70 results on '"Anna K. Bonkhoff"'
Search Results
2. Abstract 067: Outcomes for large vessel occlusion patients with severe baseline disability with and without endovascular thrombectomy
- Author
-
Amine J. Awad, Michael J. Young, Alexander Andreev, Adam A. Dmytriw, Justin E. Vranic, James D. Rabinov, Christopher J. Stapleton, Alvin S. Das, Anna K. Bonkhoff, Lara Carvalho de Oliveira, Markus D. Schirmer, Thabele M. Leslie‐Mazwi, Aneesh B. Singhal, Aman B. Patel, Natalia S. Rost, and Robert R. Regenhardt
- Subjects
Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction Patients with baseline disability account for one‐third of stroke presentations. However, there remains controversy in treatment selection for endovascular thrombectomy (EVT). We compared long‐term outcomes and likelihood of transitioning to comfort care for large vessel occlusion (LVO) patients with severe pre‐stroke disability treated with EVT versus medical management at a single center from 2017‐2020. Methods Individuals who presented with LVO were identified retrospectively from a prospectively maintained database. Severe baseline disability was defined as modified Rankin Scale (mRS) 3‐5. Delta mRS was defined as the difference between baseline and 90‐day mRS. Logistic and ordinal regressions were performed to evaluate the relationships between EVT and outcomes. A mixed‐methods analysis was performed to assess rates and reasons for transitions to comfort care. Results A total of 175/1008 (17%) were identified with severe baseline disability. The median age was 82 (IQR 70‐89), and 59% were female. Thirty‐two (18%) with severe baseline disability were treated with EVT. EVT was independently associated with improved delta mRS (B=‐1.048; 95%CI=‐1.777,‐0.318; p=0.005) accounting for age and NIHSS. However, EVT did not reduce the odds of transitioning to comfort care (aOR=0.794; 95%CI=0.347,1.818; p=0.585) accounting for age and NIHSS. Seventy‐six (43%) with severe baseline disability were transitioned to comfort care. Of the 99 not transitioned to comfort care, 18 were treated with EVT, and EVT was independently associated with improved delta mRS (B=‐2.794; 95%CI=‐4.002,‐1.586; p
- Published
- 2023
- Full Text
- View/download PDF
3. Abstract 251: Characterizing coma in patients presenting with large vessel occlusion stroke
- Author
-
Michael J. Young, Amine Awad, Alexander Andreev, Anna K. Bonkhoff, Markus Schirmer, Adam A. Dmytriw, Justin E. Vranic, James D. Rabinov, Omer Doron, Christopher J. Stapleton, Alvin J. S. Das, Aneesh B. Singhal, Natalia S. Rost, Aman B. Patel, and Robert W. Regenhardt
- Subjects
Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Introduction Coma is an unresponsive state of disordered consciousness characterized by impaired arousal and awareness. The epidemiology and pathophysiology of coma in ischemic stroke has been underexplored. We sought to characterize the incidence and clinical features of coma as a presentation of large vessel occlusion (LVO) stroke. Methods Individuals who presented with LVO were retrospectively identified from July 2018 to December 2020. Coma was defined as an unresponsive state of impaired arousal and awareness, operationalized as a score of 3 on NIH Stroke Scale (NIHSS) item 1a. Results A total of 28/637 (4.4%) patients with LVO stroke were identified as presenting with coma. The median NIHSS was 32 (IQR 29‐34) for those with coma versus 11 (5‐18) for those without (p
- Published
- 2023
- Full Text
- View/download PDF
4. Spoke‐Administered Thrombolysis Improves Large‐Vessel Occlusion Early Recanalization: The Real‐World Experience of a Large Academic Hub‐and‐Spoke Telestroke Network
- Author
-
Andrew W. Kraft, Robert W. Regenhardt, Amine Awad, Joseph A. Rosenthal, Adam A. Dmytriw, Justin E. Vranic, Anna K. Bonkhoff, Martin Bretzner, Joshua A. Hirsch, James D. Rabinov, Christopher J. Stapleton, Lee H. Schwamm, Aneesh B. Singhal, Natalia S. Rost, Thabele M. Leslie‐Mazwi, and Aman B. Patel
- Subjects
stroke ,thrombectomy ,thrombolysis ,Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) for large‐vessel occlusion (LVO) stroke is increasingly controversial. Recent trials suggest MT without IVT is reasonable for patients presenting directly to MT‐capable “hub” centers. However, bypassing IVT has not been evaluated for patients presenting to IVT‐capable “spoke” hospitals that require hub transfer for MT. A perceived lack of efficacy of IVT to result in LVO early recanalization (ER) is often cited to support bypassing IVT, but data for IVT in patients who require interhospital transfer are limited. Here, we examined LVO ER rates after spoke‐administered IVT in our hub‐and‐spoke stroke network. Methods Patients presenting to 25 spokes before hub transfer for MT consideration from 2018 to 2020 were retrospectively identified from a prospectively maintained database. Inclusion criteria were pretransfer computed tomography angiography–defined LVO, Alberta Stroke Program Early Computed Tomography Score ≥6, and posttransfer repeat vessel imaging. Results Of 167 patients, median age was 69, and 51% were women. Seventy‐six received spoke IVT, and 91 did not. Alteplase was the only IVT used in this study. Comorbidities and National Institutes of Health Stroke Scale were similar between groups. ER frequency was increased 7.2‐fold in patients who received spoke IVT (12/76 [15.8%] versus 2/91 [2.2%]; P
- Published
- 2023
- Full Text
- View/download PDF
5. Direct to Angio‐Suite Large Vessel Occlusion Stroke Transfers Achieve Faster Arrival‐to‐Puncture Times and Improved Outcomes
- Author
-
Robert W. Regenhardt, Joseph A. Rosenthal, Adam A. Dmytriw, Justin E. Vranic, Anna K. Bonkhoff, Martin Bretzner, Joshua A. Hirsch, James D. Rabinov, Christopher J. Stapleton, Aman B. Patel, Aneesh B. Singhal, Natalia S. Rost, Thabele M. Leslie‐Mazwi, and Mark R. Etherton
- Subjects
acute ischemic stroke ,direct to angio‐suite ,endovascular thrombectomy ,hub and spoke ,large vessel occlusion ,mechanical thrombectomy ,Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background For patients with large vessel occlusion (LVO) stroke, time to treatment with endovascular thrombectomy is crucial to prevent infarction and improve outcomes. We sought to evaluate the hub arrival‐to‐puncture times and outcomes for transferred patients accepted directly to the angio‐suite (LVO to operating room, LVO2OR) versus those accepted through the emergency department in a hub‐and‐spoke telestroke network. Methods Consecutive patients transferred for endovascular thrombectomy with spoke computed tomography angiography–confirmed LVO, spoke Alberta Stroke Program Early Computed Tomography score >6, and last known well–to–hub arrival
- Published
- 2022
- Full Text
- View/download PDF
6. Characterizing Reasons for Stroke Thrombectomy Ineligibility Among Potential Candidates Transferred in a Hub‐and‐Spoke Network
- Author
-
Robert W. Regenhardt, Amine Awad, Andrew W. Kraft, Joseph A. Rosenthal, Adam A. Dmytriw, Justin E. Vranic, Anna K. Bonkhoff, Martin Bretzner, Mark R. Etherton, Joshua A. Hirsch, James D. Rabinov, Aneesh B. Singhal, Natalia S. Rost, Christopher J. Stapleton, Thabele M. Leslie‐Mazwi, and Aman B. Patel
- Subjects
acute ischemic stroke ,endovascular thrombectomy ,health care systems ,hub‐and‐spoke network ,large vessel occlusion ,telemedicine ,Neurology. Diseases of the nervous system ,RC346-429 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Access to endovascular thrombectomy (EVT) is relatively limited. Hub‐and‐spoke networks seek to transfer appropriate large‐vessel occlusion stroke candidates to EVT‐capable hubs. However, some patients are ineligible upon hub arrival, and factors that drive transfer inefficiencies are not well described. We sought to quantify EVT transfer efficiency and identify reasons for EVT ineligibility. Methods Consecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pretransfer computed tomography angiography‐defined large‐vessel occlusion and Alberta Stroke Program Early Computed Tomography Score of ≥6 were identified from a prospectively maintained database. Outcomes of interest included hub EVT, reasons for EVT ineligibility, and 90‐day modified Rankin scale score of ≤2. Results Among 258 patients, the median age was 70 years (interquartile range, 60–81 years); 50% were women. A total of 56% were ineligible for EVT after hub arrival. Cited reasons were large established infarct (49%), mild symptoms (33%), recanalization (6%), distal occlusion (5%), subocclusive lesion (3%), and goals of care (3%). Late window patients (last known well >6 hours) were more likely to be ineligible (67% versus 43%; P
- Published
- 2022
- Full Text
- View/download PDF
7. Deep profiling of multiple ischemic lesions in a large, multi-center cohort: Frequency, spatial distribution, and associations to clinical characteristics
- Author
-
Anna K. Bonkhoff, Teresa Ullberg, Martin Bretzner, Sungmin Hong, Markus D. Schirmer, Robert W. Regenhardt, Kathleen L. Donahue, Marco J. Nardin, Adrian V. Dalca, Anne-Katrin Giese, Mark R. Etherton, Brandon L. Hancock, Steven J. T. Mocking, Elissa C. McIntosh, John Attia, John W. Cole, Amanda Donatti, Christoph J. Griessenauer, Laura Heitsch, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Steven J. Kittner, Robin Lemmens, Christopher R. Levi, Caitrin W. McDonough, James F. Meschia, Chia-Ling Phuah, Stefan Ropele, Jonathan Rosand, Jaume Roquer, Tatjana Rundek, Ralph L. Sacco, Reinhold Schmidt, Pankaj Sharma, Agnieszka Slowik, Alessandro Sousa, Tara M. Stanne, Daniel Strbian, Turgut Tatlisumak, Vincent Thijs, Achala Vagal, Daniel Woo, Ramin Zand, Patrick F. McArdle, Bradford B. Worrall, Christina Jern, Arne G. Lindgren, Jane Maguire, Ona Wu, Petrea Frid, Natalia S. Rost, and Johan Wasselius
- Subjects
magnetic resonance imaging ,acute ischemic stroke ,lesion volume ,multiple acute ischemic lesions ,quantitative imaging ,Bayesian hierarchical regression ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Background purposeA substantial number of patients with acute ischemic stroke (AIS) experience multiple acute lesions (MAL). We here aimed to scrutinize MAL in a large radiologically deep-phenotyped cohort.Materials and methodsAnalyses relied upon imaging and clinical data from the international MRI-GENIE study. Imaging data comprised both Fluid-attenuated inversion recovery (FLAIR) for white matter hyperintensity (WMH) burden estimation and diffusion-weighted imaging (DWI) sequences for the assessment of acute stroke lesions. The initial step featured the systematic evaluation of occurrences of MAL within one and several vascular supply territories. Associations between MAL and important imaging and clinical characteristics were subsequently determined. The interaction effect between single and multiple lesion status and lesion volume was estimated by means of Bayesian hierarchical regression modeling for both stroke severity and functional outcome.ResultsWe analyzed 2,466 patients (age = 63.4 ± 14.8, 39% women), 49.7% of which presented with a single lesion. Another 37.4% experienced MAL in a single vascular territory, while 12.9% featured lesions in multiple vascular territories. Within most territories, MAL occurred as frequently as single lesions (ratio ∼1:1). Only the brainstem region comprised fewer patients with MAL (ratio 1:4). Patients with MAL presented with a significantly higher lesion volume and acute NIHSS (7.7 vs. 1.7 ml and 4 vs. 3, pFDR < 0.001). In contrast, patients with a single lesion were characterized by a significantly higher WMH burden (6.1 vs. 5.3 ml, pFDR = 0.048). Functional outcome did not differ significantly between patients with single versus multiple lesions. Bayesian analyses suggested that the association between lesion volume and stroke severity between single and multiple lesions was the same in case of anterior circulation stroke. In case of posterior circulation stroke, lesion volume was linked to a higher NIHSS only among those with MAL.ConclusionMultiple lesions, especially those within one vascular territory, occurred more frequently than previously reported. Overall, multiple lesions were distinctly linked to a higher acute stroke severity, a higher total DWI lesion volume and a lower WMH lesion volume. In posterior circulation stroke, lesion volume was linked to a higher stroke severity in multiple lesions only.
- Published
- 2022
- Full Text
- View/download PDF
8. Outcome after acute ischemic stroke is linked to sex-specific lesion patterns
- Author
-
Anna K. Bonkhoff, Markus D. Schirmer, Martin Bretzner, Sungmin Hong, Robert W. Regenhardt, Mikael Brudfors, Kathleen L. Donahue, Marco J. Nardin, Adrian V. Dalca, Anne-Katrin Giese, Mark R. Etherton, Brandon L. Hancock, Steven J. T. Mocking, Elissa C. McIntosh, John Attia, Oscar R. Benavente, Stephen Bevan, John W. Cole, Amanda Donatti, Christoph J. Griessenauer, Laura Heitsch, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Steven J. Kittner, Robin Lemmens, Christopher R. Levi, Caitrin W. McDonough, James F. Meschia, Chia-Ling Phuah, Arndt Rolfs, Stefan Ropele, Jonathan Rosand, Jaume Roquer, Tatjana Rundek, Ralph L. Sacco, Reinhold Schmidt, Pankaj Sharma, Agnieszka Slowik, Martin Söderholm, Alessandro Sousa, Tara M. Stanne, Daniel Strbian, Turgut Tatlisumak, Vincent Thijs, Achala Vagal, Johan Wasselius, Daniel Woo, Ramin Zand, Patrick F. McArdle, Bradford B. Worrall, Christina Jern, Arne G. Lindgren, Jane Maguire, Danilo Bzdok, Ona Wu, MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium, and Natalia S. Rost
- Subjects
Science - Abstract
Acute ischemic stroke impacts men and women differently. Here, the authors show how different lesion patterns in men and women are linked to the extent of stroke severity.
