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  • 1
    Online Resource
    Online Resource
    Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data
    Elsevier BV ; 2020
    In:  The Lancet Vol. 396, No. 10262 ( 2020-11), p. 1574-1584
    Details
    In: The Lancet, Elsevier BV, Vol. 396, No. 10262 ( 2020-11), p. 1574-1584
    Type of Medium: Online Resource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(20)32163-2
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
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    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
    SSG: 5,21
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  • 2
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    Chronic sensory stroke with and without central pain is associated with bilaterally distributed sensory abnormalities as detected by quantitative sensory testing
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Pain Vol. 157, No. 1 ( 2016-01), p. 194-202
    Details
    In: Pain, Ovid Technologies (Wolters Kluwer Health), Vol. 157, No. 1 ( 2016-01), p. 194-202
    Type of Medium: Online Resource
    ISSN: 0304-3959
    URL: Article
    DOI: 10.1097/j.pain.0000000000000354
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1494115-6
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  • 3
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    Can intracranial time-of-flight-MR angiography predict extracranial carotid artery stenosis?
    Springer Science and Business Media LLC ; 2022
    In:  Journal of Neurology Vol. 269, No. 5 ( 2022-05), p. 2743-2749
    Details
    In: Journal of Neurology, Springer Science and Business Media LLC, Vol. 269, No. 5 ( 2022-05), p. 2743-2749
    Abstract: Extracranial stenosis of the internal carotid artery (ICA) is an important cause of ischemic stroke and transient ischemic attack (TIA). It can be diagnosed using contrast-enhanced CT or MR angiography (MRA) as well as Doppler ultrasound. In this study, we assessed the diagnostic value of intracranial time-of-flight (TOF) MRA to predict extracranial ICA stenosis (ICAS). Methods We retrospectively analyzed consecutive patients with acute ischemic stroke or TIA and middle- (50–69%) or high-grade (70–99%) unilateral extracranial ICAS according to NASCET criteria assessed by ultrasound between January 2016 and August 2018. The control group consisted of patients without extracranial ICAS. Intraluminal signal intensities (SI) of the intracranial ICA on the side of the extracranial stenosis were compared to the contralesional side on TOF-MRA source images. SI ratios (SIR) of contralesional:lesional side were compared between groups. Results In total, 151 patients were included in the main analysis. Contralesional:lesional SIR in the intracranial C4-segment was significantly higher in patients with ipsilateral extracranial ICA stenosis ( n  = 51, median 74 years, 57% male) compared to the control group ( n  = 100, median 68 years, 48% male). Mean SIR was 1.463 vs. 1.035 ( p   〈  0.001) for right-sided stenosis and 1.362 vs. 1.000 ( p   〈  0.001) for left-sided stenosis. Receiver-operating characteristic curve demonstrated a cut-off value of 1.086 for right-sided [sensitivity/specificity 75%/81%; area under the curve (AUC) 0.81] and 1.104 for left-sided stenosis (sensitivity/specificity 70%/84%; AUC 0.80) in C4 as a good predictor for high-grade extracranial ICAS. Conclusions SIR on TOF-MRA can be a marker of extracranial ICAS.
