Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke after Reperfusion Therapy

Kambiz Nael, James R. Knitter, Reza Jahan, Jeffery Gornbein, Zahra Ajani, Lei Feng, Brett C. Meyer, Lee H. Schwamm, Albert J. Yoo, Randolph S. Marshall, Philip M. Meyers, Dileep R Yavagal, Max Wintermark, David S. Liebeskind, Judy Guzy, Sidney Starkman, Jeffrey L. Saver, Chelsea S. Kidwell

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background and Purpose - Patients with acute ischemic stroke are at increased risk of developing parenchymal hemorrhage (PH), particularly in the setting of reperfusion therapies. We have developed a predictive model to examine the risk of PH using combined magnetic resonance perfusion and diffusion parameters, including cerebral blood volume (CBV), apparent diffusion coefficient, and microvascular permeability (K2). Methods - Voxel-based values of CBV, K2, and apparent diffusion coefficient from the ischemic core were obtained using pretreatment magnetic resonance imaging data from patients enrolled in the MR RESCUE clinical trial (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy). The associations between PH and extreme values of imaging parameters were assessed in univariate and multivariate analyses. Receiver-operating characteristic curve analysis was performed to determine the optimal parameter(s) and threshold for predicting PH. Results - In 83 patients included in this analysis, 20 developed PH. Univariate analysis showed significantly lower 10th percentile CBV and 10th percentile apparent diffusion coefficient values and significantly higher 90th percentile K2 values within the infarction core of patients with PH. Using classification tree analysis, the 10th percentile CBV at threshold of 0.47 and 90th percentile K2 at threshold of 0.28 resulted in overall predictive accuracy of 88.7%, sensitivity of 90.0%, and specificity of 87.3%, which was superior to any individual or combination of other classifiers. Conclusions - Our results suggest that combined 10th percentile CBV and 90th percentile K2 is an independent predictor of PH in patients with acute ischemic stroke with diagnostic accuracy superior to individual classifiers alone. This approach may allow risk stratification for patients undergoing reperfusion therapies. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00389467.

Original languageEnglish (US)
Pages (from-to)664-670
Number of pages7
JournalStroke
Volume48
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Reperfusion
Stroke
Magnetic Resonance Imaging
Hemorrhage
Therapeutics
Clinical Trials
Embolectomy
Capillary Permeability
ROC Curve
Infarction
Magnetic Resonance Spectroscopy
Multivariate Analysis
Perfusion
Cerebral Blood Volume
Sensitivity and Specificity

Keywords

  • biomarkers
  • embolectomy
  • hemorrhage
  • permeability
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke after Reperfusion Therapy. / Nael, Kambiz; Knitter, James R.; Jahan, Reza; Gornbein, Jeffery; Ajani, Zahra; Feng, Lei; Meyer, Brett C.; Schwamm, Lee H.; Yoo, Albert J.; Marshall, Randolph S.; Meyers, Philip M.; Yavagal, Dileep R; Wintermark, Max; Liebeskind, David S.; Guzy, Judy; Starkman, Sidney; Saver, Jeffrey L.; Kidwell, Chelsea S.

In: Stroke, Vol. 48, No. 3, 01.03.2017, p. 664-670.

Research output: Contribution to journalArticle

Nael, K, Knitter, JR, Jahan, R, Gornbein, J, Ajani, Z, Feng, L, Meyer, BC, Schwamm, LH, Yoo, AJ, Marshall, RS, Meyers, PM, Yavagal, DR, Wintermark, M, Liebeskind, DS, Guzy, J, Starkman, S, Saver, JL & Kidwell, CS 2017, 'Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke after Reperfusion Therapy', Stroke, vol. 48, no. 3, pp. 664-670. https://doi.org/10.1161/STROKEAHA.116.014343
Nael, Kambiz ; Knitter, James R. ; Jahan, Reza ; Gornbein, Jeffery ; Ajani, Zahra ; Feng, Lei ; Meyer, Brett C. ; Schwamm, Lee H. ; Yoo, Albert J. ; Marshall, Randolph S. ; Meyers, Philip M. ; Yavagal, Dileep R ; Wintermark, Max ; Liebeskind, David S. ; Guzy, Judy ; Starkman, Sidney ; Saver, Jeffrey L. ; Kidwell, Chelsea S. / Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke after Reperfusion Therapy. In: Stroke. 2017 ; Vol. 48, No. 3. pp. 664-670.
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abstract = "Background and Purpose - Patients with acute ischemic stroke are at increased risk of developing parenchymal hemorrhage (PH), particularly in the setting of reperfusion therapies. We have developed a predictive model to examine the risk of PH using combined magnetic resonance perfusion and diffusion parameters, including cerebral blood volume (CBV), apparent diffusion coefficient, and microvascular permeability (K2). Methods - Voxel-based values of CBV, K2, and apparent diffusion coefficient from the ischemic core were obtained using pretreatment magnetic resonance imaging data from patients enrolled in the MR RESCUE clinical trial (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy). The associations between PH and extreme values of imaging parameters were assessed in univariate and multivariate analyses. Receiver-operating characteristic curve analysis was performed to determine the optimal parameter(s) and threshold for predicting PH. Results - In 83 patients included in this analysis, 20 developed PH. Univariate analysis showed significantly lower 10th percentile CBV and 10th percentile apparent diffusion coefficient values and significantly higher 90th percentile K2 values within the infarction core of patients with PH. Using classification tree analysis, the 10th percentile CBV at threshold of 0.47 and 90th percentile K2 at threshold of 0.28 resulted in overall predictive accuracy of 88.7{\%}, sensitivity of 90.0{\%}, and specificity of 87.3{\%}, which was superior to any individual or combination of other classifiers. Conclusions - Our results suggest that combined 10th percentile CBV and 90th percentile K2 is an independent predictor of PH in patients with acute ischemic stroke with diagnostic accuracy superior to individual classifiers alone. This approach may allow risk stratification for patients undergoing reperfusion therapies. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00389467.",
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AU - Nael, Kambiz

