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Purpose@#To propose standardized and feasible imaging protocols for constructing artificial intelligence (AI) database in acute stroke by assessing the current practice at tertiary hospitals in South Korea and reviewing evolving AI models. @*Materials and Methods@#A nationwide survey on acute stroke imaging protocols was conducted using an electronic questionnaire sent to 43 registered tertiary hospitals between April and May 2021. Imaging protocols for endovascular thrombectomy (EVT) in the early and late time windows and during follow-up were assessed. Clinical applications of AI techniques in stroke imaging and required sequences for developing AI models were reviewed. Standardized and feasible imaging protocols for data curation in acute stroke were proposed. @*Results@#There was considerable heterogeneity in the imaging protocols for EVT candidates in the early and late time windows and posterior circulation stroke. Computed tomography (CT)-based protocols were adopted by 70% (30/43), and acquisition of noncontrast CT, CT angiography and CT perfusion in a single session was most commonly performed (47%, 14/30) with the preference of multiphase (70%, 21/30) over single phase CT angiography. More hospitals performed magnetic resonance imaging (MRI)-based protocols or additional MRI sequences in a late time window and posterior circulation stroke. Diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) were most commonly performed MRI sequences with considerable variation in performing other MRI sequences. AI models for diagnostic purposes required noncontrast CT, CT angiography and DWI while FLAIR, dynamic susceptibility contrast perfusion, and T1-weighted imaging (T1WI) were additionally required for prognostic AI models. @*Conclusion@#Given considerable heterogeneity in acute stroke imaging protocols at tertiary hospitals in South Korea, standardized and feasible imaging protocols are required for constructing AI database in acute stroke. The essential sequences may be noncontrast CT, DWI, CT/MR angiography and CT/MR perfusion while FLAIR and T1WI may be additionally required.
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Objective@#We aimed to evaluate the efficacy of EmboTrap II in terms of first-pass recanalization and to determine whether it could yield favorable outcomes. @*Materials and Methods@#In this multicenter, prospective study, we consecutively enrolled patients who underwent mechanical thrombectomy using EmboTrap II as a front-line device. The primary outcome was the first pass effect (FPE) rate defined by modified Thrombolysis In Cerebral Infarction (mTICI) grade 2c or 3 by the first pass of EmboTrap II. In addition, modified FPE (mFPE; mTICI grade 2b–3 by the first pass of EmboTrap II), successful recanalization (final mTICI grade 2b–3), and clinical outcomes were assessed. We also analyzed the effect of FPE on a modified Rankin Scale (mRS) score of 0–2 at 3 months. @*Results@#Two hundred-ten patients (mean age ± standard deviation, 73.3 ± 11.4 years; male, 55.7%) were included. Ninetynine patients (47.1%) had FPE, and mFPE was achieved in 150 (71.4%) patients. Successful recanalization was achieved in 191 (91.0%) patients. Among them, 164 (85.9%) patients underwent successful recanalization by exclusively using EmboTrap II. The time from groin puncture to FPE was 25.0 minutes (interquartile range, 17.0–35.0 minutes). Procedure-related complications were observed in seven (3.3%) patients. Symptomatic intracranial hemorrhage developed in 14 (6.7%) patients. One hundred twenty-three (58.9% of 209 completely followed) patients had an mRS score of 0–2. Sixteen (7.7% of 209) patients died during the follow-up period. Patients who had successful recanalization with FPE were four times more likely to have an mRS score of 0–2 than those who had successful recanalization without FPE (adjusted odds ratio, 4.13;95% confidence interval, 1.59–10.8; p = 0.004). @*Conclusion@#Mechanical thrombectomy using the front-line EmboTrap II is effective and safe. In particular, FPE rates were high. Achieving FPE was important for an mRS score of 0–2, even in patients with successful recanalization.
