondary injury volumes in patients with complete recanalization has not been analyzed. We hypothesized that IVT is associated with worse functional outcome and aggravated secondary injury volumes when administered to patients who subsequently attained complete reperfusion after EVT. Anterior circulation ischemic stroke patients with complete reperfusion after thrombectomy defined as thrombolysis in cerebral infarctions (TICI) scale 3 after thrombectomy admitted between January 2013–January 2021 were analyzed. Primary endpoints were the proportion of patients with functional independence defined as modified Rankin Scale (mRS) score 0–2 at day 90, and secondary injury volumes: Edema volume in follow-up imaging measured using quantitative net water uptake (NWU), and the rate of symptomatic intracerebral hemorrhage (sICH). A total of 219 patients were included and 128 (58%) patients received bridging IVT before thrombectomy. The proportion of patients with functional independence was 28% for patients with bridging IVT, and 34% for patients with direct thrombectomy (p = 0.35). The rate of sICH was significantly higher after bridging IVT (20% versus 7.7%, p = 0.01). Multivariable logistic and linear regression analysis confirmed the independent association of bridging IVT with sICH (aOR: 2.78, 95% CI: 1.02–7.56, p = 0.046), and edema volume (aOR: 8.70, 95% CI: 2.57–14.85, p = 0.006). Bridging IVT was associated with increased edema volume and risk for sICH as secondary injury volumes. The results of this study encourage direct EVT approaches, particularly in patients with higher likelihood of successful EVT. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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15 pages, 41709 KiB

Open AccessArticle

Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Detection in Acute Ischemic Stroke Patients

by Marta Leńska-Mieciek, Aleksandra Kuls-Oszmaniec, Natalia Dociak, Marcin Kowalewski, Krzysztof Sarwiński, Andrzej Osiecki and Urszula Fiszer

J. Clin. Med. 2022, 11(3), 665; https://doi.org/10.3390/jcm11030665 - 27 Jan 2022

Cited by 2 | Viewed by 2016

Abstract

(1) Background: AliveCor KardiaMobile (KM) is a portable electrocardiography recorder for detection of atrial fibrillation (AF). The aim of the study was to define the group of acute ischemic stroke (AIS) patients who can use the KM device and assess the diagnostic test [...] Read more.

(1) Background: AliveCor KardiaMobile (KM) is a portable electrocardiography recorder for detection of atrial fibrillation (AF). The aim of the study was to define the group of acute ischemic stroke (AIS) patients who can use the KM device and assess the diagnostic test accuracy. (2) Methods: the AIS patients were recruited to the study. Thirty-second single-lead electrocardiogram (ECG) usages were recorded on demand for three days using KM portable device. Each KM ECG record was verified by a cardiologist. The feasibility was evaluated using operationalization criteria. (3) Results: the recruitment rate among AIS patients was 26.3%. The withdrawal rate before the start of the intervention was 26%. The withdrawal rate after the start of the intervention was 6%. KM device detected AF in 2.8% of AIS patients and in 2.2% of ECG records. Cardiologist confirmed the AF in 0.3% AIS patients. Sensitivity and specificity of KM for AF was 100% and 98.3%, respectively. (4) Conclusions: the results of this study suggest that it is feasible to use KM device to detect AF in the selected AIS patients (younger and in better neurological condition). KM detected AF in the selected AIS patients with high specificity and sensitivity. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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13 pages, 1068 KiB

Open AccessArticle

Iron Deficiency and Reduced Muscle Strength in Patients with Acute and Chronic Ischemic Stroke

by Nadja Scherbakov, Anja Sandek, Miroslava Valentova, Antje Mayer, Stephan von Haehling, Ewa Jankowska, Stefan D. Anker and Wolfram Doehner

J. Clin. Med. 2022, 11(3), 595; https://doi.org/10.3390/jcm11030595 - 25 Jan 2022

Cited by 5 | Viewed by 2873

Abstract

(1) Introduction: Iron deficiency (ID) contributes to impaired functional performance and reduced quality of life in patients with chronic illnesses. The role of ID in stroke is unclear. The aim of this prospective study was to evaluate the prevalence of ID and to [...] Read more.

