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1. Phantom-based standardization of CT angiography images for spot sign detection

Author

Morotti, Andrea, Romero, Javier M, Jessel, Michael J, Hernandez, Andrew M, Vashkevich, Anastasia, Schwab, Kristin, Burns, Joseph D, Shah, Qaisar A, Bergman, Thomas A, Suri, M Fareed K, Ezzeddine, Mustapha, Kirmani, Jawad F, Agarwal, Sachin, Shapshak, Angela Hays, Messe, Steven R, Venkatasubramanian, Chitra, Palmieri, Katherine, Lewandowski, Christopher, Chang, Tiffany R, Chang, Ira, Rose, David Z, Smith, Wade, Hsu, Chung Y, Liu, Chun-Lin, Lien, Li-Ming, Hsiao, Chen-Yu, Iwama, Toru, Afzal, Mohammad Rauf, Cassarly, Christy, Greenberg, Steven M, Martin, Renee’ Hebert, Qureshi, Adnan I, Rosand, Jonathan, Boone, John M, Goldstein, Joshua N, and On Behalf of ATACH-II and NETT Investigators

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Stroke, Biomedical Imaging, Bioengineering, Clinical Trials and Supportive Activities, Clinical Research, Calibration, Cerebral Hemorrhage, Computed Tomography Angiography, Hematoma, Humans, Iodine, Phantoms, Imaging, Sensitivity and Specificity, Software, Intracerebral hemorrhage, Spot sign, CT angiography, Phantom standardization, ATACH-II and NETT Investigators, Neurosciences, Nuclear Medicine & Medical Imaging, Clinical sciences
Abstract

PurposeThe CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance.MethodsA custom phantom containing known concentrations of iodine was designed and scanned using the stroke CT protocol at each institution. Custom software was developed to read the CT volume datasets and calculate the Hounsfield unit as a function of iodine concentration for each phantom scan. CTA images obtained within 8 h from symptom onset were analyzed by two trained readers comparing the calibrated vs. uncalibrated density cutoffs for spot sign identification. ICH expansion was defined as hematoma volume growth >33%.ResultsA total of 90 subjects qualified for the study, of whom 17/83 (20.5%) experienced ICH expansion. The number of spot sign positive scans was higher in the calibrated analysis (67.8 vs 38.9% p

Published
2017

2. A team science approach for the preclinical and clinical characterization and biomarker development for post‐traumatic epilepsy.

Author

Iyengar, Sloka S., Lubbers, Laura S., Harte‐Hargrove, Lauren, Churn, Severn B., Coulter, Douglas, Hunt, Amanda, Kapur, Jaideep, Lowenstein, Daniel, Martin, Renee Hebert, McNamara, James, Umoh, Nsini, White, H. Steve, Whittemore, Vicky, Wright, David W., Bacskai, Brian, Bambrick, Michael, Browning, Jack L., Butler, Mitchell, Carroll, Rona, and Costine‐Bartell, Beth A.

Abstract

Objective: Post‐traumatic epilepsy (PTE) is an acquired epilepsy that develops in the months or years following a traumatic brain injury (TBI) and can lead to substantial personal, financial, and societal burden. To date, PTE is rarely curable; current treatments are partially effective and often accompanied by adverse side effects. While research on PTE has expanded significantly in the last several years, there remain numerous challenges to identifying effective prevention and treatment strategies. In this paper, we describe advances from the CURE Epilepsy PTE Initiative, including its implementation and the emphasis on team science. Methods: The CURE Epilepsy PTE Initiative funded six research teams to link preclinical and clinical studies to engage in the validation of experimental models, characterization of pathophysiology and biological pathways, and identification of risk factors associated with PTE. Three teams had projects with both a preclinical and a clinical component; these teams focused on: targeting the epileptogenic effects of subarachnoid blood, exploring the neuropathological mechanisms of epileptogenesis, and defining the role of extracellular matrix injury. Two teams undertook entirely preclinical projects: exploring the role of vascular injury, gliosis, and neurogenesis as drivers for PTE, and identifying genetic, proteomic, metabolomic, and microRNA biosignatures to improve the prediction of PTE. One team's project was entirely clinical and investigated genetic and protein biomarkers to improve the prediction of PTE. Results: In addition to scientific discoveries including characterization of a variety of animal models and progress towards the understanding of biological underpinnings and biomarkers for PTE, significant programmatic and personnel‐related processes were incorporated, including standardized, rigorous policies and procedures to ensure quality and accountability between and within groups. Significance: We propose CURE Epilepsy's team science approach as an effective way to bring together a diverse set of investigators to explore biological mechanisms that may lead to cures for the epilepsies. [ABSTRACT FROM AUTHOR]

