Search

Your search keyword '"Wegener, Susanne"' showing total 729 results
Start Over Author "Wegener, Susanne"
729 results on '"Wegener, Susanne"'

1. ISLES 2024: The first longitudinal multimodal multi-center real-world dataset in (sub-)acute stroke

Author

Riedel, Evamaria O., de la Rosa, Ezequiel, Baran, The Anh, Petzsche, Moritz Hernandez, Baazaoui, Hakim, Yang, Kaiyuan, Robben, David, Seia, Joaquin Oscar, Wiest, Roland, Reyes, Mauricio, Su, Ruisheng, Zimmer, Claus, Boeckh-Behrens, Tobias, Berndt, Maria, Menze, Bjoern, Wiestler, Benedikt, Wegener, Susanne, and Kirschke, Jan S.

Subjects
Computer Science - Computer Vision and Pattern Recognition
Abstract

Stroke remains a leading cause of global morbidity and mortality, placing a heavy socioeconomic burden. Over the past decade, advances in endovascular reperfusion therapy and the use of CT and MRI imaging for treatment guidance have significantly improved patient outcomes and are now standard in clinical practice. To develop machine learning algorithms that can extract meaningful and reproducible models of brain function for both clinical and research purposes from stroke images - particularly for lesion identification, brain health quantification, and prognosis - large, diverse, and well-annotated public datasets are essential. While only a few datasets with (sub-)acute stroke data were previously available, several large, high-quality datasets have recently been made publicly accessible. However, these existing datasets include only MRI data. In contrast, our dataset is the first to offer comprehensive longitudinal stroke data, including acute CT imaging with angiography and perfusion, follow-up MRI at 2-9 days, as well as acute and longitudinal clinical data up to a three-month outcome. The dataset includes a training dataset of n = 150 and a test dataset of n = 100 scans. Training data is publicly available, while test data will be used exclusively for model validation. We are making this dataset available as part of the 2024 edition of the Ischemic Stroke Lesion Segmentation (ISLES) challenge (https://www.isles-challenge.org/), which continuously aims to establish benchmark methods for acute and sub-acute ischemic stroke lesion segmentation, aiding in creating open stroke imaging datasets and evaluating cutting-edge image processing algorithms.

Published
2024

2. ISLES'24: Improving final infarct prediction in ischemic stroke using multimodal imaging and clinical data

Author

de la Rosa, Ezequiel, Su, Ruisheng, Reyes, Mauricio, Wiest, Roland, Riedel, Evamaria O., Kofler, Florian, Yang, Kaiyuan, Baazaoui, Hakim, Robben, David, Wegener, Susanne, Kirschke, Jan S., Wiestler, Benedikt, and Menze, Bjoern

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition
Abstract

Accurate estimation of core (irreversibly damaged tissue) and penumbra (salvageable tissue) volumes is essential for ischemic stroke treatment decisions. Perfusion CT, the clinical standard, estimates these volumes but is affected by variations in deconvolution algorithms, implementations, and thresholds. Core tissue expands over time, with growth rates influenced by thrombus location, collateral circulation, and inherent patient-specific factors. Understanding this tissue growth is crucial for determining the need to transfer patients to comprehensive stroke centers, predicting the benefits of additional reperfusion attempts during mechanical thrombectomy, and forecasting final clinical outcomes. This work presents the ISLES'24 challenge, which addresses final post-treatment stroke infarct prediction from pre-interventional acute stroke imaging and clinical data. ISLES'24 establishes a unique 360-degree setting where all feasibly accessible clinical data are available for participants, including full CT acute stroke imaging, sub-acute follow-up MRI, and clinical tabular data. The contributions of this work are two-fold: first, we introduce a standardized benchmarking of final stroke infarct segmentation algorithms through the ISLES'24 challenge; second, we provide insights into infarct segmentation using multimodal imaging and clinical data strategies by identifying outperforming methods on a finely curated dataset. The outputs of this challenge are anticipated to enhance clinical decision-making and improve patient outcome predictions. All ISLES'24 materials, including data, performance evaluation scripts, and leading algorithmic strategies, are available to the research community following \url{https://isles-24.grand-challenge.org/}.