ABSTRACT
The role of neuroimaging in patients with acute ischemic stroke has been gradually increasing. The ultimate goal of stroke imaging is to make a streamlined imaging workflow for safe and efficient treatment based on optimized patient selection. In the era of multimodal comprehensive imaging in strokes, imaging based on computed tomography (CT) has been preferred for use in acute ischemic stroke, because, despite the unique strengths of magnetic resonance imaging (MRI), MRI has a longer scan duration than does CT-based imaging. However, recent improvements, such as multicoil technology and novel MRI acceleration techniques, including parallel imaging, simultaneous multi-section imaging, and compressed sensing, highlight the potential of comprehensive MR-based imaging for strokes. In this review, we discuss the role of stroke imaging in acute ischemic stroke management, as well as the strengths and limitations of MR-based imaging. Given these concepts, we review the current MR acceleration techniques that could be applied to stroke imaging and provide an overview of the previous research on each essential sequence: diffusionweighted imaging, gradient-echo, fluid-attenuated inversion recovery, contrastenhanced MR angiography, and MR perfusion imaging.
ABSTRACT
The role of neuroimaging in patients with acute ischemic stroke has been gradually increasing. The ultimate goal of stroke imaging is to make a streamlined imaging workflow for safe and efficient treatment based on optimized patient selection. In the era of multimodal comprehensive imaging in strokes, imaging based on computed tomography (CT) has been preferred for use in acute ischemic stroke, because, despite the unique strengths of magnetic resonance imaging (MRI), MRI has a longer scan duration than does CT-based imaging. However, recent improvements, such as multicoil technology and novel MRI acceleration techniques, including parallel imaging, simultaneous multi-section imaging, and compressed sensing, highlight the potential of comprehensive MR-based imaging for strokes. In this review, we discuss the role of stroke imaging in acute ischemic stroke management, as well as the strengths and limitations of MR-based imaging. Given these concepts, we review the current MR acceleration techniques that could be applied to stroke imaging and provide an overview of the previous research on each essential sequence: diffusionweighted imaging, gradient-echo, fluid-attenuated inversion recovery, contrastenhanced MR angiography, and MR perfusion imaging.
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Purpose@#Identifying current practices in acute stroke imaging is essential for establishing optimal imaging protocols. We surveyed and assessed the current status of acute stroke imaging for endovascular thrombectomy (EVT) at tertiary hospitals throughout South Korea. @*Materials and Methods@#An electronic questionnaire on imaging protocols for EVT in patients with acute ischemic stroke was e-mailed to physicians at 42 registered tertiary hospitals, and their responses were collected between February and March 2020. @*Results@#Of the 36 hospitals participating in the survey, 69% (25/36) adopted computed tomography (CT)-based protocols, whereas 31% (11/36) adopted magnetic resonance (MR)-based protocols. Non-enhanced CT (NECT) was the initial imaging study at 28%, NECT with CT angiography (CTA) at 36%, and NECT with CTA and CT perfusion (CTP) at 33% of hospitals. Perfusion imaging was performed at 61% (22/36), CTP at 44% (16/36), and MR perfusion at 17% (6/36) of hospitals. Multiphase CTA was performed at 67%, single-phase CTA at 11%, time-of-flight MR angiography (MRA) at 8%, contrast-enhanced MRA at 8%, and both at 6% of hospitals. For late time window stroke, 50% of hospitals used identical imaging protocols to those for early time window stroke, 39% used additional MR imaging (MRI), and 6% converted the imaging strategy from CT to MRI. Post-processing programs were used at 28% (10/36), and RAPID software at 14% (5/36) of hospitals, respectively. Most hospitals (92%) used the same imaging protocols for posterior and anterior circulation strokes. @*Conclusion@#Our multicenter survey demonstrated considerable heterogeneity in acute stroke imaging protocols across South Korean tertiary hospitals, suggesting that hospitals refine their imaging protocols according to hospital-specific conditions.
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Three neonatal pigs from the same litter in a domestic farm were born with skin lesions. Grossly, multiple wellcircumscribed, round papules distributed over the skin of the three piglets. Two piglets were submitted for a diagnosis of skin disease.Microscopically, epidermal hyperplasia with ballooning degeneration of stratum spinosum keratinocytes was observed. Some keratinocytes contained eosinophilic intracytoplasmic inclusions and a central nuclear vacuole and chromatin margination. Swinepox (SWP) virus was detected by polymerase chain reaction and nucleotide sequencing, and Staphylococcus hyicus was isolated in skin lesions. Based on the gross findings and laboratory results, these piglets were diagnosed with congenital SWP with a secondary staphylococcal infection.