- Published
- 2021
- Full Text
- View/download PDF
9. Development and Validation of Prediction Models for Severe Complications After Acute Ischemic Stroke: A Study Based on the Stroke Registry of Northwestern Germany
- Author
-
Anna K. Bonkhoff, Nicole Rübsamen, Christian Grefkes, Natalia S. Rost, Klaus Berger, and André Karch
- Subjects
ischemic stroke ,machine learning ,mortality ,prediction ,severe outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background The treatment of stroke has been undergoing rapid changes. As treatment options progress, prediction of those under risk for complications becomes more important. Available models have, however, frequently been built based on data no longer representative of today’s care, in particular with respect to acute stroke management. Our aim was to build and validate prediction models for 4 clinically important, severe outcomes after stroke. Methods and Results We used German registry data from 152 710 patients with acute ischemic stroke obtained in 2016 (development) and 2017 (validation). We took into account potential predictors that were available at admission and focused on in‐hospital mortality, intracranial mass effect, secondary intracerebral hemorrhage, and deep vein thrombosis as outcomes. Validation cohort prediction and calibration performances were assessed using the following 4 statistical approaches: logistic regression with backward selection, l1‐regularized logistic regression, k‐nearest neighbor, and gradient boosting classifier. In‐hospital mortality and intracranial mass effects could be predicted with high accuracy (both areas under the curve, 0.90 [95% CI, 0.90–0.90]), whereas the areas under the curve for intracerebral hemorrhage (0.80 [95% CI, 0.80–0.80]) and deep vein thrombosis (0.73 [95% CI, 0.73–0.73]) were considerably lower. Stroke severity was the overall most important predictor. Models based on gradient boosting achieved better performances than those based on logistic regression for all outcomes. However, area under the curve estimates differed by a maximum of 0.02. Conclusions We validated prediction models for 4 severe outcomes after acute ischemic stroke based on routinely collected, recent clinical data. Model performance was superior to previously proposed approaches. These predictions may help to identify patients at risk early after stroke and thus facilitate an individualized level of care.
- Published
- 2022
- Full Text
- View/download PDF
10. Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke
- Author
-
Sungmin Hong, Anne-Katrin Giese, Markus D. Schirmer, Anna K. Bonkhoff, Martin Bretzner, Pamela Rist, Adrian V. Dalca, Robert W. Regenhardt, Mark R. Etherton, Kathleen L. Donahue, Marco Nardin, Steven J. T. Mocking, Elissa C. McIntosh, John Attia, Oscar R. Benavente, John W. Cole, Amanda Donatti, Christoph J. Griessenauer, Laura Heitsch, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Jaume Roquer, Steven J. Kittner, Robin Lemmens, Christopher R. Levi, Caitrin W. McDonough, James F. Meschia, Chia-Ling Phuah, Arndt Rolfs, Stefan Ropele, Jonathan Rosand, Tatjana Rundek, Ralph L. Sacco, Reinhold Schmidt, Christian Enzinger, Pankaj Sharma, Agnieszka Slowik, Alessandro Sousa, Tara M. Stanne, Daniel Strbian, Turgut Tatlisumak, Vincent Thijs, Achala Vagal, Johan Wasselius, Daniel Woo, Ramin Zand, Patrick F. McArdle, Bradford B. Worrall, Ona Wu, Christina Jern, Arne G. Lindgren, Jane Maguire, Liisa Tomppo, Polina Golland, Natalia S. Rost, and The MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium
- Subjects
white matter hyper intensity ,stroke ,brain health ,brain vulnerability ,post-stroke outcomes ,functional independence ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective: To personalize the prognostication of post-stroke outcome using MRI-detected cerebrovascular pathology, we sought to investigate the association between the excessive white matter hyperintensity (WMH) burden unaccounted for by the traditional stroke risk profile of individual patients and their long-term functional outcomes after a stroke.Methods: We included 890 patients who survived after an acute ischemic stroke from the MRI-Genetics Interface Exploration (MRI-GENIE) study, for whom data on vascular risk factors (VRFs), including age, sex, atrial fibrillation, diabetes mellitus, hypertension, coronary artery disease, smoking, prior stroke history, as well as acute stroke severity, 3- to−6-month modified Rankin Scale score (mRS), WMH, and brain volumes, were available. We defined the unaccounted WMH (uWMH) burden via modeling of expected WMH burden based on the VRF profile of each individual patient. The association of uWMH and mRS score was analyzed by linear regression analysis. The odds ratios of patients who achieved full functional independence (mRS < 2) in between trichotomized uWMH burden groups were calculated by pair-wise comparisons.Results: The expected WMH volume was estimated with respect to known VRFs. The uWMH burden was associated with a long-term functional outcome (β = 0.104, p < 0.01). Excessive uWMH burden significantly reduced the odds of achieving full functional independence after a stroke compared to the low and average uWMH burden [OR = 0.4, 95% CI: (0.25, 0.63), p < 0.01 and OR = 0.61, 95% CI: (0.42, 0.87), p < 0.01, respectively].Conclusion: The excessive amount of uWMH burden unaccounted for by the traditional VRF profile was associated with worse post-stroke functional outcomes. Further studies are needed to evaluate a lifetime brain injury reflected in WMH unrelated to the VRF profile of a patient as an important factor for stroke recovery and a plausible indicator of brain health.
- Published
- 2021
- Full Text
- View/download PDF
11. MRI Radiomic Signature of White Matter Hyperintensities Is Associated With Clinical Phenotypes
- Author
-
Martin Bretzner, Anna K. Bonkhoff, Markus D. Schirmer, Sungmin Hong, Adrian V. Dalca, Kathleen L. Donahue, Anne-Katrin Giese, Mark R. Etherton, Pamela M. Rist, Marco Nardin, Razvan Marinescu, Clinton Wang, Robert W. Regenhardt, Xavier Leclerc, Renaud Lopes, Oscar R. Benavente, John W. Cole, Amanda Donatti, Christoph J. Griessenauer, Laura Heitsch, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Steven J. Kittner, Robin Lemmens, Christopher R. Levi, Patrick F. McArdle, Caitrin W. McDonough, James F. Meschia, Chia-Ling Phuah, Arndt Rolfs, Stefan Ropele, Jonathan Rosand, Jaume Roquer, Tatjana Rundek, Ralph L. Sacco, Reinhold Schmidt, Pankaj Sharma, Agnieszka Slowik, Alessandro Sousa, Tara M. Stanne, Daniel Strbian, Turgut Tatlisumak, Vincent Thijs, Achala Vagal, Johan Wasselius, Daniel Woo, Ona Wu, Ramin Zand, Bradford B. Worrall, Jane M. Maguire, Arne Lindgren, Christina Jern, Polina Golland, Grégory Kuchcinski, and Natalia S. Rost
- Subjects
stroke ,cerebrovascular disease (CVD) ,MRI ,radiomics ,machine learning ,brain health ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
ObjectiveNeuroimaging measurements of brain structural integrity are thought to be surrogates for brain health, but precise assessments require dedicated advanced image acquisitions. By means of quantitatively describing conventional images, radiomic analyses hold potential for evaluating brain health. We sought to: (1) evaluate radiomics to assess brain structural integrity by predicting white matter hyperintensities burdens (WMH) and (2) uncover associations between predictive radiomic features and clinical phenotypes.MethodsWe analyzed a multi-site cohort of 4,163 acute ischemic strokes (AIS) patients with T2-FLAIR MR images with total brain and WMH segmentations. Radiomic features were extracted from normal-appearing brain tissue (brain mask–WMH mask). Radiomics-based prediction of personalized WMH burden was done using ElasticNet linear regression. We built a radiomic signature of WMH with stable selected features predictive of WMH burden and then related this signature to clinical variables using canonical correlation analysis (CCA).ResultsRadiomic features were predictive of WMH burden (R2 = 0.855 ± 0.011). Seven pairs of canonical variates (CV) significantly correlated the radiomics signature of WMH and clinical traits with respective canonical correlations of 0.81, 0.65, 0.42, 0.24, 0.20, 0.15, and 0.15 (FDR-corrected p-valuesCV1–6 < 0.001, p-valueCV7 = 0.012). The clinical CV1 was mainly influenced by age, CV2 by sex, CV3 by history of smoking and diabetes, CV4 by hypertension, CV5 by atrial fibrillation (AF) and diabetes, CV6 by coronary artery disease (CAD), and CV7 by CAD and diabetes.ConclusionRadiomics extracted from T2-FLAIR images of AIS patients capture microstructural damage of the cerebral parenchyma and correlate with clinical phenotypes, suggesting different radiographical textural abnormalities per cardiovascular risk profile. Further research could evaluate radiomics to predict the progression of WMH and for the follow-up of stroke patients’ brain health.
- Published
- 2021
- Full Text
- View/download PDF
12. 3D-StyleGAN: A Style-Based Generative Adversarial Network for Generative Modeling of Three-Dimensional Medical Images.
- Author
-
Sungmin Hong, Razvan V. Marinescu, Adrian V. Dalca, Anna K. Bonkhoff, Martin Bretzner, Natalia S. Rost, and Polina Golland
- Published
- 2021
- Full Text
- View/download PDF
13. Hypernet-Ensemble Learning of Segmentation Probability for Medical Image Segmentation with Ambiguous Labels.
- Author
-
Sungmin Hong, Anna K. Bonkhoff, Andrew Hoopes, Martin Bretzner, Markus D. Schirmer, Anne-Katrin Giese, Adrian V. Dalca, Polina Golland, and Natalia S. Rost
- Published
- 2021
14. Characterizing reasons for stroke thrombectomy ineligibility among potential candidates transferred in a hub-and-spoke network
- Author
-
Robert W. Regenhardt, Amine Awad, Andrew W. Kraft, Joseph A. Rosenthal, Adam A. Dmytriw, Justin E. Vranic, Anna K. Bonkhoff, Martin Bretzner, Mark R. Etherton, Joshua A. Hirsch, James D. Rabinov, Aneesh B. Singhal, Natalia S. Rost, Christopher J. Stapleton, Thabele M. Leslie‐Mazwi, and Aman B. Patel
- Abstract
BackgroundAccess to endovascular thrombectomy (EVT) is relatively limited. Hub‐and‐spoke networks seek to transfer appropriate large‐vessel occlusion stroke candidates to EVT‐capable hubs. However, some patients are ineligible upon hub arrival, and factors that drive transfer inefficiencies are not well described. We sought to quantify EVT transfer efficiency and identify reasons for EVT ineligibility.MethodsConsecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pretransfer computed tomography angiography‐defined large‐vessel occlusion and Alberta Stroke Program Early Computed Tomography Score of ≥6 were identified from a prospectively maintained database. Outcomes of interest included hub EVT, reasons for EVT ineligibility, and 90‐day modified Rankin scale score of ≤2.ResultsAmong 258 patients, the median age was 70 years (interquartile range, 60–81 years); 50% were women. A total of 56% were ineligible for EVT after hub arrival. Cited reasons were large established infarct (49%), mild symptoms (33%), recanalization (6%), distal occlusion (5%), subocclusive lesion (3%), and goals of care (3%). Late window patients (last known well >6 hours) were more likely to be ineligible (67% versus 43%;PP=0.04), had lower National Institutes of Health Stroke Scale score (10 versus 16;PPPP=0.04) compared with eligible patients. EVT ineligibility independently reduced the odds of 90‐day modified Rankin scale score of ≤2 (adjusted odds ratio, 0.26; 95% CI, 0.12–0.56;P=0.001) when controlling for age, National Institutes of Health Stroke Scale score, and last known well‐to‐hub arrival time.ConclusionsAmong patients transferred for EVT, there are multiple reasons for ineligibility upon hub arrival, with most excluded for infarct growth and mild symptoms. Understanding factors that drive transfer inefficiencies is important to improve EVT access and outcomes.