AU - Knitter, James R.

AU - Jahan, Reza

AU - Gornbein, Jeffery

AU - Ajani, Zahra

AU - Feng, Lei

AU - Meyer, Brett C.

AU - Schwamm, Lee H.

AU - Yoo, Albert J.

AU - Marshall, Randolph S.

AU - Meyers, Philip M.

AU - Yavagal, Dileep R

AU - Wintermark, Max

AU - Liebeskind, David S.

AU - Guzy, Judy

AU - Starkman, Sidney

AU - Saver, Jeffrey L.

AU - Kidwell, Chelsea S.

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Y1 - 2017/3/1

N2 - Background and Purpose - Patients with acute ischemic stroke are at increased risk of developing parenchymal hemorrhage (PH), particularly in the setting of reperfusion therapies. We have developed a predictive model to examine the risk of PH using combined magnetic resonance perfusion and diffusion parameters, including cerebral blood volume (CBV), apparent diffusion coefficient, and microvascular permeability (K2). Methods - Voxel-based values of CBV, K2, and apparent diffusion coefficient from the ischemic core were obtained using pretreatment magnetic resonance imaging data from patients enrolled in the MR RESCUE clinical trial (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy). The associations between PH and extreme values of imaging parameters were assessed in univariate and multivariate analyses. Receiver-operating characteristic curve analysis was performed to determine the optimal parameter(s) and threshold for predicting PH. Results - In 83 patients included in this analysis, 20 developed PH. Univariate analysis showed significantly lower 10th percentile CBV and 10th percentile apparent diffusion coefficient values and significantly higher 90th percentile K2 values within the infarction core of patients with PH. Using classification tree analysis, the 10th percentile CBV at threshold of 0.47 and 90th percentile K2 at threshold of 0.28 resulted in overall predictive accuracy of 88.7%, sensitivity of 90.0%, and specificity of 87.3%, which was superior to any individual or combination of other classifiers. Conclusions - Our results suggest that combined 10th percentile CBV and 90th percentile K2 is an independent predictor of PH in patients with acute ischemic stroke with diagnostic accuracy superior to individual classifiers alone. This approach may allow risk stratification for patients undergoing reperfusion therapies. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00389467.

AB - Background and Purpose - Patients with acute ischemic stroke are at increased risk of developing parenchymal hemorrhage (PH), particularly in the setting of reperfusion therapies. We have developed a predictive model to examine the risk of PH using combined magnetic resonance perfusion and diffusion parameters, including cerebral blood volume (CBV), apparent diffusion coefficient, and microvascular permeability (K2). Methods - Voxel-based values of CBV, K2, and apparent diffusion coefficient from the ischemic core were obtained using pretreatment magnetic resonance imaging data from patients enrolled in the MR RESCUE clinical trial (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy). The associations between PH and extreme values of imaging parameters were assessed in univariate and multivariate analyses. Receiver-operating characteristic curve analysis was performed to determine the optimal parameter(s) and threshold for predicting PH. Results - In 83 patients included in this analysis, 20 developed PH. Univariate analysis showed significantly lower 10th percentile CBV and 10th percentile apparent diffusion coefficient values and significantly higher 90th percentile K2 values within the infarction core of patients with PH. Using classification tree analysis, the 10th percentile CBV at threshold of 0.47 and 90th percentile K2 at threshold of 0.28 resulted in overall predictive accuracy of 88.7%, sensitivity of 90.0%, and specificity of 87.3%, which was superior to any individual or combination of other classifiers. Conclusions - Our results suggest that combined 10th percentile CBV and 90th percentile K2 is an independent predictor of PH in patients with acute ischemic stroke with diagnostic accuracy superior to individual classifiers alone. This approach may allow risk stratification for patients undergoing reperfusion therapies. Clinical Trial Registration - URL: https://www.clinicaltrials.gov. Unique identifier: NCT00389467.

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