Published
2024

4. A Robust Ensemble Algorithm for Ischemic Stroke Lesion Segmentation: Generalizability and Clinical Utility Beyond the ISLES Challenge

Author

de la Rosa, Ezequiel, Reyes, Mauricio, Liew, Sook-Lei, Hutton, Alexandre, Wiest, Roland, Kaesmacher, Johannes, Hanning, Uta, Hakim, Arsany, Zubal, Richard, Valenzuela, Waldo, Robben, David, Sima, Diana M., Anania, Vincenzo, Brys, Arne, Meakin, James A., Mickan, Anne, Broocks, Gabriel, Heitkamp, Christian, Gao, Shengbo, Liang, Kongming, Zhang, Ziji, Siddiquee, Md Mahfuzur Rahman, Myronenko, Andriy, Ashtari, Pooya, Van Huffel, Sabine, Jeong, Hyun-su, Yoon, Chi-ho, Kim, Chulhong, Huo, Jiayu, Ourselin, Sebastien, Sparks, Rachel, Clèrigues, Albert, Oliver, Arnau, Lladó, Xavier, Chalcroft, Liam, Pappas, Ioannis, Bertels, Jeroen, Heylen, Ewout, Moreau, Juliette, Hatami, Nima, Frindel, Carole, Qayyum, Abdul, Mazher, Moona, Puig, Domenec, Lin, Shao-Chieh, Juan, Chun-Jung, Hu, Tianxi, Boone, Lyndon, Goubran, Maged, Liu, Yi-Jui, Wegener, Susanne, Kofler, Florian, Ezhov, Ivan, Shit, Suprosanna, Petzsche, Moritz R. Hernandez, Menze, Bjoern, Kirschke, Jan S., and Wiestler, Benedikt

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition
Abstract

Diffusion-weighted MRI (DWI) is essential for stroke diagnosis, treatment decisions, and prognosis. However, image and disease variability hinder the development of generalizable AI algorithms with clinical value. We address this gap by presenting a novel ensemble algorithm derived from the 2022 Ischemic Stroke Lesion Segmentation (ISLES) challenge. ISLES'22 provided 400 patient scans with ischemic stroke from various medical centers, facilitating the development of a wide range of cutting-edge segmentation algorithms by the research community. Through collaboration with leading teams, we combined top-performing algorithms into an ensemble model that overcomes the limitations of individual solutions. Our ensemble model achieved superior ischemic lesion detection and segmentation accuracy on our internal test set compared to individual algorithms. This accuracy generalized well across diverse image and disease variables. Furthermore, the model excelled in extracting clinical biomarkers. Notably, in a Turing-like test, neuroradiologists consistently preferred the algorithm's segmentations over manual expert efforts, highlighting increased comprehensiveness and precision. Validation using a real-world external dataset (N=1686) confirmed the model's generalizability. The algorithm's outputs also demonstrated strong correlations with clinical scores (admission NIHSS and 90-day mRS) on par with or exceeding expert-derived results, underlining its clinical relevance. This study offers two key findings. First, we present an ensemble algorithm (https://github.com/Tabrisrei/ISLES22_Ensemble) that detects and segments ischemic stroke lesions on DWI across diverse scenarios on par with expert (neuro)radiologists. Second, we show the potential for biomedical challenge outputs to extend beyond the challenge's initial objectives, demonstrating their real-world clinical applicability.

Published
2024

5. Benchmarking the CoW with the TopCoW Challenge: Topology-Aware Anatomical Segmentation of the Circle of Willis for CTA and MRA

Author

Yang, Kaiyuan, Musio, Fabio, Ma, Yihui, Juchler, Norman, Paetzold, Johannes C., Al-Maskari, Rami, Höher, Luciano, Li, Hongwei Bran, Hamamci, Ibrahim Ethem, Sekuboyina, Anjany, Shit, Suprosanna, Huang, Houjing, Prabhakar, Chinmay, de la Rosa, Ezequiel, Waldmannstetter, Diana, Kofler, Florian, Navarro, Fernando, Menten, Martin, Ezhov, Ivan, Rueckert, Daniel, Vos, Iris, Ruigrok, Ynte, Velthuis, Birgitta, Kuijf, Hugo, Hämmerli, Julien, Wurster, Catherine, Bijlenga, Philippe, Westphal, Laura, Bisschop, Jeroen, Colombo, Elisa, Baazaoui, Hakim, Makmur, Andrew, Hallinan, James, Wiestler, Bene, Kirschke, Jan S., Wiest, Roland, Montagnon, Emmanuel, Letourneau-Guillon, Laurent, Galdran, Adrian, Galati, Francesco, Falcetta, Daniele, Zuluaga, Maria A., Lin, Chaolong, Zhao, Haoran, Zhang, Zehan, Ra, Sinyoung, Hwang, Jongyun, Park, Hyunjin, Chen, Junqiang, Wodzinski, Marek, Müller, Henning, Shi, Pengcheng, Liu, Wei, Ma, Ting, Yalçin, Cansu, Hamadache, Rachika E., Salvi, Joaquim, Llado, Xavier, Estrada, Uma Maria Lal-Trehan, Abramova, Valeriia, Giancardo, Luca, Oliver, Arnau, Liu, Jialu, Huang, Haibin, Cui, Yue, Lin, Zehang, Liu, Yusheng, Zhu, Shunzhi, Patel, Tatsat R., Tutino, Vincent M., Orouskhani, Maysam, Wang, Huayu, Mossa-Basha, Mahmud, Zhu, Chengcheng, Rokuss, Maximilian R., Kirchhoff, Yannick, Disch, Nico, Holzschuh, Julius, Isensee, Fabian, Maier-Hein, Klaus, Sato, Yuki, Hirsch, Sven, Wegener, Susanne, and Menze, Bjoern

