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  • 1
    Online-Ressource
    Online-Ressource
    Kidney Disease, Hypertension Treatment, and Cerebral Perfusion and Structure
    Elsevier BV ; 2022
    In:  American Journal of Kidney Diseases Vol. 79, No. 5 ( 2022-05), p. 677-687.e1
    Details
    In: American Journal of Kidney Diseases, Elsevier BV, Vol. 79, No. 5 ( 2022-05), p. 677-687.e1
    Materialart: Online-Ressource
    ISSN: 0272-6386
    URL: Article
    DOI: 10.1053/j.ajkd.2021.07.024
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2022
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
    Online-Ressource
    Abstract 8: Hypoperfusion Lesion And Target Mismatch Prediction In Acute Ischemic Stroke From Baseline Mr Diffusion Imaging Using A 3d Convolutional Neural Network
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Kurzfassung: Purpose: Perfusion imaging assesses target mismatch but requires contrast and processing software. Clinical/diffusion mismatch can miss cases that have target mismatch and could benefit from thrombectomy. We explored whether a neural network can predict hypoperfusion and identify target mismatch from diffusion-weighted imaging (DWI) and clinical information alone. Methods: Acute ischemic stroke cases with baseline MR perfusion and DWI were included from two multi-center trials and one registry for model development and a separate randomized trial for external validation. MR perfusion images were processed by RAPID, which segments Tmax lesion (Tmax≥6s) and the ischemic core lesion (apparent diffusion coefficient [ADC]≤ 620). A 3D U-Net was trained using baseline DWI, ADC, NIH stroke scale, and side of stroke as input, and the union of Tmax and ischemic core segmentation as the ground truth. 5-fold cross-validation was performed for model development cohort. Model performance was evaluated by Dice score coefficient (DSC) and volume difference. Sensitivity and specificity of model target mismatch and clinical/diffusion mismatch criteria from the DAWN were compared, using the DEFUSE 3 target mismatch as reference. Results: 413 patients were included for model development and 46 for external validation. In model development and external validation cohort, the model achieved median DSC of 0.61 (IQR 0.45, 0.71) and 0.62 (IQR 0.53, 0.72); and volume difference of 3 ml (IQR -37, 41) and 7 ml (IQR -24, 32), respectively. Compared to the clinical/diffusion mismatch approach, the model identified target mismatch with a sensitivity of 89.5% vs 49.3%, a specificity of 77.5% vs 89.2% in the model development cohort, and a sensitivity of 95.6% vs 41.3% in external validation cohort. Conclusion: A 3D U-Net can predict hypoperfusion lesions from baseline DWI and clinical information, with more sensitive classification of target mismatch than clinical/diffusion mismatch.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.8
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2022
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    Association of Intensive vs Standard Blood Pressure Control With Magnetic Resonance Imaging Biomarkers of Alzheimer Disease : Secondary Analysis of the SPRINT MIND Randomized Trial
    American Medical Association (AMA) ; 2021
    In:  JAMA Neurology Vol. 78, No. 5 ( 2021-05-01), p. 568-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 78, No. 5 ( 2021-05-01), p. 568-
    Materialart: Online-Ressource
    ISSN: 2168-6149
    URL: Article
    DOI: 10.1001/jamaneurol.2021.0178
    Sprache: Englisch
    Verlag: American Medical Association (AMA)
    Publikationsdatum: 2021
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 4
    Online-Ressource
    Online-Ressource
    Abstract 118: Quantitative Cerebral Blood Flow Measured With Arterial Spin Labeling MRI in the Unaffected Hemisphere Predicts Outcome in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Kurzfassung: Introduction: Arterial spin labeling (ASL) MRI can non-invasively measure quantitative CBF. Evaluation of hemodynamics in the ipsilateral hemisphere is a common practice for selecting patients for therapy. In this study, we hypothesized that the contralateral CBF (cCBF) may identify patients with high collateral capacity and better outcome. Hypothesis: In acute stroke, higher CBF in the unaffected hemisphere is associated with better neurological outcome. Methods: Patients were part of the prospective ‘iCAS’ (imaging the Collaterals in Acute Stroke) study. Inclusion criteria were: ischemic hemispheric stroke ( 〈 16 hrs onset to imaging time [OIT]), age 〉 =18, informed consent, and technically adequate imaging including GRE, DWI, and 3D pseudocontinuous ASL. Outcomes were assessed by NIHSS at baseline, day 1, and day 5; and mRS at day 30 and day 90. After image registration to an MNI template, mean cCBF was calculated at standard ASPECTS levels in the contralateral hemisphere. Patients were dichotomized by median cCBF into low and high cCBF groups. Results are reported as medians with interquartile ranges [IQR]. Outcome differences were assessed with Wilcoxon (NIHSS) and Fisher’s exact test (mRS). Results: 61 patients met inclusion criteria: 32 F, age 66 yrs [54-77], OIT 4.8 hrs [3.4-7.2] , baseline NIHSS 13 [8-19], 36 underwent thrombectomy [28 with final TICI 〉 = 2b], cCBF 38.8 [31-46] ml/100 g/min. There was no difference between groups in age, gender, OIT, or reperfusion. Median NIHSS at baseline/day1/day5 for low and high cCBF groups was 13/14/11 and 12/6/4, respectively, which was significantly different on day 1 (p=.009) and day 5 (p=.031). Patients with higher cCBF had lower contralateral arterial transit time (p=.029) and better day 90 mRS (p=.029). Conclusion: Higher ASL cCBF predicts better outcome in acute stroke independent of baseline NIHSS and reperfusion status. This may reflect a better underlying capacity for collateral flow to the ischemic hemisphere.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.118