(1) Introduction: Iron deficiency (ID) contributes to impaired functional performance and reduced quality of life in patients with chronic illnesses. The role of ID in stroke is unclear. The aim of this prospective study was to evaluate the prevalence of ID and to evaluate its association with long-term functional outcome in patients with ischemic stroke. (2) Patients and Methods: 140 patients (age 69 ± 13 years, BMI 27.7 ± 4.6 kg/m², mean ± SD) admitted to a university hospital stroke Unit, with acute ischemic stroke of the middle cerebral artery were consecutively recruited to this observational study. Study examinations were completed after admission (3 ± 2 days after acute stroke) and at one-year follow up (N = 64, 382 ± 27 days after stroke). Neurological status was evaluated according to the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin scale (mRS). Muscle isometric strength of the non-affected limb was assessed by the maximum handgrip test and knee extension leg test. ID was diagnosed with serum ferritin levels ≤ 100 µg/L (ID Type I) or 100–300 µg/L if transferrin saturation (TSAT) < 20% (ID Type II). (3) Results: The prevalence of ID in acute stroke patients was 48% (N = 67), with about two-thirds of patients (N = 45) displaying ID Type I and one-third (N = 22) Type II. Handgrip strength (HGS) and quadriceps muscle strength were reduced in patients with ID compared to patients without ID at baseline (HGS: 26.5 ± 10.4 vs. 33.8 ± 13.2 kg, p < 0.001 and quadriceps: 332 ± 130 vs. 391 ± 143 N, p = 0.06). One year after stroke, prevalence of ID increased to 77% (p = 0.001). While an improvement of HGS was observed in patients with normal iron status, patients with ID had no improvement in HGS difference (4.6 ± 8.3 vs. −0.7 ± 6.5 kg, p < 0.05). Patients with ID remained with lower HGS compared to patients with normal iron status (28.2 ± 12.5 vs. 44.0 ± 8.6 kg, p < 0.0001). (4) Conclusions: Prevalence of ID was high in patients after acute stroke and further increased one year after stroke. ID was associated with lower muscle strength in acute stroke patients. In patients with ID, skeletal muscle strength did not improve one year after stroke. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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Review

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9 pages, 936 KiB

Open AccessReview

Admission Severity of Atrial-Fibrillation-Related Acute Ischemic Stroke in Patients under Anticoagulation Treatment: A Systematic Review and Meta-Analysis

by Catarina Garcia, Marcelo Silva, Mariana Araújo, Mariana Henriques, Marta Margarido, Patrícia Vicente, Hipólito Nzwalo and Ana Macedo

J. Clin. Med. 2022, 11(12), 3563; https://doi.org/10.3390/jcm11123563 - 20 Jun 2022

Cited by 9 | Viewed by 1973

Abstract

Background: In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission [...] Read more.

Background: In non-valvular-associated atrial fibrillation (AF), direct oral anticoagulants (DOAC) are as effective as vitamin K antagonists (VKA) for the prevention of acute ischemic stroke (AIS). DOAC are associated with decreased risk and severity of intracranial hemorrhage. It is unknown if different pre-admission anticoagulants impact the prognosis of AF related AIS (AF-AIS). We sought to analyze the literature to assess the association between pre-admission anticoagulation (VKA or DOAC) and admission severity of AF-AIS. Methods: A Systematic literature search (PubMed and ScienceDirect) between January 2011 to April 2021 was undertaken to identify studies describing the outcome of AF-AIS. Results: A total of 128 articles were identified. Of 9493 patients, 1767 were on DOAC, 919 were on therapeutical VKA, 792 were on non-therapeutical VKA and 6015 were not anticoagulated. In comparison to patients without anticoagulation, patients with therapeutical VKA and under DOAC presented with less severe stroke (MD −1.69; 95% CI [−2.71, −0.66], p = 0.001 and MD −2.96; 95% Cl [−3.75, −2.18], p < 0.00001, respectively). Patients with non-therapeutical VKA presented with more severe stroke (MD 1.28; 95% Cl [0.45, 2.12], p = 0.003). Conclusions: In AF-AIS, patients under therapeutical VKA or DOAC have reduced stroke severity on admission in comparison to patients without any anticoagulation, with higher magnitude of protection for DOAC. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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12 pages, 693 KiB

Open AccessReview

Neuroimaging Techniques as Potential Tools for Assessment of Angiogenesis and Neuroplasticity Processes after Stroke and Their Clinical Implications for Rehabilitation and Stroke Recovery Prognosis

by Lidia Włodarczyk, Natalia Cichon, Joanna Saluk-Bijak, Michal Bijak, Agata Majos and Elzbieta Miller

J. Clin. Med. 2022, 11(9), 2473; https://doi.org/10.3390/jcm11092473 - 28 Apr 2022

Cited by 10 | Viewed by 3246

Abstract

Stroke as the most frequent cause of disability is a challenge for the healthcare system as well as an important socio-economic issue. Therefore, there are currently a lot of studies dedicated to stroke recovery. Stroke recovery processes include angiogenesis and neuroplasticity and advances [...] Read more.