- Published
- 2023
15. Veridical stimulus localization is linked to human area V5/MT+ activity.
- Author
-
Anna K. Bonkhoff, Eckart Zimmermann, and Gereon R. Fink
- Published
- 2017
- Full Text
- View/download PDF
16. The relevance of rich club regions for functional outcome post-stroke is enhanced in women
- Author
-
Anna K. Bonkhoff, Markus D. Schirmer, Martin Bretzner, Sungmin Hong, Robert W. Regenhardt, Kathleen L. Donahue, Marco J. Nardin, Adrian V. Dalca, Anne-Katrin Giese, Mark R. Etherton, Brandon L. Hancock, Steven J. T. Mocking, Elissa C. McIntosh, John Attia, John W. Cole, Amanda Donatti, Christoph J. Griessenauer, Laura Heitsch, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Steven J. Kittner, Robin Lemmens, Christopher R. Levi, Caitrin W. McDonough, James F. Meschia, Chia-Ling Phuah, Stefan Ropele, Jonathan Rosand, Jaume Roquer, Tatjana Rundek, Ralph L. Sacco, Reinhold Schmidt, Pankaj Sharma, Agnieszka Slowik, Alessandro Sousa, Tara M. Stanne, Daniel Strbian, Turgut Tatlisumak, Vincent Thijs, Achala Vagal, Johan Wasselius, Daniel Woo, Ramin Zand, Patrick F. McArdle, Bradford B. Worrall, Christina Jern, Arne G. Lindgren, Jane Maguire, Ona Wu, Natalia S. Rost, Neurologian yksikkö, HUS Neurocenter, University of Helsinki, and Clinicum
- Subjects
sex differences ,SEX-DIFFERENCES ,RATIONALE ,Neuroimaging ,ORGANIZATION ,CONNECTOME ,Lesion-symptom mapping ,3124 Neurology and psychiatry ,functional outcome ,CONNECTIVITY ,Sex differences ,Radiology, Nuclear Medicine and imaging ,IMPORTANT DETERMINANT ,Rich club ,Bayesian hierarchical modeling ,Science & Technology ,Radiological and Ultrasound Technology ,Radiology, Nuclear Medicine & Medical Imaging ,Neurosciences ,lesion-symptom mapping ,3112 Neurosciences ,ASSOCIATION ,rich club ,Functional outcome ,HUMAN BRAIN ,ISCHEMIC-STROKE ,Neurology ,NETWORK HUBS ,Neurology (clinical) ,Neurosciences & Neurology ,Anatomy ,Life Sciences & Biomedicine - Abstract
This study aimed to investigate the influence of stroke lesions in pre-defined highly interconnected (rich club) brain regions on functional outcome post-stroke, determine their spatial specificity and explore the effects of biological sex on their relevance.We analyzed MRI data recorded at index stroke and ∼3-months modified Rankin Scale (mRS) data from patients with acute ischemic stroke (AIS) enrolled in the multisite MRI-GENIE study. Structural stroke lesions were spatially normalized and parcellated into 108 atlas-defined bilateral (sub)cortical brain regions. Unfavorable outcome (mRS>2) was modeled in a Bayesian logistic regression framework that relied on both lesion location, as well as the covariates: age, sex, total DWI lesion volume and comorbidities. Effects of individual brain regions were captured as two compound effects for (i) six bilateral rich club and (ii) all further non-rich club regions. Via model comparisons, we first tested whether the rich club region model was superior to a baseline model considering clinical covariates and lesion volume only. In spatial specificity analyses, we randomized the split into “rich club” and “non-rich club” regions and compared the effect of the actual rich club regions to the distribution of effects from 1,000 combinations of six random regions. In sex-specific analyses, we introduced an additional hierarchical level in our model structure to compare male and female-specific rich club region effects.A total of 822 patients (age: 64.7 (standard deviation: 15.0), 39% women, 27.7% with mRS>2) were analyzed. The rich club model substantially outperformed the baseline model (weights of model comparison: rich club model: 0.96; baseline: 0.04). Rich club regions had substantial relevance in explaining unfavorable functional outcome (mean of posterior distribution: 0.08, area under the curve: 0.8). In particular, the rich club-combination had a higher relevance than 98.4% of random constellations (15/1,000 random constellations with higher mean posterior values). Among the these 15 random constellations with higher means, the most frequently selected regions were the inferior temporal gyrus (posterior division, 8/15), the putamen (8/15), the cingulate gyrus (7/15) and the superior parietal lobule (6/15). Rich club regions were substantially more important in explaining long-term outcome in women than in men (mean of the difference distribution:-0.107, 90%-HDPI:-0.193 to -0.0124).Lesions in rich club regions were associated with increased odds of unfavorable outcome. These effects were spatially specific, i.e., the majority of random combinations of six regions had comparably smaller effects on long-term outcome. Effects were substantially more pronounced in women.
- Published
- 2023
17. Abstract Number ‐ 34: Basal ganglia infarct volume and risk of hemorrhagic transformation after endovascular thrombectomy
- Author
-
Robert W Regenhardt, Anna K Bonkhoff, Markus D Schirmer, Alvin S Das, Adam A Dmytriw, Justin E Vranic, Rajiv Gupta, James D Rabinov, Christopher J Stapleton, Aman B Patel, and Natalia S Rost
- Abstract
Introduction As more large vessel occlusion stroke patients are treated with endovascular thrombectomy (EVT), understanding the pathophysiology of reperfusion injury and the risks of hemorrhagic transformation (HT) are increasingly important. Pre‐EVT infarct topography may have implications for acute interventional treatments such as stenting, and post thrombectomy care such as antithrombotic choice. We sought to quantify region‐specific volumes of infarcted tissue on pre‐EVT MRI, understand their importance for HT, and identify associations with clinical and imaging characteristics. Methods Patients with pre‐EVT MRI were identified retrospectively from a prospectively maintained database. Each patient’s diffusion weighted sequence underwent manual infarct delineation and was registered to a standard space for overlay with cortical, subcortical, and white matter atlases. Structure‐specific lesion volumes were determined. HT was defined as PH1 or PH2 hemorrhage by ECASS criteria. Variables with p< 0.10 in univariate analyses were included in multivariable models. Logistic regression was performed for associations with hemorrhagic transformation and linear regressions for infarct volumes. Results 165 participants [median age 69 years (interquartile range, IQR 56–79), 56% women] were identified. Risk factors included hypertension (70%), diabetes (20%), atrial fibrillation (34%), and prior stroke/TIA (13%). 52% were treated with intravenous alteplase; 70% achieved TICI 2b‐3 reperfusion. HT occurred in 8%. Pre‐EVT infarct volumes [median (IQR)] were 22 cc (12‐43 cc) for total, 11 cc (6‐19 cc) for white matter, 5 cc (1‐19 cc) for cortex, and 3 cc (1‐6 cc) for basal ganglia. Pre‐EVT infarcts [median (IQR)] were made up of 48% (38‐60%) white matter, 23% (6‐47%) cortex, and 15% (4‐28%) basal ganglia. Paramagnetic sequences showed 3% had petechial hemorrhage and 40% had susceptibility vessel sign. Basal ganglia infarct volume was independently associated with HT (OR = 1.342, 95%CI = 1.002,1.797) in a model including white matter infarct volume, cortex infarct volume, smoking, and puncture‐recanalization time. Basal ganglia infarct volume was linked to susceptibility vessel sign (Beta = 0.233, p = 0.006) and NIHSS (Beta = 0.220, p = 0.012), when controlling for total infarct volume. Conclusions In this cohort, greater basal ganglia infarct volume was associated with a higher risk of hemorrhagic transformation, even when accounting for infarct volume in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery thrombus occlusion of perforators. These findings require further study in larger cohorts.
- Published
- 2023
18. Abstract TMP72: Multimodal Prediction Of Stroke Severity
- Author
-
Anna K Bonkhoff, Alexander Cohen, William Drew, Michael A Ferguson, Christopher Lin, Frederic Schaper, Anthony Bourached, Martin Bretzner, Sungmin Hong, Robert W Regenhardt, Markus D Schirmer, Ona Wu, Christina Jern, Arne G Lindgren, Jane Maguire, Michael Fox, and Natalia S Rost
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Predicting individual outcomes post-stroke with the highest possible accuracy is a crucial steppingstone in the realization of precision medicine. We here evaluated various types of lesion information in their capacity to predict stroke severity in a large cohort of patients with acute ischemic stroke. Methods: A total of 1,075 patients of the MRI-GENIE study [age: 64.2(14.7), 38% women] contributed to analyses (N=792 as train and N=283 as test sample). We employed ridge regression with hyperparameter optimization and nested five-fold cross-validation to predict acute NIHSS-based stroke severity. Our baseline model considered DWI lesion volume. Further models tested structural lesion location, indirect structural and functional lesion connectivity, individually and combined with lesion volume. Data was preprocessed by principal component analysis (PCA), retaining 95% of the variance of the original data. Model performance was compared in terms of explained variance (R-squared) and 95% confidence intervals in the outer loop of the training set and the test set. Results: Structural lesion connectivity enabled the highest prediction performance in the test set ( Figure 1 ). Prediction performance did not change notably with inclusion of lesion volume information. This contrasted with the combination of functional lesion connectivity and lesion volume that achieved a substantially higher prediction performance compared to functional lesion connectivity or lesion volume in isolation. Lesion location resulted in a prediction performance that was in the range of lesion volume alone and significantly lower than the ones of structural or functional connectivity with lesion volume. Conclusions: Structural connectivity facilitated the most convincing prediction of stroke severity. The capacity of functional lesion connectivity was substantially improved by the inclusion of lesion volume, indicating both represent complementary information.
- Published
- 2023
19. Abstract WMP58: Scaling Behaviors Of Deep Learning And Linear Algorithms For The Prediction Of Stroke Severity
- Author
-
Anthony P Bourached, Anna K Bonkhoff, Markus D Schirmer, Robert W Regenhardt, Sungmin Hong, Martin Bretzner, Ona Wu, Christina Jern, Arne G Lindgren, Jane Maguire, John Rhee, Eyal Kimchi, and Natalia S Rost
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Deep learning (DL) has allowed for substantial progress in many, often machine vision-focused medical scenarios. Since DL models typically require 10 5 -10 7 examples, it is currently unknown whether DL can also enhance predictions of outcomes post-stroke in real-world samples of stroke patients that are several magnitudes smaller. We here compared the capacities of linear and DL algorithms regarding their prediction of stroke severity. Methods: Our analyses relied on a total of 1435 patients assembled from the MRI-GENIE study and a Massachusetts General Hospital-based study. The primary outcome was acute NIHSS-based stroke severity, which we predicted by means of lesion location. We automatically derived lesion segmentations from DWI scans, performed spatial normalization and principal component analysis (PCA), retaining 95% of the variance of the original data. We then separated a train, validation, and test set, of sizes 918, 230, and 287 respectively. We downsampled the train set to 100, 300, and 900 and learned to predict the NIHSS score for each sample size with regularized linear regression and an 8-layered neural network. We selected hyperparameters on the validation set and conducted 500 dataset splits. We here report explained variance (R-squared) in the test set. Results: While linear regression performed favorably for a sample size of 100 patients (R-squared=0.28), DL started to significantly outperform linear regression when trained on 900 patients (R-squared=0.34, Figure 1 ). Average prediction performance improved by ~20% when increasing the sample size 9x. Conclusions: For sample sizes of ~1000 patients, DL showed a more convincing prediction performance for stroke severity than typically employed linear methods. Our findings suggest the existence of non-linear relationships between lesion location and outcome post-stroke that can be utilized for an improved prediction performance once samples are reasonably large.
- Published
- 2023
20. Understanding Delays in MRI-based Selection of Large Vessel Occlusion Stroke Patients for Endovascular Thrombectomy
- Author
-
Robert W. Regenhardt, Neal M. Nolan, Joseph A. Rosenthal, Joyce A. McIntyre, Martin Bretzner, Anna K. Bonkhoff, Samuel B. Snider, Alvin S. Das, Naif M. Alotaibi, Justin E. Vranic, Adam A. Dmytriw, Christopher J. Stapleton, Aman B. Patel, Natalia S. Rost, and Thabele M. Leslie-Mazwi
- Subjects
Radiology, Nuclear Medicine and imaging ,Neurology (clinical) - Published
- 2022
21. Association of Infarct Topography and Outcome After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke
- Author
-
Robert W. Regenhardt, Anna K. Bonkhoff, Martin Bretzner, Mark R. Etherton, Alvin S. Das, Sungmin Hong, Naif M. Alotaibi, Justin E. Vranic, Adam A. Dmytriw, Christopher J. Stapleton, Aman B. Patel, Thabele M. Leslie-Mazwi, and Natalia S. Rost
- Subjects
Aged, 80 and over ,Male ,Endovascular Procedures ,Bayes Theorem ,Cerebral Infarction ,Middle Aged ,Brain Ischemia ,Cohort Studies ,Stroke ,Treatment Outcome ,Humans ,Female ,Neurology (clinical) ,Aged ,Ischemic Stroke ,Retrospective Studies ,Thrombectomy ,Research Article - Abstract
Background and ObjectivesThe care of patients with large vessel occlusion (LVO) stroke has been revolutionized by endovascular thrombectomy (EVT). While EVT has a large effect size, most patients treated with EVT remain disabled or die within 90 days. A better understanding of outcomes may influence EVT selection criteria, novel therapies, and prognostication. We sought to identify associations between outcomes and brain regions involved in ischemic lesions.MethodsFor this cohort study, consecutive patients with LVO who were treated with EVT and underwent post-EVT MRI were identified from a tertiary referral center (2011–2019). Acute ischemic lesions were manually segmented from diffusion-weighted imaging and spatially normalized. Individual lesions were parcellated (atlas-defined 94 cortical regions, 14 subcortical nuclei, 20 white matter tracts) and reduced to 10 essential lesion patterns with the use of unsupervised dimensionality reduction techniques. Ninety-day modified Rankin Scale (mRS) score (>2) was modeled via bayesian regression, taking the 10 lesion patterns as inputs and controlling for lesion size, age, sex, acute NIH Stroke Scale (NIHSS) score, alteplase, prior stroke, intracerebral hemorrhage, and good reperfusion (Thrombolysis in Cerebral Infarction 2b–3). In comparative analyses, 90-day mRS score was modeled considering covariates only, and compartment-wise relevances for acute stroke severity and 90-day mRS score were evaluated.ResultsThere were 151 patients with LVO identified (age 68 ± 15 years, 52% female). The median NIHSS score was 16 (interquartile range 13–20); 56% had mRS score >2. Lesion locations predictive of 90-day mRS score involved bilateral but left hemispherically more pronounced precentral and postcentral gyri, insular and opercular cortex, and left putamen and caudate (area under the curve 0.91, highest probability density interval [HPDI] covering 90% certainty 0.90–0.92). The lesion location model outperformed the simpler model relying on covariates only (bayesian model comparison of 97% weight to the model with vs 3% weight to the model without lesion location). While lesions affecting subcortical nuclei had the highest relevance for stroke severity (posterior distribution mean 0.75, 90% HPDI 0.256–1.31), lesions affecting white matter tracts had the highest relevance for 90-day mRS score (0.656, 90% HPDI 0.0864–1.12).DiscussionThese data describe the significance for outcomes of specific brain regions involved in ischemic lesions on MRI after EVT. Future work in additional datasets is needed to confirm these granular findings.