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2018
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 5
    Online-Ressource
    Online-Ressource
    Abstract WMP11: Arterial Occlusive Lesion Location Does Not Impact Functional Outcome in Patients with Endovascular Reperfusion
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Kurzfassung: Introduction: The relationship between clinical outcome and arterial occlusive lesion (AOL) location in patients after endovascular therapy is not fully determined. We aimed to investigate if the location of the arterial occlusive lesion (AOL) is an independent predictor of good functional outcome. Hypothesis: AOL location impacts clinical outcome with distal lesions having higher rates of good functional outcome (GFO) in reperfused patients. Methods: Using data from the CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP), a multi-center, NIH-sponsored prospective cohort study, we analyzed the effect of AOL location on clinical outcome. Patients were included if they had documented reperfusion on early follow-up MR or CT perfusion imaging ( 〉 50% reduction in Tmax 〉 6s lesion volume) or on angiography (TICI 2b or 3). Good functional outcome was defined as mRS score 0-2 at day 90. AOL location was categorized as proximal ICA, distal ICA, MCA-M1, or MCA-M2. Fully automated perfusion software (RAPID) was used to calculate CTP infarct core volume (rCBF 〈 30%) and critically hypoperfused tissue volume (Tmax 〉 6s). We assessed whether age, NIHSS score, infarct core, critically hypoperfused tissue, and AOL are associated with GFO using univariate and multivariate analyses. Results: The analysis included 167 of 201 patients (proximal ICA=21, distal ICA=32, M1=99, M2=15). Median NIHSS score (IQR) for groups were respectively: 18(14-22), 18(15-23), 17(11-20), 15( 13-19). Mean core volumes (mL) (IQR) were: 24.2(1.1-22.9), 13.0(0.0-17.7), 16.5(0.0-26.2), 10.6(1.1-13.0). Significant independent predictors of GFO were age (OR 0.82 for every 5 year increment, 95% CI 0.72-0.94), NIHSS score (OR 0.86, 95% CI 0.79-0.93), and core volume (OR 0.78 for every 10 mL increase, 95% CI 0.62-0.94), whereas AOL location (p=0.8-0.9) and the volume of critically hypoperfused tissue (p=0.5) were not significant in univariate and multivariate analyses. Conclusion: Baseline symptom severity, infarct core volume, and age drive functional outcomes in stroke patients with successful endovascular reperfusion. These variables, but not AOL location and volume of critically hypoperfused tissue, should be used for prognostication in the acute setting.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wmp11
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 6
    Online-Ressource
    Online-Ressource
    Abstract 158: The Malignant CTP Imaging Profile Predicts Worse Functional Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Kurzfassung: Introduction: The Malignant MRI profile, defined as a large lesion on DWI or PWI (Tmax 〉 10s), has been proposed as a marker of poor outcome despite reperfusion. It is not known if a corresponding malignant CT perfusion (CTP) profile can be used to identify stroke patients with a poor prognosis despite timely reperfusion. Hypothesis: The Malignant CTP profile identifies stroke patients with poor clinical outcomes despite endovascular reperfusion. Methods: The NIH-funded CTP to predict Response to recanalization in Ischemic Stroke Project (CRISP) prospectively enrolled acute ischemic stroke patients undergoing intra-arterial thrombectomy. CTP was obtained prior to the procedure and followed by a post-procedural MRI within 36 hours. The CTP Malignant profile was pre-specified as an infarct core (rCBF 〈 30%) ≥70mL or a lesion with severe hypoperfusion (Tmax 〉 10s) ≥100mL. Poor functional outcome was defined as a mRS 5-6 at 90 days. We evaluated performance of the pre-specified Malignant CTP profile for predicting poor functional outcome. We then performed an ROC analysis to optimize the ischemic core and Tmax 〉 10s volumes for predicting poor outcome with high specificity (≥90%). Results: Among 190 patients who underwent endovascular therapy, and had technically adequate CTP and 90-day outcome data, 51 (27%) had the Malignant CTP profile (45 on Tmax10 criteria alone, 6 on both infarct core and Tmax10 criteria). The Malignant CTP profile was associated with an increased rate of poor outcome (26% vs 14%; OR = 2.2; 95% CI 0.98-4.8; p=0.08). In patients with reperfusion (n=170), the percent of poor outcomes was significantly higher among patients with the Malignant CTP profile (27% vs 12%, p=0.02; OR = 3.1; 95% CI 1.3-7.4, adjusted for age). Based on ROC analysis, a CTP infarct core 〉 50 mL or a Tmax 〉 10s lesion 〉 150 mL predicted poor outcome with high specificity (90%), but corresponding sensitivity was low (28%) and PPV was modest (36%, or 9/25). Conclusion: Although presence of the Malignant CTP profile doubled the likelihood of poor outcome, only 1 out of 3 patients with this profile who had endovascular reperfusion experienced a poor outcome. This suggests that a subset of patients with the Malignant CTP profile may benefit from endovascular therapy.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.158