Stroke as the most frequent cause of disability is a challenge for the healthcare system as well as an important socio-economic issue. Therefore, there are currently a lot of studies dedicated to stroke recovery. Stroke recovery processes include angiogenesis and neuroplasticity and advances in neuroimaging techniques may provide indirect description of this action and become quantifiable indicators of these processes as well as responses to the therapeutical interventions. This means that neuroimaging and neurophysiological methods can be used as biomarkers—to make a prognosis of the course of stroke recovery and define patients with great potential of improvement after treatment. This approach is most likely to lead to novel rehabilitation strategies based on categorizing individuals for personalized treatment. In this review article, we introduce neuroimaging techniques dedicated to stroke recovery analysis with reference to angiogenesis and neuroplasticity processes. The most beneficial for personalized rehabilitation are multimodal panels of stroke recovery biomarkers, including neuroimaging and neurophysiological, genetic-molecular and clinical scales. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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21 pages, 747 KiB

Open AccessReview

The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches

by Tadeusz J. Popiela, Wirginia Krzyściak, Fabio Pilato, Anna Ligęzka, Beata Bystrowska, Karolina Bukowska-Strakova, Paweł Brzegowy, Karthik Muthusamy and Tamas Kozicz

J. Clin. Med. 2022, 11(7), 1864; https://doi.org/10.3390/jcm11071864 - 28 Mar 2022

Cited by 9 | Viewed by 3310

Abstract

Ischemic stroke accounts for over 80% of all strokes and is one of the leading causes of mortality and permanent disability worldwide. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is an approved treatment strategy for acute ischemic stroke of large arteries within [...] Read more.

Ischemic stroke accounts for over 80% of all strokes and is one of the leading causes of mortality and permanent disability worldwide. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is an approved treatment strategy for acute ischemic stroke of large arteries within 4.5 h of onset, and mechanical thrombectomy can be used for large arteries occlusion up to 24 h after onset. Improving diagnostic work up for acute treatment, reducing onset-to-needle time and urgent radiological access angiographic CT images (angioCT) and Magnetic Resonance Imaging (MRI) are real problems for many healthcare systems, which limits the number of patients with good prognosis in real world compared to the results of randomized controlled trials. The applied endovascular procedures demonstrated high efficacy, but some cellular mechanisms, following reperfusion, are still unknown. Changes in the morphology and function of mitochondria associated with reperfusion and ischemia-reperfusion neuronal death are still understudied research fields. Moreover, future research is needed to elucidate the relationship between continuously refined imaging techniques and the variable structure or physical properties of the clot along with vascular permeability and the pleiotropism of ischemic reperfusion lesions in the penumbra, in order to define targeted preventive procedures promoting long-term health benefits. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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Open AccessBrief Report

Machine Learning for Onset Prediction of Patients with Intracerebral Hemorrhage

by Thilo Rusche, Jakob Wasserthal, Hanns-Christian Breit, Urs Fischer, Raphael Guzman, Jens Fiehler, Marios-Nikos Psychogios and Peter B. Sporns

J. Clin. Med. 2023, 12(7), 2631; https://doi.org/10.3390/jcm12072631 - 31 Mar 2023

Cited by 3 | Viewed by 2869

Abstract

Objective: Intracerebral hemorrhage (ICH) has a high mortality and long-term morbidity and thus has a significant overall health–economic impact. Outcomes are especially poor if the exact onset is unknown, but reliable imaging-based methods for onset estimation have not been established. We hypothesized that [...] Read more.

Objective: Intracerebral hemorrhage (ICH) has a high mortality and long-term morbidity and thus has a significant overall health–economic impact. Outcomes are especially poor if the exact onset is unknown, but reliable imaging-based methods for onset estimation have not been established. We hypothesized that onset prediction of patients with ICH using artificial intelligence (AI) may be more accurate than human readers. Material and Methods: A total of 7421 computed tomography (CT) datasets between January 2007–July 2021 from the University Hospital Basel with confirmed ICH were extracted and an ICH-segmentation algorithm as well as two classifiers (one with radiomics, one with convolutional neural networks) for onset estimation were trained. The classifiers were trained based on the gold standard of 644 datasets with a known onset of >1 and <48 h. The results of the classifiers were compared to the ratings of two radiologists. Results: Both the AI-based classifiers and the radiologists had poor discrimination of the known onsets, with a mean absolute error (MAE) of 9.77 h (95% CI (confidence interval) = 8.52–11.03) for the convolutional neural network (CNN), 9.96 h (8.68–11.32) for the radiomics model, 13.38 h (11.21–15.74) for rater 1 and 11.21 h (9.61–12.90) for rater 2, respectively. The results of the CNN and radiomics model were both not significantly different to the mean of the known onsets (p = 0.705 and p = 0.423). Conclusions: In our study, the discriminatory power of AI-based classifiers and human readers for onset estimation of patients with ICH was poor. This indicates that accurate AI-based onset estimation of patients with ICH based only on CT-data may be unlikely to change clinical decision making in the near future. Perhaps multimodal AI-based approaches could improve ICH onset prediction and should be considered in future studies. Full article

(This article belongs to the Special Issue New Advances in Diagnostic Radiology of Ischemic Stroke)

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