Subjects
Computer Science - Computer Vision and Pattern Recognition, Computer Science - Machine Learning, Quantitative Biology - Quantitative Methods, Quantitative Biology - Tissues and Organs
Abstract

The Circle of Willis (CoW) is an important network of arteries connecting major circulations of the brain. Its vascular architecture is believed to affect the risk, severity, and clinical outcome of serious neuro-vascular diseases. However, characterizing the highly variable CoW anatomy is still a manual and time-consuming expert task. The CoW is usually imaged by two angiographic imaging modalities, magnetic resonance angiography (MRA) and computed tomography angiography (CTA), but there exist limited public datasets with annotations on CoW anatomy, especially for CTA. Therefore we organized the TopCoW Challenge in 2023 with the release of an annotated CoW dataset. The TopCoW dataset was the first public dataset with voxel-level annotations for thirteen possible CoW vessel components, enabled by virtual-reality (VR) technology. It was also the first large dataset with paired MRA and CTA from the same patients. TopCoW challenge formalized the CoW characterization problem as a multiclass anatomical segmentation task with an emphasis on topological metrics. We invited submissions worldwide for the CoW segmentation task, which attracted over 140 registered participants from four continents. The top performing teams managed to segment many CoW components to Dice scores around 90%, but with lower scores for communicating arteries and rare variants. There were also topological mistakes for predictions with high Dice scores. Additional topological analysis revealed further areas for improvement in detecting certain CoW components and matching CoW variant topology accurately. TopCoW represented a first attempt at benchmarking the CoW anatomical segmentation task for MRA and CTA, both morphologically and topologically., Comment: 24 pages, 11 figures, 9 tables. Summary Paper for the MICCAI TopCoW 2023 Challenge

Published
2023

12. Deep transformation models for functional outcome prediction after acute ischemic stroke

Author

Herzog, Lisa, Kook, Lucas, Götschi, Andrea, Petermann, Katrin, Hänsel, Martin, Hamann, Janne, Dürr, Oliver, Wegener, Susanne, and Sick, Beate

Subjects
Statistics - Applications
Abstract

In many medical applications, interpretable models with high prediction performance are sought. Often, those models are required to handle semi-structured data like tabular and image data. We show how to apply deep transformation models (DTMs) for distributional regression which fulfill these requirements. DTMs allow the data analyst to specify (deep) neural networks for different input modalities making them applicable to various research questions. Like statistical models, DTMs can provide interpretable effect estimates while achieving the state-of-the-art prediction performance of deep neural networks. In addition, the construction of ensembles of DTMs that retain model structure and interpretability allows quantifying epistemic and aleatoric uncertainty. In this study, we compare several DTMs, including baseline-adjusted models, trained on a semi-structured data set of 407 stroke patients with the aim to predict ordinal functional outcome three months after stroke. We follow statistical principles of model-building to achieve an adequate trade-off between interpretability and flexibility while assessing the relative importance of the involved data modalities. We evaluate the models for an ordinal and dichotomized version of the outcome as used in clinical practice. We show that both, tabular clinical and brain imaging data, are useful for functional outcome prediction, while models based on tabular data only outperform those based on imaging data only. There is no substantial evidence for improved prediction when combining both data modalities. Overall, we highlight that DTMs provide a powerful, interpretable approach to analyzing semi-structured data and that they have the potential to support clinical decision making., Comment: Preprint under review

Published
2022
Full Text
View/download PDF

13. Blood Oxygenation Level–Dependent Cerebrovascular Reactivity–Derived Steal Phenomenon May Indicate Tissue Reperfusion Failure After Successful Endovascular Thrombectomy

Author

Bellomo, Jacopo, Sebök, Martina, Stumpo, Vittorio, van Niftrik, Christiaan H. B., Meisterhans, Darja, Piccirelli, Marco, Michels, Lars, Reolon, Beno, Esposito, Giuseppe, Schubert, Tilman, Kulcsar, Zsolt, Luft, Andreas R., Wegener, Susanne, Regli, Luca, and Fierstra, Jorn