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 7
    Online-Ressource
    Online-Ressource
    Abstract WP58: Evolution of FLAIR Volume and Signal Intensity Following Endovascular Stroke Therapy
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Kurzfassung: Background: Infarct volume is an important surrogate marker for assessing the efficacy of acute stroke therapies. We studied the evolution of acute stroke lesions on FLAIR images over time following endovascular therapy in a subgroup of patients (n=35) from the DEFUSE 2 study. Methods: FLAIR images were acquired both post-revascularization (median 12h after symptom onset) and at day 5. Patients were separated into two groups based on the degree of reperfusion achieved on Tmax 〉 6s perfusion imaging ( 〉 90% vs. 〈 90%). After co-registration and signal normalization, lesion volumes and signal intensity were assessed in both initial infarct (lesion visible after revascularization), and recruited infarct (additional lesion visible lesion on day 5). Results: All 35 patients had FLAIR lesion growth between post-revascularization and day 5. Median infarct growth was significantly larger in patients with 90% (8.12ml, p=0.003). In the initial infarct, signal intensity did not change between post-revascularization and day 5 in the 〉 90% reperfused group, while it increased in the 〈 90% reperfused group (p = 0.01). In the recruited infarct, signal increased significantly in both groups between post-revascularization and day 5 (p 〈 0.0001). Conclusions: Compared with patients who have 〈 90% reperfusion, patients with 〉 90% reperfusion have significantly less infarct growth between post- endovascular revascularization and day 5. Therefore, reductions in ischemic lesion growth attributable to reperfusion therapies are likely to be more apparent at day 5 compared to early post-revascularization.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp58
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 8
    Online-Ressource
    Online-Ressource
    Abstract WMP17: Severe CT Perfusion Bolus Delays Predict Infarct Growth Despite Reperfusion
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Kurzfassung: Introduction: Prior studies based on MR data have shown that large perfusion lesions with long perfusion delays (Tmax 〉 10s) are associated with poor functional and imaging outcomes. It is uncertain if the same associations exist for patients imaged with CT perfusion (CTP). Hypothesis: Patients with large volumes ( 〉 100mL) of tissue with a Tmax delay exceeding 10s (malignant Tmax profile) on CTP exhibit more infarct growth and have larger infarct outcomes than patients without this profile. Methods: The CRISP study is a multi-center NIH-sponsored prospective cohort study designed to evaluate if the presence of a CTP mismatch pattern is associated with a favorable response to reperfusion. All patients underwent CTP prior to endovascular therapy, early follow-up MRI ( 〈 36 hours from baseline CTP), and MRI at day 5. Infarct growth was calculated as the difference between the infarct core volume on baseline CTP (tissue with rCBF 〈 30%) and the day 5 FLAIR. Reperfusion was defined as 〉 50% resolution of the Tmax 〉 6s lesion between baseline and early follow-up, or TICI 2b or 3 reperfusion by angiography in the absence of an early follow up scan. The volumes were compared using Wilcoxons rank-sum test, we report median, [IQR]. Results: Baseline mismatch profile, reperfusion status and day 5 MRI were available in 109/201 patients, of whom 99 reperfused. Among patients with reperfusion, those with a malignant Tmax profile (n=24) had more infarct growth than patients without a malignant profile (n=75) (90,[49-116] vs 43,[18-81] mL, p=0.006). Patients with malignant profile also had larger final infarct volumes (110,[61-155] vs 48,[21-99] mL, p=0.001). Both the time from stroke onset and from baseline CTP to intravascular therapy were balanced between the two Tmax profile groups (p=0.32 and 0.53). Of the 10 patients without reperfusion, only 1 had malignant Tmax profile and no comparisons we performed in this group. Conclusion: A Tmax 〉 10s lesion of 100 mL or more on CTP is associated with more than doubling of both infarct growth and final infarct volume despite successful reperfusion. While this does not exclude potential benefit from intraarterial thrombectomy, it suggests that the beneficial effect of reperfusion may be attenuated among patients with a malignant CTP profile.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wmp17