- Published
- 2022
22. Recovery after stroke: the severely impaired are a distinct group
- Author
-
Anna K Bonkhoff, Tom Hope, Danilo Bzdok, Adrian G Guggisberg, Rachel L Hawe, Sean P Dukelow, François Chollet, David J Lin, Christian Grefkes, and Howard Bowman
- Subjects
Stroke Rehabilitation ,Bayes Theorem ,Recovery of Function ,01 natural sciences ,Stroke ,Upper Extremity ,010104 statistics & probability ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Humans ,Surgery ,Neurology (clinical) ,0101 mathematics ,030217 neurology & neurosurgery - Abstract
IntroductionStroke causes different levels of impairment and the degree of recovery varies greatly between patients. The majority of recovery studies are biased towards patients with mild-to-moderate impairments, challenging a unified recovery process framework. Our aim was to develop a statistical framework to analyse recovery patterns in patients with severe and non-severe initial impairment and concurrently investigate whether they recovered differently.MethodsWe designed a Bayesian hierarchical model to estimate 3–6 months upper limb Fugl-Meyer (FM) scores after stroke. When focusing on the explanation of recovery patterns, we addressed confounds affecting previous recovery studies and considered patients with FM-initial scores FM-initial=5–30). In model comparisons, we evaluated whether impairment-level-specific recovery patterns indeed existed. Finally, we estimated the out-of-sample prediction performance for patients across the entire initial impairment range.ResultsRecovery data was assembled from eight patient cohorts (n=489). Data were best modelled by incorporating two subgroups (breakpoint: FM-initial=10). Both subgroups recovered a comparable constant amount, but with different proportional components: severely affected patients recovered more the smaller their impairment, while non-severely affected patients recovered more the larger their initial impairment. Prediction of 3–6 months outcomes could be done with an R2=63.5% (95% CI=51.4% to 75.5%).ConclusionsOur work highlights the benefit of simultaneously modelling recovery of severely-to-non-severely impaired patients and demonstrates both shared and distinct recovery patterns. Our findings provide evidence that the severe/non-severe subdivision in recovery modelling is not an artefact of previous confounds. The presented out-of-sample prediction performance may serve as benchmark to evaluate promising biomarkers of stroke recovery.
- Published
- 2021
23. Scaling behaviors of deep learning and linear algorithms for the prediction of stroke severity
- Author
-
Anthony Bourached, Anna K. Bonkhoff, Markus D. Schirmer, Robert W. Regenhardt, Martin Bretzner, Sungmin Hong, Adrian V. Dalca, Anne-Katrin Giese, Stefan Winzeck, Christina Jern, Arne G. Lindgren, Jane Maguire, Ona Wu, John Rhee, Eyal Y. Kimchi, and Natalia S. Rost
- Abstract
IntroductionDeep learning has allowed for remarkable progress in many medical scenarios. Since deep learning prediction models often require 105-107examples, it is currently unknown whether deep learning can also enhance predictions of symptoms post-stroke in real-world samples of stroke patients that are often several magnitudes smaller. Such stroke outcome predictions however could be particularly instrumental in guiding acute clinical and rehabilitation care decisions. We here compared the capacities of classically used linear and novel deep learning algorithms in their prediction of stroke severity.MethodsOur analyses relied on a total of 1,430 patients assembled from the MRI-GENIE collaboration and a Massachusetts General Hospital-based study. The outcome of interest was NIHSS-based stroke severity in the acute phase after ischemic stroke onset, which we predict by means of MRI-derived lesion location. We automatically derived lesion segmentations from diffusion-weighted clinical MRI scans, performed spatial normalization and included a principal component analysis (PCA) step, retaining 95% of the variance of the original data. We then repeatedly separated a train, validation, and test set to investigate the effects of sample size, we subsampled the train set to 100, 300, and 900 and trained the algorithms to predict the NIHSS score for each sample size with regularized linear regression and an 8-layered neural network. We selected hyperparameters on the validation set. We evaluated model performance based on the explained variance (R-squared) in the test set.ResultsWhile linear regression performed significantly better for a sample size of 100 patients, deep learning started to significantly outperform linear regression when trained on 900 patients. Average prediction performance improved by ∼20% when increasing the sample size 9x (maximum for 100 patients: 0.279 ± 0.005 (R2, 95% confidence interval), 900 patients: 0.337 ± 0.006).ConclusionsFor sample sizes of 900 patients, deep learning showed a higher prediction performance than typically employed linear methods. These findings suggest the existence of non-linear relationships between lesion location and stroke severity that can be utilized for an improved prediction performance for larger sample sizes.
- Published
- 2022
24. Radiomic signature of DWI‐FLAIR mismatch in large vessel occlusion stroke
- Author
-
Adam A Dmytriw, Anna K. Bonkhoff, Martin Bretzner, Thabele M Leslie-Mazwi, Aman B. Patel, Mark R Etherton, Christopher J Stapleton, Robert W. Regenhardt, Sungmin Hong, Alvin S. Das, Natalia S. Rost, Naif M. Alotaibi, Grégory Kuchcinski, Justin E Vranic, and Maria Clara Zanon Zotin
- Subjects
medicine.medical_specialty ,Time Factors ,Fluid-attenuated inversion recovery ,Article ,Brain Ischemia ,Visual grading ,Radiomics ,Neuroimaging ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Grading (tumors) ,Stroke ,Aged ,Ischemic Stroke ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Hyperintensity ,Diffusion Magnetic Resonance Imaging ,Female ,Neurology (clinical) ,Radiology ,business ,Large vessel occlusion - Abstract
BACKGROUND AND PURPOSE Ischemic diffusion-weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch may be useful in guiding acute stroke treatment decisions given its relationship to onset time and parenchymal viability; however, it relies on subjective grading. Radiomics is an emerging image quantification methodology that may objectively represent continuous image characteristics. We propose a novel radiomics approach to characterize DWI-FLAIR mismatch. METHODS Ischemic lesions were visually graded for FLAIR positivity (absent, subtle, obvious) among consecutive large vessel occlusion stroke patients who underwent hyperacute MRI. Radiomic features were extracted from within the lesions on DWI and FLAIR. The DWI-FLAIR mismatch radiomics signature was built with features systematically selected by a cross-validated ElasticNet linear regression model of mismatch. RESULTS We identified 103 patients with mean age 68 ± 16 years; 63% were female. FLAIR hyperintensity was absent in 25%, subtle in 55%, and obvious in 20%. Inter-rater agreement for visual grading was moderate (Κ = .58). The radiomics signature of DWI-FLAIR mismatch included native FLAIR histogram kurtosis and local binary pattern-filtered FLAIR gray-level cluster shade; both correlated with visual grading (ρ = -.42, p
- Published
- 2021
25. Fronto-Striatal Dynamic Connectivity is linked to Dopaminergic Motor Response in Parkinson’s Disease
- Author
-
Lukas Hensel, Aline Seger, Ezequiel Farrher, Anna K. Bonkhoff, N. Jon Shah, Gereon R. Fink, Christian Grefkes, Michael Sommerauer, and Christopher E. J. Doppler
- Abstract
BackgroundDifferences in dopaminergic motor response in Parkinson’s disease (PD) patients are related to specific PD subtypes. An important factor driving dopaminergic response might lie in the temporal dynamics in corticostriatal connections.ObjectivesThe aim of this study is to determine if altered resting-state dynamic functional network connectivity (dFNC) is associated with dopaminergic motor response.MethodsWe assessed static and dFNC in 32 PD patients and 18 healthy controls (HC). Patients were subgrouped according to their dopaminergic motor response as low and high responders using a median split.ResultsPatients featuring high dopaminergic responses spent more time in a regionally more integrated state 1 compared to HC. Furthermore, dFNC between aMCC/dACC (anterior midcingulate cortex/dorsal anterior cingulate cortex) and putamen was lower in low responders during a more segregated state 2 and correlated with dopaminergic motor response.ConclusionsAlterations in temporal dynamics of fronto-striatal connectivity might underlie treatment response in PD.
- Published
- 2022
26. Association of Stroke Lesion Pattern and White Matter Hyperintensity Burden With Stroke Severity and Outcome
- Author
-
Anna K. Bonkhoff, Sungmin Hong, Martin Bretzner, Markus D. Schirmer, Robert W. Regenhardt, E. Murat Arsava, Kathleen Donahue, Marco Nardin, Adrian Dalca, Anne-Katrin Giese, Mark R. Etherton, Brandon L. Hancock, Steven J.T. Mocking, Elissa McIntosh, John Attia, Oscar Benavente, John W. Cole, Amanda Donatti, Christoph Griessenauer, Laura Heitsch, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Steven Kittner, Robin Lemmens, Christopher Levi, Caitrin W. McDonough, James Meschia, Chia-Ling Phuah, Arndt Rolfs, Stefan Ropele, Jonathan Rosand, Jaume Roquer, Tatjana Rundek, Ralph L. Sacco, Reinhold Schmidt, Pankaj Sharma, Agnieszka Slowik, Martin Soederholm, Alessandro Sousa, Tara M. Stanne, Daniel Strbian, Turgut Tatlisumak, Vincent Thijs, Achala Vagal, Johan Wasselius, Daniel Woo, Ramin Zand, Patrick McArdle, Bradford B. Worrall, Christina Jern, Arne G. Lindgren, Jane Maguire, Polina Golland, Danilo Bzdok, Ona Wu, and Natalia S. Rost
- Subjects
Male ,Neurology & Neurosurgery ,Leukoaraiosis ,Bayes Theorem ,Middle Aged ,Magnetic Resonance Imaging ,White Matter ,Brain Ischemia ,Stroke ,Humans ,Female ,Neurology (clinical) ,1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Sciences ,Research Article ,Aged ,Ischemic Stroke - Abstract
Background and ObjectivesTo examine whether high white matter hyperintensity (WMH) burden is associated with greater stroke severity and worse functional outcomes in lesion pattern–specific ways.MethodsMR neuroimaging and NIH Stroke Scale data at index stroke and the modified Rankin Scale (mRS) score at 3–6 months after stroke were obtained from the MRI–Genetics Interface Exploration study of patients with acute ischemic stroke (AIS). Individual WMH volume was automatically derived from fluid-attenuated inversion recovery images. Stroke lesions were automatically segmented from diffusion-weighted imaging (DWI) images, parcellated into atlas-defined brain regions and further condensed to 10 lesion patterns via machine learning–based dimensionality reduction. Stroke lesion effects on AIS severity and unfavorable outcomes (mRS score >2) were modeled within purpose-built Bayesian linear and logistic regression frameworks. Interaction effects between stroke lesions and a high vs low WMH burden were integrated via hierarchical model structures. Models were adjusted for age, age2, sex, total DWI lesion and WMH volumes, and comorbidities. Data were split into derivation and validation cohorts.ResultsA total of 928 patients with AIS contributed to acute stroke severity analyses (age: 64.8 [14.5] years, 40% women) and 698 patients to long-term functional outcome analyses (age: 65.9 [14.7] years, 41% women). Stroke severity was mainly explained by lesions focused on bilateral subcortical and left hemispherically pronounced cortical regions across patients with both a high and low WMH burden. Lesions centered on left-hemispheric insular, opercular, and inferior frontal regions and lesions affecting right-hemispheric temporoparietal regions had more pronounced effects on stroke severity in case of high compared with low WMH burden. Unfavorable outcomes were predominantly explained by lesions in bilateral subcortical regions. In difference to the lesion location–specific WMH effects on stroke severity, higher WMH burden increased the odds of unfavorable outcomes independent of lesion location.DiscussionHigher WMH burden may be associated with an increased stroke severity in case of stroke lesions involving left-hemispheric insular, opercular, and inferior frontal regions (potentially linked to language functions) and right-hemispheric temporoparietal regions (potentially linked to attention). Our findings suggest that patients with specific constellations of WMH burden and lesion locations may have greater benefits from acute recanalization treatments. Future clinical studies are warranted to systematically assess this assumption and guide more tailored treatment decisions.
- Published
- 2022
27. Reclassifying stroke lesion anatomy
- Author
-
Geraint Rees, Parashkev Nachev, Robert Gray, Hans Rolf Jäger, Tianbo Xu, Amy Nelson, Jorge Cardoso, Sebastien Ourselin, Anna K. Bonkhoff, and Ashwani Jha
- Subjects
Cognitive Neuroscience ,media_common.quotation_subject ,t-SNE, t-stochastic neighbour embedding ,Fidelity ,Experimental and Cognitive Psychology ,Brain imaging ,Machine learning ,computer.software_genre ,DWI, diffusion-weighted imaging ,Humans ,Limit (mathematics) ,Simplicity ,media_common ,Ground truth ,Brain Mapping ,business.industry ,Dimensionality reduction ,Representation (systemics) ,Lesion anatomy ,Brain ,Cognition ,Outcome (probability) ,Stroke ,NMF, non-negative matrix factorization ,Neuropsychology and Physiological Psychology ,Clinical Neuroanatomy ,BA, Brodmann Area ,Artificial intelligence ,Psychology ,business ,computer ,Lesion–deficit prediction - Abstract
Cognitive and behavioural outcomes in stroke reflect the interaction between two complex anatomically-distributed patterns: the functional organization of the brain and the structural distribution of ischaemic injury. Conventional outcome models—for individual prediction or population-level inference—commonly ignore this complexity, discarding anatomical variation beyond simple characteristics such as lesion volume. This sets a hard limit on the maximum fidelity such models can achieve. High-dimensional methods can overcome this problem, but only at prohibitively large data scales. Drawing on one of the largest published collections of anatomically-registered imaging of acute stroke—N = 1333—here we use non-linear dimensionality reduction to derive a succinct latent representation of the anatomical patterns of ischaemic injury, agglomerated into 21 distinct intuitive categories. We compare the maximal predictive performance it enables against both simpler low-dimensional and more complex high-dimensional representations, employing multiple empirically-informed ground truth models of distributed structure–outcome relationships. We show our representation sets a substantially higher ceiling on predictive fidelity than conventional low-dimensional approaches, but lower than that achievable within a high-dimensional framework. Where descriptive simplicity is a necessity, such as within clinical care or research trials of modest size, the representation we propose arguably offers a favourable compromise of compactness and fidelity.