Published
2023
Full Text
View/download PDF

15. Leptomeningeal collaterals regulate reperfusion in ischemic stroke and rescue the brain from futile recanalization

Author

Binder, Nadine Felizitas, El Amki, Mohamad, Glück, Chaim, Middleham, William, Reuss, Anna Maria, Bertolo, Adrien, Thurner, Patrick, Deffieux, Thomas, Lambride, Chryso, Epp, Robert, Handelsmann, Hannah-Lea, Baumgartner, Philipp, Orset, Cyrille, Bethge, Philipp, Kulcsar, Zsolt, Aguzzi, Adriano, Tanter, Mickael, Schmid, Franca, Vivien, Denis, Wyss, Matthias Tasso, Luft, Andreas, Weller, Michael, Weber, Bruno, and Wegener, Susanne

Published
2024
Full Text
View/download PDF

16. Sex Differences in Outcomes of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Preadmission Use of Antiplatelets

Author

Noseda, Roberta, Rea, Federico, Pagnamenta, Alberto, Agazzi, Pamela, Bianco, Giovanni, Sihabdeen, Shairin, Seiffge, David, Michel, Patrik, Nedeltchev, Krassen, Bonati, Leo, Kägi, Georg, Niederhauser, Julien, Nyffeler, Thomas, Luft, Andreas, Wegener, Susanne, Schelosky, Ludwig, Medlin, Friedrich, Rodic, Biljana, Peters, Nils, Renaud, Susanne, Mono, Marie-Luise, Carrera, Emmanuel, Fischer, Urs, Ceschi, Alessandro, and Cereda, Carlo Walter

Published
2023
Full Text
View/download PDF

17. Integrating uncertainty in deep neural networks for MRI based stroke analysis

Author

Herzog, Lisa, Murina, Elvis, Dürr, Oliver, Wegener, Susanne, and Sick, Beate

Subjects
Electrical Engineering and Systems Science - Image and Video Processing, Computer Science - Computer Vision and Pattern Recognition, Computer Science - Machine Learning, Quantitative Biology - Quantitative Methods, Statistics - Machine Learning
Abstract

At present, the majority of the proposed Deep Learning (DL) methods provide point predictions without quantifying the models uncertainty. However, a quantification of the reliability of automated image analysis is essential, in particular in medicine when physicians rely on the results for making critical treatment decisions. In this work, we provide an entire framework to diagnose ischemic stroke patients incorporating Bayesian uncertainty into the analysis procedure. We present a Bayesian Convolutional Neural Network (CNN) yielding a probability for a stroke lesion on 2D Magnetic Resonance (MR) images with corresponding uncertainty information about the reliability of the prediction. For patient-level diagnoses, different aggregation methods are proposed and evaluated, which combine the single image-level predictions. Those methods take advantage of the uncertainty in image predictions and report model uncertainty at the patient-level. In a cohort of 511 patients, our Bayesian CNN achieved an accuracy of 95.33% at the image-level representing a significant improvement of 2% over a non-Bayesian counterpart. The best patient aggregation method yielded 95.89% of accuracy. Integrating uncertainty information about image predictions in aggregation models resulted in higher uncertainty measures to false patient classifications, which enabled to filter critical patient diagnoses that are supposed to be closer examined by a medical doctor. We therefore recommend using Bayesian approaches not only for improved image-level prediction and uncertainty estimation but also for the detection of uncertain aggregations at the patient-level., Comment: 21 pages, 13 figures