ABSTRACT
Congenital midline cervical cleft is a rare congenital disease. The disease is often misdiagnosed as a branchial cleft deformity, thyroglossal duct cyst, or other skin diseases. It has the following characteristics: skin defect at the midline of the anterior neck, a skin tag at the upper end of the lesion, and a blind sinus tract at the caudal aspect with or without mucoid discharge. Treatment is usually for aesthetic purposes; therefore, early surgical en bloc resection with Z-plasty or W-plasty is recommended to reduce recurrence and scar formation.
ABSTRACT
Three neonatal pigs from the same litter in a domestic farm were born with skin lesions. Grossly, multiple wellcircumscribed, round papules distributed over the skin of the three piglets. Two piglets were submitted for a diagnosis of skin disease.Microscopically, epidermal hyperplasia with ballooning degeneration of stratum spinosum keratinocytes was observed. Some keratinocytes contained eosinophilic intracytoplasmic inclusions and a central nuclear vacuole and chromatin margination. Swinepox (SWP) virus was detected by polymerase chain reaction and nucleotide sequencing, and Staphylococcus hyicus was isolated in skin lesions. Based on the gross findings and laboratory results, these piglets were diagnosed with congenital SWP with a secondary staphylococcal infection.
ABSTRACT
Congenital midline cervical cleft is a rare congenital disease. The disease is often misdiagnosed as a branchial cleft deformity, thyroglossal duct cyst, or other skin diseases. It has the following characteristics: skin defect at the midline of the anterior neck, a skin tag at the upper end of the lesion, and a blind sinus tract at the caudal aspect with or without mucoid discharge. Treatment is usually for aesthetic purposes; therefore, early surgical en bloc resection with Z-plasty or W-plasty is recommended to reduce recurrence and scar formation.
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Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers. In this consensus statement, Korean Society of Interventional Neuroradiology and Korean Stroke Society Joint Task Force Team propose a standard workflow to reduce door-to-reperfusion time for stroke patients eligible for EVT. This includes early stroke identification and pre-hospital notification to stroke team of receiving hospital in pre-hospital phase, the transfer of stroke patients from door of the emergency department to computed tomography (CT) room, warming call to neurointervention (NI) team for EVT candidate prior to imaging, NI team preparation in parallel with thrombolysis, direct transportation from CT room to angiography suite following immediate decision of EVT and standardized procedure for rapid reperfusion. Implementation of optimized workflow will improve stroke time process metrics and clinical outcome of the patient treated with EVT.
Subject(s)
Humans , Advisory Committees , Angiography , Benchmarking , Consensus , Emergency Service, Hospital , Joints , Reperfusion , Stroke , TransportationABSTRACT
Recent clinical trials demonstrated the clinical benefit of endovascular treatment (EVT) in patients with acute ischemic stroke due to large vessel occlusion. These trials confirmed that good outcome after EVT depends on the time interval from symptom onset to reperfusion and that in-hospital delay leads to poor clinical outcome. However, there has been no universally accepted in-hospital workflow and performance benchmark for rapid reperfusion. Additionally, wide variety in workflow for EVT is present between each stroke centers. In this consensus statement, Korean Society of Interventional Neuroradiology and Korean Stroke Society Joint Task Force Team propose a standard workflow to reduce door-to-reperfusion time for stroke patients eligible for EVT. This includes early stroke identification and pre-hospital notification to stroke team of receiving hospital in pre-hospital phase, the transfer of stroke patients from door of the emergency department to computed tomography (CT) room, warming call to neurointervention team for EVT candidate prior to imaging, neurointervention team preparation in parallel with thrombolysis, direct transportation from CT room to angiography suite following immediate decision of EVT and standardized procedure for rapid reperfusion. Implementation of optimized workflow will improve stroke time process metrics and clinical outcome of the patient treated with EVT.