- Published
- 2021
28. Abstract TMP26: Understanding Changes In Thrombectomy Eligibility Among Large Vessel Occlusion Stroke Transfers In A Hub-and-spoke Telestroke System
- Author
-
Robert W Regenhardt, Amine Awad, Andrew W Kraft, Joseph A Rosenthal, Adam A Dmytriw, Justin E Vranic, Anna K Bonkhoff, Martin Bretzner, Mark R Etherton, Joshua A Hirsch, James D Rabinov, Aneesh B Singhal, Natalia S Rost, Christopher J Stapleton, Thabele M Leslie-mazwi, and Aman B Patel
- Subjects
Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Endovascular thrombectomy (EVT) has revolutionized the care of emergent large vessel occlusion (ELVO) stroke patients. It is, therefore, crucial to optimize its delivery to eligible candidates. Within hub-and-spoke hospital system models, some patients first present to distant spoke hospitals and require transfer to hub hospitals for EVT. We sought to understand changes in EVT eligibility during transfer. Methods: Consecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pre-transfer CTA-defined ELVO and Alberta Stroke Program Early CT Score ≥6 were identified from a prospectively maintained database. Outcomes of interest included hub EVT, reasons for EVT ineligibility, and 90-day functional independence (modified Rankin Scale, mRS ≤2). Results: Among 258 patients, the median age was 70 years (IQR 60-81) and 50% were female. Forty-four percent underwent EVT upon hub arrival, of which 87% achieved Thrombolysis in Cerebral Infarction 2b-3 reperfusion. Compared to EVT-eligible patients, ineligible patients were older (73 vs 68 years, p=0.04), had lower NIH Stroke Scale (NIHSS, 10 vs 16, p Conclusions: These data support that approaches to increase EVT eligibility among ELVO transfers may improve long term outcomes. Infarct growth represents the primary reason for ineligibility. Possible interventions include direct field triage to the hub when feasible, improving inter-hospital transfer times, supporting ischemic penumbra before EVT, and developing novel agents to slow infarct growth.
- Published
- 2022
29. Understanding Delays in MRI-based Selection of Large Vessel Occlusion Stroke Patients for Endovascular Thrombectomy
- Author
-
Robert W, Regenhardt, Neal M, Nolan, Joseph A, Rosenthal, Joyce A, McIntyre, Martin, Bretzner, Anna K, Bonkhoff, Samuel B, Snider, Alvin S, Das, Naif M, Alotaibi, Justin E, Vranic, Adam A, Dmytriw, Christopher J, Stapleton, Aman B, Patel, Natalia S, Rost, and Thabele M, Leslie-Mazwi
- Abstract
Given the efficacy of endovascular thrombectomy (EVT), optimizing systems of delivery is crucial. Magnetic resonance imaging (MRI) is the gold standard for evaluating tissue viability but may require more time to obtain and interpret. We sought to identify determinants of arrival-to-puncture time for patients who underwent MRI-based EVT selection in a real-world setting.Patients were identified from a prospectively maintained database from 2011-2019 that included demographics, presentations, treatments, and outcomes. Process times were obtained from the medical charts. MRI times were obtained from time stamps on the first sequence. Linear and logistic regressions were used to infer explanatory variables of arrival-to-puncture times and effects of arrival-to-puncture time on functional outcomes.In this study 192 patients (median age 70 years, 57% women, 12% non-white) underwent MRI-based EVT selection. 66% also underwent computed tomography (CT) at the hub before EVT. General anesthesia was used for 33%. Among the entire cohort, the median arrival-to-puncture was 102 min; however, among those without CT it was 77 min. Longer arrival-to-puncture times independently reduced the odds of 90-day good outcome (∆mRS ≤ 2 from pre-stroke, aOR = 0.990, 95%CI = 0.981-0.999, p = 0.040) when controlling for age, NIHSS, and good reperfusion (TICI 2b-3). Independent determinants of longer arrival-to-puncture were CT plus MRI (β = 0.205, p = 0.003), non-white race/ethnicity (β = 0.162, p = 0.012), coronary disease (β = 0.205, p = 0.001), and general anesthesia (β = 0.364, p 0.0001).Minimizing arrival-to-puncture time is important for outcomes. Real-world challenges exist in an MRI-based EVT selection protocol; avoiding double imaging is key to saving time. Racial/ethnic disparities require further study. Understanding variables associated with delay will inform protocol changes.
- Published
- 2021
30. Lesions in putative language and attention regions are linked to more severe strokes in patients with higher white matter hyperintensity burden
- Author
-
Jaume Roquer, Daniel Woo, Oscar R. Benavente, Tatjana Rundek, Alessandro Sousa, Stefan Ropele, Turgut Tatlisumak, E. Murat Arsava, Christoph J. Griessenauer, Robert W. Regenhardt, Reinhold Schmidt, Chia-Ling Phuah, Brandon L. Hancock, Sungmin Hong, Pankaj Sharma, Anna K. Bonkhoff, Caitrin W. McDonough, Daniel Strbian, Polina Golland, Tara M. Stanne, Bradford B. Worrall, Steven J. T. Mocking, Lukas Holmegaard, Jonathan Rosand, Johan Wassélius, James F. Meschia, Natalia S. Rost, Markus D. Schirmer, Mark R Etherton, Martin Bretzner, Christina Jern, Kathleen L. Donahue, Ona Wu, Jordi Jimenez-Conde, Marco Nardin, Ramin Zand, Agnieszka Slowik, Elissa C. McIntosh, Steven J. Kittner, Patrick F. McArdle, Giscome Investigators, Danilo Bzdok, John W. Cole, Robin Lemmens, Amanda Donatti, Achala Vagal, Arndt Rolfs, Katarina Jood, Jane Maguire, John Attia, Adrian V. Dalca, Vincent Thijs, Ralph L. Sacco, Anne-Katrin Giese, Martin Söderholm, Laura Heitsch, Arne Lindgren, and Christopher R Levi
- Subjects
0303 health sciences ,medicine.medical_specialty ,Stroke scale ,business.industry ,Stroke severity ,medicine.disease ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,White matter hyperintensity ,Neuroimaging ,Modified Rankin Scale ,Internal medicine ,Cardiology ,medicine ,In patient ,medicine.symptom ,business ,Stroke ,030217 neurology & neurosurgery ,030304 developmental biology - Abstract
ObjectiveTo examine whether high white matter hyperintensity (WMH) burden is associated with greater stroke severity and worse functional outcomes in lesion pattern-specific ways.MethodsMR neuroimaging and National Institutes of Health Stroke Scale data at index stroke, as well as modified Rankin Scale (mRS) at 3-6 months post-stroke were obtained from MRI-GENIE study of acute ischemic stroke (AIS) patients. Individual WMH volume was automatically derived from FLAIR-images. Stroke lesions were automatically segmented from DWI-images, spatially normalized and parcellated into atlas-defined brain regions. Stroke lesion effects on AIS severity and unfavorable outcomes (mRS>2) were modeled within a purpose-built machine learning and Bayesian regression framework. In particular, interaction effects between stroke lesions and a high versus low WMH burden were integrated via hierarchical model structures. Models were adjusted for the covariates age, age2, sex, total DWI-lesion and WMH volumes, and comorbidities. Data were split into derivation and validation cohorts.ResultsA total of 928 AIS patients contributed to stroke severity analyses (mean age: 64.8(14.5), 40% women), 698 patients to functional outcome analyses (mean age: 65.9(14.7), 41% women). Individual stroke lesions were represented in five anatomically distinct left-hemispheric and five right-hemispheric lesion patterns. Across all patients, acute stroke severity was substantially explained by three of these patterns, that were particularly focused on bilateral subcortical and left-hemispherically pronounced cortical regions. In high WMH burden patients, two lesion patterns consistently emerged as more pronounced in case of stroke severity: the first pattern was centered on left-hemispheric insular, opercular and inferior frontal regions, while the second pattern combined right-hemispheric temporo-parietal regions. Bilateral subcortical regions were most relevant in explaining long term unfavorable outcome. No WMH-specific lesion patterns of functional outcomes were substantiated. However, a higher overall WMH burden was associated with higher odds of unfavorable outcomes.ConclusionsHigher WMH burden increases stroke severity in case of stroke lesions involving left-hemispheric insular, opercular and inferior frontal regions (potentially linked to language functions) and right-hemispheric temporo-parietal regions (potentially linked to attention). These findings may contribute to augment stroke outcome predictions and motivate a WMH burden and stroke lesion pattern-specific clinical management of AIS patients.
- Published
- 2021
31. Abstract 1122‐000023: In a Hub‐and‐Spoke Network, Spoke‐Administered Thrombolysis Reduces Mechanical Thrombectomy Procedure Time and Number of Passes
- Author
-
Andrew W Kraft, Amine Awad, Joseph A Rosenthal, Adam A Dmytriw, Justin E Vranic, Anna K Bonkhoff, Martin Bretzner, Joshua A Hirsch, James D Rabinov, Christopher J Stapleton, Aneesh B Singhal, Natalia S Rost, Thabele M Leslie‐Mazwi, Aman B Patel, and Robert W Regenhardt
- Abstract
This meeting abstract was removed due to the OA licensing requirements of this journal. The full abstract is listed here : https://www.svin.org/files/SVIN_2021_Abstracts_for_Web.pdf
- Published
- 2021
32. Abstract 1122‐000031: Reasons Thrombectomy Candidates Become Ineligible After Transfer for Treatment in a Hub‐And‐Spoke Telestroke Model
- Author
-
Robert W Regenhardt, Amine Awad, Andrew W Kraft, Joseph A Rosenthal, Adam A Dmytriw, Justin E Vranic, Anna K Bonkhoff, Martin Bretzner, Joshua A Hirsch, James D Rabinov, Christopher J Stapleton, Mark R Etherton, Aneesh B Singhal, Natalia S Rost, Thabele M Leslie‐Mazwi, and Aman B Patel
- Abstract
Introduction : The care of emergent large vessel occlusion (ELVO) stroke patients has been revolutionized by endovascular thrombectomy (EVT). Given its robust efficacy, it is crucial to optimize delivery to eligible patients. Within hub‐and‐spoke hospital system models, some patients first present to distant spoke hospitals and require transfer to hub hospitals for EVT. We sought to understand reasons EVT candidates become ineligible after transfer for treatment. Methods : Consecutive EVT candidates presenting to 25 spokes from 2018 to 2020 with pre‐transfer CTA‐defined ELVO and Alberta Stroke Program Early CT Score ≥6 were identified from a prospectively maintained database. Outcomes of interest included hub EVT, reasons for EVT ineligibility, and 90‐day functional independence (modified Rankin Scale, mRS ≤2). Results : 258 patients were identified with median age 70 years (IQR 60–81) and 50% female. 44% underwent EVT upon hub arrival, of which 87% achieved Thrombolysis in Cerebral Infarction 2b‐3 reperfusion. Compared to EVT‐eligible patients, ineligible patients were older (73 vs 68 years, p = 0.04), had lower NIH Stroke Scale (NIHSS, 10 vs 16, p Conclusions : Approaches to increase EVT eligibility among ELVO transfers may improve long term outcomes. A primary reason for becoming EVT ineligible is infarct growth. Future studies should explore triaging patients directly to EVT‐capable hubs when feasible, improving inter‐hospital transfer times, supporting ischemic penumbra before EVT, and developing novel neuroprotective agents.
- Published
- 2021
33. Radiomics Derived Brain Age Predicts Functional Outcome After Acute Ischemic Stroke
- Author
-
Arndt Rolfs, Jane Maguire, Ralph L. Sacco, Grégory Kuchcinski, Mark R Etherton, Christina Jern, Oscar R. Benavente, Anne-Katrin Giese, Amanda Donatti, Arne Lindgren, Pamela M. Rist, Tatjana Rundek, Stefan Ropele, Turgut Tatlisumak, Vincent Thijs, John W. Cole, Jaume Roquer, Natalia S. Rost, Robin Lemmens, Jordi Jimenez-Conde, Christopher R Levi, Daniel Woo, Renaud Lopes, Adrian V. Dalca, Daniel Strbian, Robert W. Regenhardt, Laura Heitsch, Polina Golland, Tara M. Stanne, Achala Vagal, Patrick F. McArdle, Johan Wassélius, James F. Meschia, Alessandro Sousa, Caitrin W. McDonough, Bradford B. Worrall, Clinton J. Wang, Pankaj Sharma, Marco Nardin, Morgan Gautherot, Markus D. Schirmer, Katharina Jood, Kathleen Donahue, Ramin Zand, Agnieszka Slowik, Sungmin Hong, Xavier Leclerc, Jonathan Rosand, Anna K. Bonkhoff, Ona Wu, Chia-Ling Phuah, Christoph J. Griessenauer, Steven J. Kittner, Lukas Holmegaard, Reinhold E. Schmidt, and Martin Bretzner
- Subjects
medicine.medical_specialty ,Radiomics ,business.industry ,Internal medicine ,Cardiology ,Medicine ,business ,Acute ischemic stroke ,Outcome (game theory) - Abstract
While chronological age is one of the most influential determinants of post-stroke outcomes, little is known of the impact of neuroimaging-derived biological brain age. We here first examine whether radiomics analysis of the texture of brain T2-FLAIR MRI images can be used to predict brain age in stroke patients. We then assess the clinical determinants of accelerated brain aging and, finally, its impact on post-stroke functional outcomes. Leveraging a multisite cohort of 4,163 ischemic stroke patients, we show that older-appearing patients have more hypertension, diabetes mellitus, prior strokes, and smoking history and are more likely to develop worse post-stroke outcomes than their younger-appearing counterparts. Our results strengthen the importance of preventive medicine for maintaining brain health in stroke patients as they age and suggest a novel methodology to capture previously undescribed prognostic information available on commonly acquired MRI sequences during routine stroke care.