Published
2023
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4. Differences in Ischemic and Hemorrhagic Recurrence Rates among Race-Ethnic Groups in the PRoFESS Secondary Stroke Prevention Trial

Author

Estol, Conrado J, Bath, Philip M. W., Gorelick, Philip B., Martin, Renee Hebert, Diener, H. C., Bath, P., Donnan, G. A., Cotton, D., Estol, C., Hilbrich, L., Humphreys, M., Ôunpuu, S., Roberts, R., Teal, P., Toni, Danilo, Sacco, R., and Yusuf, S.

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Myocardial Infarction, Ethnic group, Blood Pressure, Kaplan-Meier Estimate, Cerebrovascular disease, Race-ethnicity, Stroke, Vascular recurrence, Aged, Antihypertensive Agents, Benzimidazoles, Benzoates, Drug Therapy, Combination, Ethnic Groups, Female, Humans, Ischemia, Middle Aged, Multivariate Analysis, Platelet Aggregation Inhibitors, Recurrence, Secondary Prevention, Intracranial Hemorrhages, Neurology, Medicine (all), Pharmacotherapy, Internal medicine, Ethnicity, medicine, Telmisartan, Myocardial infarction, business.industry, Clopidogrel, medicine.disease, Surgery, Blood pressure, Platelet aggregation inhibitor, business, medicine.drug
Abstract

Background and Aims Epidemiological studies show that vascular risk factors are the same across the world but their effect vary between different race-ethnic groups. However, few studies have evaluated differences in recurrent stroke rates in various race-ethnicities. In >20 000 patients spanning 35 countries encompassing most race-ethnicities, we evaluated the incidence of ischemic and hemorrhagic strokes and myocardial infarction in patients within the context of the largest secondary stroke prevention trial (Prevention Regimen for Effectively Avoiding Secondary Strokes) to identify any significant differences. Methods There were 20 332 patients with a recent ischemic stroke randomized in a factorial design to receive the antiplatelet agent clopidogrel vs. aspirin plus extended-release dipyridamole, and 80 mg of the anthypertensive telmisartan vs. placebo. The primary outcome for the trial was the time to any recurrent stroke. Statistical analysis was used to detect race-ethnic differences in recurrent vascular events. Results Mean patient age was 66 (±8·6) years and 36% were women. The study included 58% European/Caucasian, 33% Asians, 5% Latin/Hispanic, and 4% Black African. There were 74% of patients that were hypertensive, and average systolic and diastolic blood pressure was 144·1/83·8 mmHg. There was at least one significant difference in the overall test of all race-ethnic groups in myocardial infarction and symptomatic intracerebral hemorrhage occurrence. In the Kaplan–Meier hemorrhage and stroke-free survival curves, Asians showed a significantly higher recurrence of ischemic stroke risk in the 135–150 mmHg and greater than 150 mm Hg blood pressure groups, and a greater risk of hemorrhage recurrence in the greater than 150 mmHg blood pressure group. Conclusions We found a significant difference in myocardial infarction and symptomatic intracerebral hemorrhage recurrence among different race-ethnic groups. The risk of recurrent ischemic and hemorrhagic stroke was greater in Asians with high blood pressure.

Published
2014

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