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    URL: Article
    DOI: 10.1007/s00415-021-10876-0
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1421299-7
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  • 4
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    The Potential of Microvessel Density in Prediction of Infarct Growth: A Two-Month Experimental Study in Vessel Size Imaging
    S. Karger AG ; 2012
    In:  Cerebrovascular Diseases Vol. 33, No. 4 ( 2012), p. 303-309
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 33, No. 4 ( 2012), p. 303-309
    Abstract: 〈 i 〉 Objectives: 〈 /i 〉 Vessel size imaging is a novel technique to evaluate pathological changes of the microvessel density quantity Q and the mean vessel size index (VSI). As a follow-up study, we assessed these parameters for microscopic description of ischemic penumbra and their potentials in predicting lesion growth. 〈 i 〉 Methods: 〈 /i 〉 Seventy-five patients with a perfusion-diffusion mismatch were examined within 24 h from symptom onset. We defined three regions of interest: the initial infarct (INF), the ischemic penumbra (IPE), and the healthy region (HEA) symmetric to the IPE. For 23 patients with a 6th-day follow-up, IPE regions were divided into areas of infarct growth and areas of oligemia. 〈 i 〉 Result: 〈 /i 〉 The median values of Q and VSI were: for INF 0.29 s 〈 sup 〉 -1/3 〈 /sup 〉 and 15.8 µm, for IPE 0.33 s 〈 sup 〉 -1/3 〈 /sup 〉 and 20.6 µm and for HEA 0.36 s 〈 sup 〉 -1/3 〈 /sup 〉 and 17.4 µm. The Q in the IPE was significantly smaller than in HEA, and VSI was significantly larger. The Q with a threshold of 0.32 s 〈 sup 〉 -1/3 〈 /sup 〉 predicted the final infarction with a sensitivity of 69% and a specificity of 64%. 〈 i 〉 Conclusions: 〈 /i 〉 The reduced Q and increased VSI in the IPE confirmed our previous pilot results. Although Q showed a trend to identify the severity of ischemia in an overall voxel population, its potential in predicting infarct growth needs to be further tested in a larger cohort including a clear status of reperfusion and recanalization.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000335302
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
    detail.hit.zdb_id: 1482069-9
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  • 5
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    Spot Sign in Acute Intracerebral Hemorrhage in Dynamic T1-Weighted Magnetic Resonance Imaging
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 2 ( 2016-02), p. 417-423
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 2 ( 2016-02), p. 417-423
    Abstract: In computed tomographic imaging of acute intracerebral hemorrhage spot sign on computed tomographic angiography has been established as a marker for hematoma expansion and poor clinical outcome. Although, magnetic resonance imaging (MRI) can accurately visualize acute intracerebral hemorrhage, a corresponding MRI marker is lacking to date. Methods— We prospectively examined 50 consecutive patients with acute intracerebral hemorrhage within 24 hours of symptom onset. The MRI protocol consisted of a standard stroke protocol and dynamic contrast-enhanced T1-weighted imaging with a time resolution of 7.07 s/batch. Stroke scores were assessed at admission and at time of discharge. Volume measurements of hematoma size and spot sign were performed with MRIcron. Results— Contrast extravasation within sites of the hemorrhage (MRI spot sign) was seen in 46% of the patients. Patients with an MRI spot sign had a significantly shorter time to imaging than those without ( P 〈 0.001). The clinical outcome measured by the modified Rankin Scale was significantly worse in patients with spot sign compared with those without ( P ≤0.001). Hematoma expansion was observed in the spot sign group compared with the nonspot sign group, although the differences were not significant. Conclusions— Spot sign can be detected using MRI on postcontrast T1-weighted and dynamic T1-weighted images. It is associated with worse clinical outcome. The time course of contrast extravasation in dynamic T1 images indicates that these spots represent ongoing bleeding.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.011570
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 6
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    Relationship Between Changes in the Temporal Dynamics of the Blood-Oxygen-Level-Dependent Signal and Hypoperfusion in Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 4 ( 2017-04), p. 925-931
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 4 ( 2017-04), p. 925-931