- Published
- 2021
34. Outcome after acute ischemic stroke is linked to sex-specific lesion patterns
- Author
-
Jane Maguire, John Attia, Tara M. Stanne, Tatjana Rundek, Johan Wassélius, James F. Meschia, Vincent Thijs, John W. Cole, Lukas Holmegaard, Mikael Brudfors, Ralph L. Sacco, Alessandro Sousa, Anne-Katrin Giese, Reinhold Schmidt, Brandon L. Hancock, Robin Lemmens, Chia-Ling Phuah, Steven J. T. Mocking, Christopher R Levi, Danilo Bzdok, Caitrin W. McDonough, Robert W. Regenhardt, Kathleen L. Donahue, Daniel Strbian, Stephen Bevan, Martin Bretzner, Markus D. Schirmer, Oscar R. Benavente, Arne Lindgren, Patrick F. McArdle, Marco Nardin, Ramin Zand, Agnieszka Slowik, Laura Heitsch, Mark R Etherton, Elissa C. McIntosh, Natalia S. Rost, Bradford B. Worrall, Ona Wu, Adrian V. Dalca, Sungmin Hong, Jaume Roquer, Pankaj Sharma, Arndt Rolfs, Katarina Jood, Daniel Woo, Achala Vagal, Christina Jern, Jordi Jimenez-Conde, Amanda Donatti, Jonathan Rosand, Steven J. Kittner, Christoph J. Griessenauer, Anna K. Bonkhoff, Martin Söderholm, Stefan Ropele, Turgut Tatlisumak, Neurologian yksikkö, HUS Neurocenter, and University of Helsinki
- Subjects
Male ,SYMPTOMS ,Neurology ,Heart disease ,General Physics and Astronomy ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Cohort Studies ,Brain ischemia ,0302 clinical medicine ,Thalamus ,Risk Factors ,Image Processing, Computer-Assisted ,Stroke ,Aged, 80 and over ,Brain Mapping ,Multidisciplinary ,Cerebral Revascularization ,Brain ,WOMEN ,Middle Aged ,Magnetic Resonance Imaging ,3. Good health ,Multidisciplinary Sciences ,ESTROGEN ,Treatment Outcome ,Cohort ,Science & Technology - Other Topics ,Female ,Sensorimotor Cortex ,medicine.symptom ,Cohort study ,medicine.medical_specialty ,Science ,macromolecular substances ,HEART-DISEASE ,Article ,General Biochemistry, Genetics and Molecular Biology ,Lesion ,REPLACEMENT THERAPY ,03 medical and health sciences ,Sex Factors ,Internal medicine ,Severity of illness ,medicine ,Humans ,cardiovascular diseases ,Aged ,Ischemic Stroke ,GENDER-DIFFERENCES ,Science & Technology ,business.industry ,3112 Neurosciences ,Bayes Theorem ,General Chemistry ,medicine.disease ,MEDICAL-CARE ,RICH-CLUB ORGANIZATION ,UNILATERAL BRAIN-DAMAGE ,business ,MATTER ,030217 neurology & neurosurgery ,Brain Stem - Abstract
Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). This framework was developed in 555 patients (38% female). Findings were validated in an independent cohort (n = 503, 41% female). Here, we show brain lesions in regions subserving motor and language functions help explain stroke severity in both men and women, however more widespread lesion patterns are relevant in female patients. Higher stroke severity in women, but not men, is associated with left hemisphere lesions in the vicinity of the posterior circulation. Our results suggest there are sex-specific functional cerebral asymmetries that may be important for future investigations of sex-stratified approaches to management of acute ischemic stroke., Acute ischemic stroke impacts men and women differently. Here, the authors show how different lesion patterns in men and women are linked to the extent of stroke severity.
- Published
- 2021
35. Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke
- Author
-
Steven C. Cramer, Kristin Parlman, Samuel B. Snider, Kimberly Erler, Lee H. Schwamm, Nicole Lam, Leigh R. Hochberg, Jessica Ranford, Anna K. Bonkhoff, Jennifer Freeburn, David Lin, Julie DiCarlo, Seth P. Finklestein, and Audrey Cohen
- Subjects
0301 basic medicine ,Male ,Weakness ,medicine.medical_specialty ,Clinical Sciences ,computer.software_genre ,Article ,Lesion ,Upper Extremity ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Physical medicine and rehabilitation ,Cognition ,Clinical Research ,Voxel ,medicine ,Humans ,Stroke ,Neurorehabilitation ,Acute stroke ,Aged ,Neurology & Neurosurgery ,business.industry ,Rehabilitation ,Neurosciences ,Recovery of Function ,Middle Aged ,medicine.disease ,Brain Disorders ,030104 developmental biology ,Cognitive Sciences ,Female ,Neurology (clinical) ,medicine.symptom ,business ,computer ,030217 neurology & neurosurgery ,Psychomotor Performance - Abstract
ObjectiveTo test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested patients with acute stroke on 2 motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury.MethodsWe assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at 3 time points with 2 tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the 2 tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomic sites associated with motor performance.ResultsConsistent across contralesional and ipsilesional upper extremities and most pronounced immediately after stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function.ConclusionsTogether, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.
- Published
- 2021
36. Inflated Estimates of Proportional Recovery from Stroke: the Dangers of Mathematical Coupling and Compression to Ceiling
- Author
-
Howard Bowman, Christian Grefkes, Thomas M.H. Hope, Cathy J. Price, and Anna K. Bonkhoff
- Subjects
030506 rehabilitation ,Inference ,Ceiling (cloud) ,Article ,Correlation ,Upper Extremity ,03 medical and health sciences ,0302 clinical medicine ,Empirical research ,Econometrics ,Medicine ,Humans ,Survivors ,Stroke ,Advanced and Specialized Nursing ,business.industry ,Recovery of Function ,medicine.disease ,Coupling (probability) ,Prognosis ,Outcome (probability) ,Neurology (clinical) ,0305 other medical science ,Cardiology and Cardiovascular Medicine ,business ,Value (mathematics) ,030217 neurology & neurosurgery ,Biomarkers - Abstract
The proportional recovery rule states that most survivors recover a fixed proportion (~70%) of lost function after stroke. A strong (negative) correlation between the initial score and subsequent change (outcome minus initial; i.e. recovery) is interpreted as empirical support for the proportional recovery rule. However, this rule has recently been critiqued, with a central observation being that the correlation of initial-scores with change over time is confounded in the situations in which it is typically assessed. This critique has prompted reassessments of patients’ behavioural trajectory following stroke in two prominent papers. The first of these, by van der Vliet and collaborators presented an impressive modelling of upper limb deficits following stroke, which avoided the confounded correlation of initial-scores with change. The second by Kundert and collaborators reassessed the value of the proportional recovery rule, as classically formulated as the correlation between initial-scores and change. They argued that, while effective prediction of recovery trajectories of individual patients is not supported by the available evidence, group-level inferences about the existence of proportional recovery are reliable. In this paper, we respond to the van der Vliet and Kundert papers by distilling the essence of the argument for why the classic assessment of proportional recovery is confounded. In this respect, we re-emphasize the role of mathematical coupling and compression to ceiling in the confounded nature of the correlation of initial-scores with change. We further argue that this confound will be present for both individual-level and group-level inference. We then focus on the difficulties that can arise from ceiling effects, even when initial-scores are not being correlated with change/ recovery. We conclude by emphasizing the need for new techniques to analyse recovery after stroke that are not confounded in the ways highlighted here.
- Published
- 2021
37. Generative lesion pattern decomposition of cognitive impairment after stroke
- Author
-
J. Matthijs Biesbroek, Jae-Sung Lim, Anna K. Bonkhoff, Hee-Joon Bae, Nick A. Weaver, Hugo J. Kuijf, Danilo Bzdok, and Natalia S. Rost
- Subjects
0301 basic medicine ,Hippocampus ,clinical outcome prediction ,Lateralization of brain function ,Angular gyrus ,Lesion ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,0302 clinical medicine ,Gyrus ,0502 economics and business ,Medicine ,050207 economics ,Stroke ,Biological Psychiatry ,ischaemic stroke ,050208 finance ,Postcentral gyrus ,AcademicSubjects/SCI01870 ,business.industry ,05 social sciences ,hemisphere-aware analysis ,Cognition ,medicine.disease ,Psychiatry and Mental health ,machine learning ,030104 developmental biology ,medicine.anatomical_structure ,Neurology ,Cerebral hemisphere ,Bayesian hierarchical modelling ,Original Article ,AcademicSubjects/MED00310 ,medicine.symptom ,business ,Neuroscience ,Cognitive load ,030217 neurology & neurosurgery - Abstract
Cognitive impairment is a frequent and disabling sequela of stroke. There is however incomplete understanding of how lesion topographies in the left and right cerebral hemisphere brain interact to cause distinct cognitive deficits. We integrated machine learning and Bayesian hierarchical modelling to enable a hemisphere-aware analysis of 1080 acute ischaemic stroke patients with deep profiling ∼3 months after stroke. We show the relevance of the left hemisphere in the prediction of language and memory assessments and relevance of the right hemisphere in the prediction of visuospatial functioning. Global cognitive impairments were equally well predicted by lesion topographies from both sides. Damage to the hippocampal and occipital regions on the left was particularly informative about lost naming and memory functions, while damage to these regions on the right was linked to lost visuospatial functioning. Global cognitive impairment was predominantly linked to lesioned tissue in the supramarginal and angular gyrus, the post-central gyrus as well as the lateral occipital and opercular cortices of the left hemisphere. Hence, our analysis strategy uncovered that lesion patterns with unique hemispheric distributions are characteristic of how cognitive capacity is lost due to ischaemic brain tissue damage., Bonkhoff et al. integrate machine learning and Bayesian hierarchical modelling to enable hemisphere-aware analysis of 1080 stroke patients. They quantify lateralization effects of cortical and subcortical regions, such as the pallidum and hippocampus, of middle and posterior cerebral artery vascular territories to the left for naming/memory and to the right for visuospatial functions., Graphical Abstract Graphical Abstract
- Published
- 2021
38. Individualized Spatial Network Predictions Using Siamese Convolutional Neural Networks: A Resting-State fMRI Study of over 11,000 Unaffected Individuals
- Author
-
Zening Fu, Vince D. Calhoun, Rogers F. Silva, Yuhui Du, Anees Abrol, Bradley T. Baker, Thomas P. DeRamus, Reihaneh Hassanzadeh, Anna K. Bonkhoff, Eswar Damaraju, and Mustafa Salman
- Subjects
education.field_of_study ,Resting state fMRI ,medicine.diagnostic_test ,Artificial neural network ,business.industry ,Computer science ,Population ,Pattern recognition ,Convolutional neural network ,Spatial network ,Discriminative model ,medicine ,Spatial variability ,Artificial intelligence ,business ,education ,Functional magnetic resonance imaging - Abstract
Individuals can be characterized in a population according to their brain measurements and activity, given the inter-subject variability in brain anatomy, structure-function relationships, or life experience. Many neuroimaging studies have demonstrated the potential of functional network connectivity patterns estimated from resting functional magnetic resonance imaging (fMRI) to discriminate groups and predict information about individual subjects. However, the predictive signal present in the spatial heterogeneity of brain connectivity networks is yet to be extensively studied. In this study, we investigate, for the first time, the use of pairwise-relationships between resting-state independentspatial mapsto characterize individuals. To do this, we develop a deep Siamese framework comprising three-dimensional convolution neural networks for contrastive learning based on individual-level spatial maps estimated via a fully automated fMRI independent component analysis approach. The proposed framework evaluates whether pairs of spatial networks (e.g., visual network and auditory network) are capable of subject identification and assesses the spatial variability in different network pairs’ predictive power in an extensive whole-brain analysis. Our analysis on nearly 12,000 unaffected individuals from the UK Biobank study demonstrates that the proposed approach can discriminate subjects with an accuracy of up to 88% for a single network pair on the test set (best model, after several runs), and 82% average accuracy at the subcortical domain level, notably the highest average domain level accuracy attained. Further investigation of our network’s learned features revealed a higher spatial variability in predictive accuracy among younger brains and significantly higher discriminative power among males. In sum, the relationship among spatial networks appears to be both informative and discriminative of individuals and should be studied further as putative brain-based biomarkers.
- Published
- 2021
39. Precision medicine in stroke: towards personalized outcome predictions using artificial intelligence
- Author
-
Anna K Bonkhoff and Christian Grefkes
- Subjects
Machine Learning ,Stroke ,Artificial Intelligence ,Humans ,ddc:610 ,Neurology (clinical) ,Precision Medicine ,Prognosis - Abstract
Stroke ranks among the leading causes for morbidity and mortality worldwide. New and continuously improving treatment options such as thrombolysis and thrombectomy have revolutionized acute stroke treatment in recent years. Following modern rhythms, the next revolution might well be the strategic use of the steadily increasing amounts of patient-related data for generating models enabling individualized outcome predictions. Milestones have already been achieved in several health care domains, as big data and artificial intelligence have entered everyday life. The aim of this review is to synoptically illustrate and discuss how artificial intelligence approaches may help to compute single-patient predictions in stroke outcome research in the acute, subacute and chronic stage. We will present approaches considering demographic, clinical and electrophysiological data, as well as data originating from various imaging modalities and combinations thereof. We will outline their advantages, disadvantages, their potential pitfalls and the promises they hold with a special focus on a clinical audience. Throughout the review we will highlight methodological aspects of novel machine-learning approaches as they are particularly crucial to realize precision medicine. We will finally provide an outlook on how artificial intelligence approaches might contribute to enhancing favourable outcomes after stroke.
- Published
- 2021
40. Abstract P317: White Matter Hyperintensity Lesion Burden Modulates Functional Outcome After Acute Ischemic Stroke
- Author
-
Katy Donahue, Martin Bretzner, Polina Golland, Marco Nardin, Arne Lindgren, Christina Jern, Adrian V. Dalca, Anna K. Bonkhoff, Giscome Investigators, Natalia S. Rost, Mark R Etherton, Sungmin Hong, Markus D. Schirmer, Ona Wu, Anne-Katrin Giese, and Jane Maguire
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Disease ,Lesion ,White matter hyperintensity ,Internal medicine ,Ischemic stroke ,Cardiology ,Medicine ,Neurology (clinical) ,Small vessel ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Acute ischemic stroke - Abstract
Introduction: As a radiographic signature of end-stage small vessel disease, white matter hyperintensity (WMH) burden impacts recovery and outcomes after acute ischemic stroke (AIS). In this study, we sought to investigate the effect of WMH volume (WMHv) on stroke severity and functional outcomes independent of the infarct size and topography. Methods: We analyzed 503 AIS patients with MRI data obtained on admission for index stroke enrolled in the multi-center MRI-GENIE study (cohort 1), followed by validation of the findings in an independent single-site study of 555 AIS patients (cohort 2). Stroke severity (NIHSS score) at index stroke and the long-term outcome (3-6 months mRS score) were modeled via Bayesian linear regression. Models included WMHv, age, sex, a 10-dimensional spatial ischemic lesion representation, acute infarct (DWI) volume, and common vascular risk factors (hypertension, diabetes mellitus, atrial fibrillation, coronary artery disease). Results: Cohorts did not differ significantly in major clinical characteristics [cohort 1: age: 65.0±14.6, 41% female, NIHSS: 5.5±5.4, mRS: 1(iqr 2); cohort 2: age: 65.0±14.8, 38% female, NIHSS: 5.0±6.0, mRS: 1(iqr 3), p >0.05 for all comparisons]. WMHv did not substantially affect AIS severity ( Fig A ); in contrast, it emerged as an independent predictor of functional outcome in both datasets ( Fig B ). Conclusions: When accounted for AIS lesion topography and stroke volume, total WMH lesion burden did not appear to modulate initial stroke severity but was associated with worse functional post-stroke outcomes. Future studies are needed to explore potential origins of these detrimental effects of pre-existing WMH burden on recovery after AIS.