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2016
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 9
    Online-Ressource
    Online-Ressource
    Abstract 188: Correlation of Angiographic Capillary Index Score (CIS) with Diffusion and Perfusion MR Imaging in the DEFUSE 2 Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. suppl_1 ( 2014-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. suppl_1 ( 2014-02)
    Kurzfassung: Objective: The CIS has been shown to be a predictor of good clinical outcome following endovascular therapy for acute ischemic stroke. We undertook this study to determine the relationship between CIS and baseline diffusion-perfusion imaging as well as angiographic collaterals in DEFUSE 2 study patients. Methods: Patients undergoing endovascular therapy within 12 hours of stroke onset were prospectively enrolled. Only patients with an ICA/M1 occlusion and adequate demonstration of the anterior and posterior circulations at baseline angiography were included in this analysis. Blinded reading of the CIS was made using a 4 point scale from 0 (no capillary blush in ischemic territory) to 3 (blush throughout). Analysis was dichotomized to poor CIS (0-1) versus good (2-3). CIS was correlated with baseline DWI volume, PWI volume (Tmax 〉 6, Tmax 〉 10), an angiographic collateral score (using a previously described 5 point scale) and subsequent infarct growth. Results: Forty-eight patients had ICA/M1 occlusions and adequate angiographic images to evaluate CIS. Baseline DWI lesion volume correlated with CIS (p=0.001). Median DWI volume for patients with poor CIS (0-1) was 28 (IQR, 11-54) versus 13 (3-27) for those with good CIS (2-3), p=0.011. Baseline T max 〉 6 volume correlated with CIS (p=0.004). Median volume of tissue at risk (T max 〉 6 sec) in those with poor CIS was 108 ml (IQR, 74-138) versus 69(43-108) with good CIS, p=0.009. Severe T max delay ( 〉 10 sec) also correlated with CIS (p=0.001). CIS was also found to correlate with angiographic collaterals (p=0.006). On follow-up MRI CIS correlated with subsequent lesion growth (p=0.043). Conclusions: CIS provides a rapid angiographic assessment of capillary blush from collateral flow into the ischemic territory and correlates with angiographic collateral scores. In DEFUSE 2 the CIS score was strongly associated with baseline DWI and PWI lesion volumes and subsequent lesion growth.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.45.suppl_1.188
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2014
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 10
    Online-Ressource
    Online-Ressource
    Abstract P325: Validation of Deep Learning Based Critical Hypoperfusion and Ischemic Core Prediction in a Multicenter External Randomized Controlled Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Kurzfassung: Objective: We previously developed two separate deep learning (DL) models to segment the ischemic core and critically hypoperfused tissue on baseline imaging of acute ischemic stroke patients. We aimed to validate the models in an external, multi-center randomized clinical trial (DEFUSE3) and compare with the current clinical standard. Methods: The DL models were previously trained in a separate dataset in which follow-up MRI, obtained at 3-7 days, was used as the reference for critically hypoperfused tissue in patients who did not reperfuse and as the reference for the ischemic core in patients who did reperfuse. For validation, we included DEFUSE3 patients with adequate quality baseline MR perfusion and a 24-hour follow-up DWI scan. The 24-hour DWI lesion served as the reference for ischemic core in patients in the thrombectomy arm and for critically hypoperfused tissue for patients in the medical arm. RAPID was used to generate perfusion maps (Tmax, cerebral blood flow, cerebral blood volume, and mean transient time). The accuracy of segmenting the ischemic core and critically hypoperfused tissue on baseline imaging was compared between the DL approach and the traditional thresholding approach implemented in RAPID. Results: In the 46 patients included for analysis, 24 were in the medical arm and 22 in the thrombectomy arm. Compared to a traditional thresholding method, the DL model segmented the ischemic core more accurately (AUC of 0.92 vs 0.72, p=0.0001 and volume difference of -8ml vs -21ml, p=0.001). Similarly, the DL model segmented critically hypoperfused tissue more accurately (AUC of 0.93 vs 0.80, p 〈 0.0001; volume difference 14ml vs. 55ml, p=0.0005). However, great heterogeneity in final infarct was noticed in medical arm. See tables and figures. Conclusions: The DL-based critical hypoperfusion and ischemic core prediction provides more accurate prediction on final infarct than a commonly used thresholding method in this external validation.
    Materialart: Online-Ressource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P325
    RVK:
    XA 10000
    Sprache: Englisch
    Verlag: Ovid Technologies (Wolters Kluwer Health)
    Publikationsdatum: 2021
    ZDB Id: 1467823-8
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
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