    Abstract: Changes in the blood-oxygen-level-dependent (BOLD) signal provide a noninvasive measure of blood flow, but a detailed comparison with established perfusion parameters in acute stroke is lacking. We investigated the relationship between BOLD signal temporal delay and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in stroke patients. Methods— In 30 patients with acute ( 〈 24 hours) ischemic stroke, we performed Pearson correlation and multiple linear regression between DSC-MRI parameters (time to maximum [Tmax], mean transit time, cerebral blood flow, and cerebral blood volume) and BOLD-based parameters (BOLD delay and coefficient of BOLD variation). Prediction of severe hypoperfusion (Tmax 〉 6 seconds) was assessed using receiver–operator characteristic (ROC) analysis. Results— Correlation was highest between Tmax and BOLD delay (venous sinus reference; time shift range 7; median r =0.60; interquartile range=0.49–0.71). Coefficient of BOLD variation correlated with cerebral blood volume (median r = 0.37; interquartile range=0.24–0.51). Mean R 2 for predicting BOLD delay by DSC-MRI was 0.54 (SD=0.2) and for predicting coefficient of BOLD variation was 0.37 (SD=0.17). BOLD delay (whole-brain reference, time shift range 3) had an area under the curve of 0.76 for predicting severe hypoperfusion (sensitivity=69.2%; specificity=80%), whereas BOLD delay (venous sinus reference, time shift range 3) had an area under the curve of 0.76 (sensitivity=67.3%; specificity=83.5%). Conclusions— BOLD delay is related to macrovascular delay and microvascular hypoperfusion, can identify severely hypoperfused tissue in acute stroke, and is a promising alternative to gadolinium contrast agent–based perfusion assessment in acute stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00715533 and NCT02077582.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.015566
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Online Resource
    Complete Early Reversal of Diffusion-Weighted Imaging Hyperintensities After Ischemic Stroke Is Mainly Limited to Small Embolic Lesions
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 4 ( 2013-04), p. 1043-1048
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 4 ( 2013-04), p. 1043-1048
    Abstract: Case reports have demonstrated complete early reversal of hyperintensities on diffusion-weighted imaging (DWI) after clinically diagnosed stroke. We aimed to investigate systematically the rate and characteristics of reversible diffusion hyperintensities (RDHs) in the first week after stroke. Methods— Patients with clinical diagnosis of an acute cerebrovascular event and evidence of ischemia on DWI were included. MRI scans were performed on admission, on the following day, and 4 to 7 days after onset of symptoms with DWI and fluid-attenuated inversion recovery. Baseline and follow-up DWIs were coregistered and examined for individual RDHs. Characteristics of patients and of hyperintensities associated with early reversal were identified. Results— We included 153 patients with a median National Institutes of Health Stroke Scale score of 4 (interquartile range, 2–8). In 3 patients (2%), MR images normalized completely. Thirty-seven patients (24%) displayed individual RDHs. Of 611 initial DWI hyperintensities, 97 (16%) reversed. Thirteen percent of the RDHs had corresponding abnormalities on fluid-attenuated inversion recovery images at the third measurement. Median size of the RDHs was 0.029 mL (interquartile range, 0.013–0.055). RDHs were associated with a multiple infarct pattern (odds ratio, 22.1; 95% confidence interval, 4.5–109.7) and symptomatic carotid stenosis (odds ratio, 5.5; 95% confidence interval, 1.4–21.5). Fifty-nine percent of the patients with RDHs had new additional lesions on follow-up DWI. RDHs were not associated with functional improvement on the National Institutes of Health Stroke Scale score. Conclusions— In this population of mainly minor to moderate stroke patients, complete normalization of MR images was rare. Complete reversal of individual DWI hyperintensities was limited to very small lesions and mostly occurred in embolic stroke patients. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00715533.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.111.676346
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 8
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    Early Time Course of FLAIR Signal Intensity Differs between Acute Ischemic Stroke Patients with and without Hyperintense Acute Reperfusion Marker
    S. Karger AG ; 2014
    In:  Cerebrovascular Diseases Vol. 37, No. 2 ( 2014), p. 141-146
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 37, No. 2 ( 2014), p. 141-146
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 In animal models of stroke, the time course of blood-brain barrier (BBB) disruptions has been elaborately studied. In human patients, leakage of gadolinium into cerebrospinal fluid (CSF) space, visualized on MRI fluid attenuated inversion recovery (FLAIR) images, is considered a sign of BBB disruptions. It was termed ‘hyperintense acute reperfusion marker' (HARM) and was associated with hemorrhages. However, the time course of the leakage is unknown and difficult to study in human patients. Also, the association of HARM with signal intensities and enhancement in the parenchyma on FLAIR images has not been thoroughly researched. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We analyzed imaging data of acute ischemic stroke patients who underwent repetitive MRI examinations within the first 36 h after the time of symptom onset. HARM was evaluated on FLAIR images. Regions of interest (ROI) of the hyperintensities on diffusion-weighted imaging (DWI) were determined for each time point and mirrored to the contralateral side. The ROI were furthermore corrected for CSF-filled space, using apparent diffusion coefficient (ADC) images. The corrected ROI were used to determine mean signal intensities of the lesions relative to the contralateral side on FLAIR, ADC and B & #8320; images for each time point. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The 18 included patients (5 females; median age: 69 years; median NIHSS score: 5) received 3-5 MRI examinations on the first day and 1-2 examinations on day 2 after stroke. Eight of the patients (44.4%) showed HARM on at least 1 examination. In 6 of these patients, HARM was already seen at the second examination, at the earliest 3.5 h after symptom onset. The HARM-positive patients had higher relative signal intensities (rSI) on FLAIR images in the parenchyma corresponding to the DWI-positive tissue compared with the HARM-negative patients. This difference between groups was statistically significant for the 2nd and 3rd examination (medians of 4.31 and 6.37 h from symptom onset, p 〈 0.001 and p = 0.005, respectively). No significant difference in rSI between groups was seen for ADC or B & #8320; images. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 HARM does not only represent a contrast medium leakage from the pial system into the CSF space. It is accompanied by a markedly increased rSI in the early ischemic lesion on FLAIR images, which is likely due to parenchymal enhancement. The lack of differences on B & #8320; images excludes a pure T2 effect.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000357422
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
    detail.hit.zdb_id: 1482069-9
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  • 9
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    Adapting the Computed Tomography Criteria of Hemorrhagic Transformation to Stroke Magnetic Resonance Imaging
    S. Karger AG ; 2013
    In:  Cerebrovascular Diseases Extra Vol. 3, No. 1 ( 2013-8-27), p. 103-110
    Details
    In: Cerebrovascular Diseases Extra, S. Karger AG, Vol. 3, No. 1 ( 2013-8-27), p. 103-110
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 The main safety aspect in the use of stroke thrombolysis and in clinical trials of new pharmaceutical or interventional stroke therapies is the incidence of hemorrhagic transformation (HT) after treatment. The computed tomography (CT)-based classification of the European Cooperative Acute Stroke Study (ECASS) distinguishes four categories of HTs. An HT can range from a harmless spot of blood accumulation to a symptomatic space-occupying parenchymal bleeding associated with a massive deterioration of symptoms and clinical prognosis. In magnetic resonance imaging (MRI) HTs are often categorized using the ECASS criteria although this classification has not been validated in MRI. We developed MRI-specific criteria for the categorization of HT and sought to assess its diagnostic reliability in a retrospective study. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Consecutive acute ischemic stroke patients, who had received a 3-tesla MRI before and 12-36 h after thrombolysis, were screened retrospectively for an HT of any kind in post-treatment MRI. Intravenous tissue plasminogen activator was given to all patients within 4.5 h. HT categorization was based on a simultaneous read of 3 different MRI sequences (fluid-attenuated inversion recovery, diffusion-weighted imaging and T2* gradient-recalled echo). Categorization of HT in MRI accounted for the various aspects of the imaging pattern as the shape of the bleeding area and signal intensity on each sequence. All data sets were independently categorized in a blinded fashion by 3 expert and 3 resident observers. Interobserver reliability of this classification was determined for all observers together and for each group separately by calculating Kendall's coefficient of concordance 〈 i 〉 (W) 〈 /i 〉 . 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of the 186 patients screened, 39 patients (21%) had an HT in post-treatment MRI and were included for the categorization of HT by experts and residents. The overall agreement of HT categorization according to the modified classification was substantial for all observers ( 〈 i 〉 W 〈 /i 〉 = 0.79). The degrees of agreement between experts ( 〈 i 〉 W 〈 /i 〉 = 0.81) and between residents ( 〈 i 〉 W 〈 /i 〉 = 0.87) were almost perfect. For the distinction between parenchymal hematoma and hemorrhagic infarction, the interobserver agreement was almost perfect for all observers taken together ( 〈 i 〉 W 〈 /i 〉 = 0.82) as well as when experts ( 〈 i 〉 W 〈 /i 〉 = 0.82) and residents ( 〈 i 〉 W 〈 /i 〉 = 0.91) were analyzed separately. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The ECASS CT classification of HT was successfully adapted for usage in MRI. It leads to a substantial to almost perfect interobserver agreement and can be used for safety assessment in clinical trials.
    Type of Medium: Online Resource
    ISSN: 1664-5456
    URL: Article
    DOI: 10.1159/000354371
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 2651613-5
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  • 10
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    Case report of a young stroke patient showing interim normalization of the MRI diffusion-weighted imaging lesion
    Springer Science and Business Media LLC ; 2015
    In:  BMC Medical Imaging Vol. 15, No. 1 ( 2015-12)
    Details
    In: BMC Medical Imaging, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2015-12)
    Type of Medium: Online Resource
    ISSN: 1471-2342
    URL: Article
    DOI: 10.1186/s12880-015-0077-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 2061975-3
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