- Published
- 2021
41. Abstract P323: Stroke Lesion Pattern-Specific Influence of White Matter Hyperintensities on Stroke Severity in Acute Ischemic Stroke
- Author
-
Katy Donahue, Christina Jern, Natalia S. Rost, Anna K. Bonkhoff, Anne-Katrin Giese, Polina Golland, Sungmin Hong, Markus D. Schirmer, Adrian V. Dalca, Jane Maguire, Ona Wu, Marco Nardin, Mark R Etherton, Martin Bretzner, and Arne Lindgren
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Stroke severity ,medicine.disease ,behavioral disciplines and activities ,Hyperintensity ,Lesion ,White matter hyperintensity ,Internal medicine ,Ischemic stroke ,medicine ,Cardiology ,Neurology (clinical) ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Acute ischemic stroke ,Acute stroke - Abstract
Introduction: MRI-detected white matter hyperintensity (WMH) burden is linked to the overall brain health and incident stroke outcomes. However, data are limited as to whether specific acute stroke lesion patterns purport greater stroke severity in patients with extensive pre-existing WMH. In this analysis, we sought to investigate lesion pattern-specific WMH effects on AIS severity. Methods: We analyzed clinical and lesion data from 621 AIS patients enrolled in the multi-site MRI-GENIE study. The acute NIHSS was modelled via Bayesian hierarchical regression. Using ten stroke lesion patterns, that served as input variables of main interest, we introduced a hierarchical level differentiating between patients with higher and lower than median WMH volume (WMHv). Lesion pattern posterior distributions for higher and lower WMHv patients were subtracted to infer substantial differences. Results: In this AIS cohort [age: 65.3±14.6, 60% male], a higher WMHv was associated with greater stroke severity only when specific left-hemispheric brain regions were infarcted. This “lesion pattern 3” was mainly characterized by left middle and inferior frontal gyrus, insular and opercular cortex, pre- and post-central gyrus, and subcortical basal ganglia regions ( Fig ). Conclusions: Higher WMH burden appears to enhance the detrimental effect of acute stroke lesions involving left-hemispheric brain regions underlying language and motor functions. This effect might be due to an exacerbated disruption of functional network integrity by the combination of WMH and stroke lesions and could be explored further in functional imaging studies that simultaneously considered information from both lesion types.
- Published
- 2021
42. Abstract MP16: Excessive White Matter Hyperintensity Burden and Functional Outcomes After Acute Ischemic Stroke
- Author
-
Martin Bretzner, Arne Lindgren, Adrian V. Dalca, Anne-Katrin Giese, Anna K. Bonkhoff, Christina Jern, Kathleen Donahue, Sungmin Hong, Markus D. Schirmer, Natalia S. Rost, and Jane Maguire
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,White matter hyperintensity ,business.industry ,Internal medicine ,Cardiology ,medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Stroke ,Acute ischemic stroke - Abstract
Objective: Ability of the brain to recover after an acute ischemic stroke (AIS) is linked to the pre-stroke burden of white matter hyperintensity (WMH), a radiographic marker of brain health. We sought to determine the excessive WMH burden in an AIS population and investigate its association with 3-month stroke outcomes. Data: We used 2,435 subjects from the MRI-GENIE study. Three-month functional outcomes of 872 subjects among those subjects were measured by 90-day modified Ranking Scale (mRS). Methods: We automatically quantified WMH volume (WMHv) on FLAIR images and adjusted for a brain volume. We modeled a trend using the factor analysis (FA) log-linear regression using age, sex, atrial fibrillation, diabetes, hypertension, coronary artery disease and smoking as input variables. We categorized three WMH burden groups based on the conditional probability given by the model (LOW: lower 33%, MED: middle 34%, and HIGH: upper 33%). The subgroups were compared with respect to mRS (median and dichotomized odds ratio (OR) (good/poor: mRS 0-2/3-6)). Results: Five FA components out of seven with significant relationship to WMHv (p2 =0.359). The HIGH group showed higher median (median=2, IQR=2) mRS score than LOW (median=1, IQR=1) and MED (median=1, IQR=1). The odds (OR) of good AIS outcome for LOW and MED were 1.8 (p=0.0001) and 1.6 (p=0.006) times higher than HIGH, respectively. Conclusion: Once accounted for clinical covariates, the excessive WMHv was associated with worse 3-month stroke outcomes. These data suggest that a life-time of injury to the white matter reflected in WMH is an important factor for stroke recovery and an indicator of the brain health.
- Published
- 2021
43. Abstract P474: Functional Outcomes and Regional Significance of Ischemic Lesions After Thrombectomy for Large Vessel Occlusion Stroke
- Author
-
Thabele M Leslie-Mazwi, Anna K. Bonkhoff, Martin Bretzner, Christopher J Stapleton, Justin E Vranic, Mark R Etherton, Aman B. Patel, Naif M. Alotaibi, Alvin S. Das, Robert W. Regenhardt, and Natalia S. Rost
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Infarction ,Magnetic resonance imaging ,Stroke care ,medicine.disease ,Endovascular therapy ,Internal medicine ,Ischemic stroke ,Cardiology ,medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Large vessel occlusion - Abstract
Introduction: Endovascular thrombectomy (EVT) has revolutionized large vessel occlusion (LVO) stroke care. However, over half remain functionally disabled or die despite treatment. Understanding outcomes may influence EVT selection, novel therapies, and prognostication. We sought to identify associations between outcomes and brain regions involved in ischemic lesions. Methods: For consecutive LVO patients with post-EVT MRI, acute ischemic lesions were manually segmented from DWI and spatially normalized. Individual lesion volumes were automatically parcellated (atlas-defined 94 cortical regions, 14 subcortical nuclei, 20 white matter tracts) and then reduced to ten anatomically plausible lesion patterns using unsupervised dimensionality reduction techniques. Ninety-day modified Rankin Scale (mRS) was modeled via Bayesian regression, taking the ten lesion patterns as inputs and controlling for lesion size, age, sex, acute NIH Stroke Scale, alteplase, and TICI 2b-3 reperfusion. Results: We identified 153 LVO patients with mean age 68±15 years and 51% female. Median NIHSS was 16 (IQR 13-20), 56% received alteplase, and 84% achieved TICI2b-3. The lesion patterns predictive of 90-day mRS involved bilateral subcortical nuclei, pre- and postcentral gyri, insular and opercular cortex, as well as left-sided inferior frontal and angular gyri ( Figure 1A ). Lesions affecting white matter tracts had the highest relevance predicting 90-day mRS ( Figure 1B ). Conclusions: These data describe the significance for outcomes of specific brain regions involved in ischemic lesions on MRI after EVT. Future work in additional datasets is needed to confirm these granular findings.
- Published
- 2021
44. Abstract P613: Genetic Risk of Vascular Risk Factors and Severity of Leukoaraiosis in Patients With Ischemic Stroke: The MRI-GENIE Study
- Author
-
Natalia S. Rost, Martin Bretzner, Steven J. Kittner, Kathleen A. Ryan, Markus D. Schirmer, Kathleen Donahue, Anne-Katrin Giese, Anna K. Bonkhoff, Patrick F. McArdle, Huichun Xu, Braxton D. Mitchell, and Brady Gaynor
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Leukoaraiosis ,Magnetic resonance imaging ,Vascular risk ,Hyperintensity ,Blood pressure ,Internal medicine ,Ischemic stroke ,medicine ,Cardiology ,In patient ,Neurology (clinical) ,Genetic risk ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Severity of leukoaraiosis detected on T2 MRI scans as white matter hyperintensities (WMH) is associated with infarct growth and poor poststroke outcomes in patients with acute ischemic stroke (AIS). Traditional vascular risk factors (VRF) such as age, hypertension (HTN), type 2 diabetes mellitus (T2D), and cigarette smoking are linked to WMH in large population-based studies, yet casual inferences for WMH in AIS patients are limited. We sought to examine the VRFs for evidence of causal relationships with WMH burden in AIS patients using mendelian randomization principles and polygenic risk score (PRS) methods. Method: We examined FLAIR MRIs obtained within 48 hours of AIS onset in 4,362 European Caucasian patients from the MRI-GENetics Interface Exploration (MRI-GENIE) study. WMH volume (WMHv) was measured using a fully automated deep-learning trained algorithm. We considered 13 VRFs: blood pressure (HTN, SBP, DBP, Pulse Pressure), lipid (total cholesterol, HDL, LDL, TG), BMI, T2D, atrial fibrillation, alcohol use and smoking. For each factor, we calculated a weighted PRS for each individual based on the most recent GWAS with various GWAS p-value cutoff. We then used linear regression to estimate associations between each PRS and log transformed WMHv, controlling for age, gender and principal components of genetic ancestries. Strata-specific estimates were combined using inverse-variance weighting based meta-analysis. Results: PRS of both SBP and DBP were positively and robustly associated with WMHv in the meta-analysis (p value of the association ranging from Conclusion: Using mendelian randomization, our results lend further evidence that high blood pressure is a causal risk factor for WMH in AIS patients. This result is consistent with previous epidemiological studies of leukoaraiosis in stroke-free populations, and it supports universal control of HTN as common contributor to WMH burden and the overall brain health.
- Published
- 2021
45. Abstract 10: Radiomic Signature of the White Matter Hyperintensity Burden Correlates With Clinical Phenotypes
- Author
-
Anne-Katrin Giese, Anna K. Bonkhoff, Marco Nardin, Natalia S. Rost, Grégory Kuchcinski, Adrian V. Dalca, Markus D. Schirmer, Sungmin Hong, Xavier Leclerc, Martin Bretzner, Kathleen L. Donahue, and Mark R Etherton
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,White matter hyperintensity ,business.industry ,Parenchyma ,Ischemic stroke ,medicine ,Structural integrity ,Neurology (clinical) ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,behavioral disciplines and activities - Abstract
Introduction: Structural integrity of cerebral parenchyma is an essential radiographic equivalent of brain health; but its assessment usually requires dedicated advanced image acquisitions. Radiomics analyses bear the potential to describe radiophenotypes beyond what meets the naked eye. We sought to: 1) evaluate this novel approach to predict white matter hyperintensity (WMH) burden and 2) uncover latent clinico-radiological associations. Methods: An international, multi-site cohort of 4,164 acute ischemic stroke (AIS) patients with FLAIR MRI (MRI-GENIE study) underwent total brain and WMH lesion segmentation using convolutional neural networks. Radiomic features (n=1905) were extracted from clinical FLAIR images outside of the WMH (brain mask - WMH mask). Prediction of the WMH burden using radiomics was done using LASSO regression. Radiomic signature of WMH was built with the most stable selected features, then compared to the clinical variables using canonical correlation analysis. Results: In this cohort, (mean age=62.8±15.0, median WMH volume=4.2cc IQR 1.4-11.2), radiomic features were highly predictive of WMH burden (R2=0.8±0.012). Radiomic signature of WMH included 68 features. All 7 pairs of extracted canonical variates (CV) were statistically significant with respective canonical correlations of 0.79, 0.64, 0.44, 0.21, 0.16, 0.15 (Bonferroni corrected p-values CV1-6 CV7 =.003). Upon examination, CV1 was mainly influenced by age, CV2 by sex, CV3 by history of smoking and diabetes mellitus (DM), CV4 by hypertension, CV5 by atrial fibrillation (AF) and DM, CV6 by coronary artery disease (CAD) and CV7 by CAD and DM. Conclusion: Radiomics extracted from clinical grade FLAIR images of AIS patients seem able to capture structural integrity of the cerebral parenchyma and to correlate with clinical phenotypes. Further research could evaluate radiomics to predict the progression of cerebral small vessel disease on longitudinal data.
- Published
- 2021
46. Dynamic connectivity predicts acute motor impairment and recovery post-stroke
- Author
-
Harshvardhan Gazula, Natalia S. Rost, C. Grefkes, Caroline Tscherpel, Anne Kathrin Rehme, Gereon R. Fink, Vince D. Calhoun, Lukas Hensel, Anna K. Bonkhoff, Flor A. Espinoza, Lukas J. Volz, and Victor M. Vergara
- Subjects
dynamic functional network connectivity ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,AcademicSubjects/SCI01870 ,Putamen ,medicine.medical_treatment ,Functional connectivity ,precision medicine ,recovery post-stroke ,General Engineering ,Area under the curve ,Motor impairment ,Confidence interval ,upper limb motor impairment ,Physical medicine and rehabilitation ,Post stroke ,ischemic stroke ,Medicine ,Original Article ,AcademicSubjects/MED00310 ,ddc:610 ,business ,Functional magnetic resonance imaging ,Stroke recovery - Abstract
Thorough assessment of cerebral dysfunction after acute lesions is paramount to optimize predicting clinical outcomes. We here built random forest classifier-based prediction models of acute motor impairment and recovery post-stroke. Predictions relied on structural and resting-state fMRI data from 54 stroke patients scanned within the first days of symptom onset. Functional connectivity was estimated via static and dynamic approaches. Motor performance was phenotyped in the acute phase and 6 months later. A model based on the time spent in specific dynamic connectivity configurations achieved the best discrimination between patients with and without motor impairments (out-of-sample area under the curve, 95% confidence interval: 0.67 ± 0.01). In contrast, patients with moderate-to-severe impairments could be differentiated from patients with mild deficits using a model based on the variability of dynamic connectivity (0.83 ± 0.01). Here, the variability of the connectivity between ipsilesional sensorimotor cortex and putamen discriminated the most between patients. Finally, motor recovery was best predicted by the time spent in specific connectivity configurations (0.89 ± 0.01) in combination with the initial impairment. Here, better recovery was linked to a shorter time spent in a functionally integrated configuration. Dynamic connectivity-derived parameters constitute potent predictors of acute impairment and recovery, which, in the future, might inform personalized therapy regimens to promote stroke recovery., Bonkhoff et al. report the prediction of acute motor impairments and recovery in the first six months post-stroke based on dynamic connectivity information of 54 acute stroke patients. The time spent in specific connectivity configurations and the variability of dynamic connectivity involving the putamen contributed most to prediction performance., Graphical Abstract Graphical Abstract
- Published
- 2021
47. MRI Radiomic Signature of White Matter Hyperintensities Is Associated with Clinical Phenotypes
- Author
-
Tara M. Stanne, Polina Golland, Sungmin Hong, J. Roquer, Johan Wassélius, James F. Meschia, Pankaj Sharma, Xavier Leclerc, Tatjana Rundek, Bradford B. Worrall, Razvan Marinescu, Ona Wu, Anne-Katrin Giese, Marco Nardin, Amanda Donatti, Ramin Zand, Christina Jern, Agnieszka Slowik, Achala Vagal, Mark R Etherton, Anna K. Bonkhoff, Reinhold Schmidt, Lukas Holmegaard, Jordi Jimenez-Conde, Caitrin W. McDonough, Kathleen L. Donahue, John W. Cole, Arne Lindgren, Robin Lemmens, Martin Bretzner, Vincent Thijs, Oscar R. Benavente, Ralph L. Sacco, Pamela M. Rist, Arndt Rolfs, Jonathan Rosand, Christopher Levi, Patrick F. McArdle, Katarina Jood, Laura Heitsch, Chia-Ling Phuah, Jane Maguire, Steven J. Kittner, Robert W. Regenhardt, Natalia S. Rost, Christoph J. Griessenauer, Grégory Kuchcinski, Markus D. Schirmer, Adrian V. Dalca, Daniel Strbian, Clinton Wang, Renaud Lopes, Alessandro Sousa, Daniel Woo, Stefan Ropele, and Turgut Tatlisumak
- Subjects
medicine.medical_specialty ,business.industry ,Context (language use) ,Disease ,computer.software_genre ,medicine.disease ,Hyperintensity ,Neuroimaging ,Voxel ,Region of interest ,Medicine ,Radiology ,business ,computer ,Stroke ,Diffusion MRI - Abstract
IntroductionNeuroimaging measurements of brain structural integrity are thought to be surrogates for brain health, but precise assessments require dedicated advanced image acquisitions. By means of describing the texture of conventional images beyond what meets the naked eye, radiomic analyses hold potential for evaluating brain health. We sought to: 1) evaluate this novel approach to assess brain structural integrity by predicting white matter hyperintensities burdens (WMH) and 2) uncover associations between predictive radiomic features and patients’ clinical phenotypes.MethodsOur analyses were based on a multi-site cohort of 4,163 acute ischemic strokes (AIS) patients with T2-FLAIR MR images and corresponding deep-learning-generated total brain and WMH segmentation. Radiomic features were extracted from normal-appearing brain tissue (brain mask–WMH mask). Radiomics-based prediction of personalized WMH burden was done using ElasticNet linear regression. We built a radiomic signature of WMH with the most stable selected features predictive of WMH burden and then related this signature to clinical variables (age, sex, hypertension (HTN), atrial fibrillation (AF), diabetes mellitus (DM), coronary artery disease (CAD), and history of smoking) using canonical correlation analysis.ResultsRadiomic features were highly predictive of WMH burden (R2=0.855±0.011). Seven pairs of canonical variates (CV) significantly correlated the radiomics signature of WMH and clinical traits with respective canonical correlations of 0.81, 0.65, 0.42, 0.24, 0.20, 0.15, and 0.15 (FDR-corrected p-valuesCV1-6CV7=.012). The clinical CV1 was mainly influenced by age, CV2 by sex, CV3 by history of smoking and DM, CV4 by HTN, CV5 by AF and DM, CV6 by CAD, and CV7 by CAD and DM.ConclusionRadiomics extracted from T2-FLAIR images of AIS patients capture microstructural damage of the cerebral parenchyma and correlate with clinical phenotypes. Further research could evaluate radiomics to predict the progression of WMH.Research in contextEvidence before this studyWe did a systematic review on PubMed until December 1, 2020, for original articles and reviews in which radiomics were used to characterize stroke or cerebrovascular diseases. Radiomic analyses cover a broad ensemble of high-throughput quantification methods applicable to digitalized medical images that extract high-dimensional data by describing a given region of interest by its size, shape, histogram, and relationship between voxels. We used the search terms “radiomics” or “texture analysis”, and “stroke”, “cerebrovascular disease”, “small vessel disease”, or “white matter hyperintensities”. Our research identified 24 studies, 18 studying radiomics of stroke lesions and 6 studying cerebrovascular diseases. All the latter six studies were based on MRI (T1-FLAIR, dynamic contrast-enhanced imaging, T1 & T2-FLAIR, T2-FLAIR post-contrast, T2-FLAIR, and T2-TSE images). Four studies were describing small vessel disease, and two were predicting longitudinal progression of WMH. The average sample size was small with 96 patients included (maximum: 204). One study on 141 patients identified 7 T1-FLAIR radiomic features correlated with cardiovascular risk factors (age and hyperlipidemia) using univariate correlations. All studies were monocentric and performed on a single MRI scanner.Added value of this studyTo date and to the best of our knowledge, this is the largest radiomics study performed on cerebrovascular disease or any topic, and one of the very few to include a great diversity of participating sites with diverse clinical MRI scanners. This study is the first one to establish a radiomic signature of WMH and to interpret its relationship with common cardiovascular risk factors. Our findings add to the body of evidence that damage caused by small vessel disease extend beyond the visible white matter hyperintensities, but the added value resides in the detection of that subvisible damage on routinely acquired T2-FLAIR imaging. It also suggests that cardiovascular phenotypes might manifest in distinct textural patterns detectable on conventional clinical-grade T2-FLAIR images.Implications of all the available evidenceAssessing brain structural integrity has implications for treatment selection, follow-up, prognosis, and recovery prediction in stroke patients but also other neurological disease populations. Measuring cerebral parenchymal structural integrity usually requires advanced imaging such as diffusion tensor imaging or functional MRI. Translation of those neuroimaging biomarkers remains uncommon in clinical practice mainly because of their time-consuming and costly acquisition. Our study provides a potential novel solution to assess brains’ structural integrity applicable to standard, routinely acquired T2-FLAIR imaging.Future research could, for instance, benchmark this radiomics approach against diffusion or functional MRI metrics in the prediction of cognitive or functional outcomes after stroke.
- Published
- 2021
48. Female Stroke: Sex Differences in Acute Treatment and Early Outcomes of Acute Ischemic Stroke
- Author
-
André Karch, Klaus Berger, Jürgen Wellmann, Anna K. Bonkhoff, and Ralph Weber
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Stroke severity ,Logistic regression ,Internal medicine ,Germany ,Medicine ,Humans ,Acute ischemic stroke ,Stroke ,Aged ,Ischemic Stroke ,Advanced and Specialized Nursing ,Aged, 80 and over ,Sex Characteristics ,business.industry ,Thrombolysis ,Odds ratio ,Middle Aged ,medicine.disease ,Comorbidity ,Treatment Outcome ,Sample size determination ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and Purpose: Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry. Methods: Analyses were based on the Stroke Registry of Northwestern Germany from 2000 to 2018. We focused on admission-stroke severity and disability, acute recanalization treatment, and early stroke outcomes. Potential sex divergences were investigated via odds ratio (OR) using logistic regression models. Covariates were introduced in 3 steps: (1) base models (age and admission year), (2) partially adjusted models (additionally corrected for acute stroke severity and recanalization treatment), (3) fully adjusted models (additionally adjusted for onset-to-admission time interval, prestroke functional status, comorbidities, and stroke cause). Models were separately fitted for the periods 2000 to 2009 and 2010 to 2018. Results: Data from 761 106 patients with AIS were included. In fully adjusted models, there were no sex differences with respect to treatment with intravenous thrombolysis (2000–2009: OR, 0.99 [95% CI, 0.94–1.03]; 2010–2018: OR, 1.0 [0.98–1.02]), but women were more likely to receive intraarterial therapy (2010–2018: OR, 1.12 [1.08–1.15]). Despite higher disability on admission (2000–2009: OR, 1.10 [1.07–1.13]; 2010–2018: OR, 1.09 [1.07–1.10]), female patients were more likely to be discharged with a favorable functional outcome (2003–2009: OR, 1.05 [1.02–1.09]; 2010–2018: OR, 1.05 [1.04–1.07]) and experienced lower in-hospital mortality (2000–2009: OR, 0.92 [0.86–0.97]; 2010–2018: OR, 0.91 [0.88–0.93]). Conclusions: Female patients with AIS have a higher chance of receiving intraarterial treatment that cannot be explained by clinical characteristics, such as age, premorbid disability, stroke severity, or cause. Women have a more favorable in-hospital recovery than men because their higher disability upon admission was followed by a lower in-hospital mortality and a higher likelihood of favorable functional outcome at discharge after adjustment for covariates.
- Published
- 2021
49. Abnormal dynamic functional connectivity is linked to recovery after acute ischemic stroke
- Author
-
Anne-Katrin Giese, Kathleen Donahue, Natalia S. Rost, Marco Nardin, Vince D. Calhoun, Mark R Etherton, C. Grefkes, Carissa Tuozzo, Markus D. Schirmer, Martin Bretzner, Anna K. Bonkhoff, and Ona Wu
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Stroke severity ,stroke recovery ,diagnosis [Ischemic Stroke] ,Severity of Illness Index ,050105 experimental psychology ,Correlation ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Outcome Assessment, Health Care ,Connectome ,ischemic stroke ,Medicine ,Bayesian hierarchical modeling ,Humans ,0501 psychology and cognitive sciences ,Radiology, Nuclear Medicine and imaging ,ddc:610 ,Acute ischemic stroke ,Default mode network ,Research Articles ,Dynamic functional connectivity ,Aged ,diagnostic imaging [Ischemic Stroke] ,dynamic functional network connectivity ,Radiological and Ultrasound Technology ,business.industry ,physiopathology [Ischemic Stroke] ,05 social sciences ,stroke severity ,Recovery of Function ,therapy [Ischemic Stroke] ,Middle Aged ,Magnetic Resonance Imaging ,Neurology ,physiology [Recovery of Function] ,Female ,Neurology (clinical) ,Analysis of variance ,Anatomy ,business ,Stroke recovery ,030217 neurology & neurosurgery ,Research Article - Abstract
The aim of the current study was to explore the whole‐brain dynamic functional connectivity patterns in acute ischemic stroke (AIS) patients and their relation to short and long‐term stroke severity. We investigated resting‐state functional MRI‐based dynamic functional connectivity of 41 AIS patients two to five days after symptom onset. Re‐occurring dynamic connectivity configurations were obtained using a sliding window approach and k‐means clustering. We evaluated differences in dynamic patterns between three NIHSS‐stroke severity defined groups (mildly, moderately, and severely affected patients). Furthermore, we built Bayesian hierarchical models to evaluate the predictive capacity of dynamic connectivity and examine the interrelation with clinical measures, such as white matter hyperintensity lesions. Finally, we established correlation analyses between dynamic connectivity and AIS severity as well as 90‐day neurological recovery (ΔNIHSS). We identified three distinct dynamic connectivity configurations acutely post‐stroke. More severely affected patients spent significantly more time in a configuration that was characterized by particularly strong connectivity and isolated processing of functional brain domains (three‐level ANOVA: p, By employing dynamic functional connectivity analyses, Bonkhoff et al. demonstrate that severe acute ischemic stroke is linked to transiently increased isolated information processing in multiple functional domains. Additionally, they show that dynamic connectivity involving default mode network components significantly correlates with recovery in the first three months poststroke.
- Published
- 2021
50. Radiomic Signature of White Matter Hyperintensities Is Associated With Clinical Phenotypes
- Author
-
Martin Bretzner, Anna K. Bonkhoff, Markus D. Schirmer, Sungmin Hong, Adrian V. Dalca, Kathleen L. Donahue, Anne-Katrin Giese, Mark R. Etherton, Marco Nardin, Razvan Marinescu, Clinton Wang, Robert W. Regenhardt, Xavier Leclerc, Renaud Lopes, Oscar R. Benavente, John W. Cole, Amanda Donatti, Christoph J. Griessenauer, Laura Heitsch, Lukas Holmegaard, Katarina Jood, Jordi Jimenez-Conde, Steven J. Kittner, Robin Lemmens, Christopher R. Levi, Patrick D. McArdle, Caitrin W. McDonough, James F. Meschia, Chia-Ling Phuah, Arndt Rolfs, Stefan Ropele, Jonathan Rosand, Jaume Roquer, Tatjana Rundek, Ralph L. Sacco, Reinhold Schmidt, Pankaj Sharma, Agnieszka Slowik, Alessandro Sousa, Tara M. Stanne, Daniel Strebian, Turgut Tatlisumak, Vincent Thijs, Achala Vagal, Johan Wasselius, Daniel Woo, Ona Wu, Ramin Zand, Bradford B. Worrall, Jane Maguire, Arne Lindgren, Christina Jern, Polina Golland, Grégory Kuchcinski, Natalia S. Rost, MRI-GENIE and GISCOME Investigators, and International Stroke Genetics Consortium
- Published
- 2021
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.