Published
2020
Full Text
View/download PDF

20. Effect of Asymptomatic and Symptomatic COVID-19 on Acute Ischemic Stroke Revascularization Outcomes

Author

Strambo, Davide, Marto, João Pedro, Ntaios, George, Nguyen, Thanh N., Michel, Patrik, Herzig, Roman, Członkowksa, Anna, Demeestere, Jelle, Yassin Mansour, Ossama, Georgiopoulos, Georgios, Nogueira, Raul G., Salerno, Alexander, Wegener, Susanne, Baumgartner, Philipp, Cereda, Carlo W., Bianco, Giovanni, Beyeler, Morin, Arnold, Marcel, Carrera, Emmanuel, Machi, Paolo, Altersberger, Valerian, Bonati, Leo, Gensicke, Henrik, Bolognese, Manuel, Peters, Nils, Wetzel, Stephan, Magriço, Marta, Nuno Ramos, João, Sargento-Freitas, João, Machado, Rita, Maia, Carolina, Machado, Egídio, Paiva-Nunes, Ana, Ferreira, Patrícia, Pinho-e-Melo, Teresa, Carvalho-Dias, Mariana, Paula, André, Alberto Correia, Manuel, Castro, Pedro, Azevedo, Elsa, Albuquerque, Luís, Nuno-Alves, José, Ferreira-Pinto, Joana, Meira, Torcato, Pereira, Liliana, Rodrigues, Miguel, Araújo, André, Rodrigues, Marta, Rocha, Mariana, Pereira-Fonseca, Ângelo, Ribeiro, Luís, Varela, Ricardo, Cappellari, Manuel, Zivelonghi, Cecilia, Sajeva, Giulia, Zini, Andrea, Gentile, Mauro, Forlivesi, Stefano, Migliaccio, Ludovica, Sessa, Maria, Pezzini, Alessandro, Sangalli, Davide, Zedde, Marialuisa, Pascarella, Rosario, Diamanti, Susanna, Beretta, Simone, Schwarz, Ghil, Frisullo, Giovanni, Marcheselli, Simona, Seners, Pierre, Sabben, Candice, Escalard, Simon, Piotin, Michel, Maier, Benjamin, Charbonnier, Guillaume, Vuillier, Fabrice, Legris, Loic, Cuisenier, Pauline, Vodret, Francesca R., Marnat, Gaultier, Liegey, Jean-Sebastien, Sibon, Igor, Flottmann, Fabian, Broocks, Gabriel, Gloyer, Nils-Ole, Bohmann, Ferdinand O., Hendrik Schaefer, Jan, Nolte, Christian H., Audebert, Heinrich, Siebert, Eberhard, Sykora, Marek, Lang, Wilfried, Ferrari, Julia, Mayer-Suess, Lukas, Knoflach, Michael, Gizewski, Elke-Ruth, Stolp, Jeffrey, Stolze, Lotte J., Coutinho, Jonathan M., Nederkoorn, Paul J., van-den-Wijngaard, Ido, de Meris, Joke, Lemmens, Robin, De Raedt, Sylvie, Vandervorst, Fenne, Pierre Rutgers, Matthieu, Guilmot, Antoine, Dusart, Anne, Bellante, Flavio, Calleja-Castaño, Patricia, Ostos, Fernando, Gonzalez-Ortega, Guillermo, Martín-Jiménez, Paloma, García-Madrona, Sebastian, Cruz-Culebras, Antonio, Vera, Rocio, Matute, Maria-Consuelo, Fuentes, Blanca, Alonso-de-Leciñana, María, Rigual, Ricardo, Díez-Tejedor, Exuperio, Pérez-Sánchez, Soledad, Montaner, Joan, Díaz-Otero, Fernando, Perez de la Ossa, Natalia, Flores-Pina, Belén, Muñoz-Narbona, Lucia, Chamorro, Angel, Rodríguez-Vázquez, Alejandro, Renú, Arturo, Ayo-Martin, Oscar, Hernandez-Fernandez, Francisco, Segura, Tomas, Tejada-Meza, Herbert, Hlaing, Thant, See, Isaiah, Simister, Robert, Werring, David J., Saxhaug Kristoffersen, Espen, Nordanstig, Annika, Jood, Katarina, Rentzos, Alexandros, Šimůnek, Libor, Krajíčková, Dagmar, Krajina, Antonín, Mikulík, Robert, Cviková, Martina, Vinklárek, Jan, Školoudík, David, Roubec, Martin, Hurtikova, Eva, Hrubý, Rostislav, Ostry, Svatopluk, Skoda, Ondrej, Pernicka, Marek, Kočí, Lubomír, Eichlová, Zuzana, Jíra, Martin, Kovář, Martin, Panský, Michal, Mencl, Pavel, Paloušková, Hana, Tomek, Aleš, Janský, Petr, Olšerová, Anna, Šrámek, Martin, Havlíček, Roman, Malý, Petr, Trakal, Lukáš, Fiksa, Jan, Slovák, Matěj, Karliński, Michał, Nowak, Maciej, Sienkiewicz-Jarosz, Halina, Bochynska, Anna, Wrona, Pawel, Homa, Tomasz, Sawczynska, Katarzyna, Slowik, Agnieszka, Wlodarczyk, Ewa, Wiącek, Marcin, Tomaszewska-Lampart, Izabella, Sieczkowski, Bartosz, Bartosik-Psujek, Halina, Bilik, Marta, Bandzarewicz, Anna, Dorobek, Malgorzata, Zielińska-Turek, Justyna, Nowakowska-Kotas, Marta, Obara, Krystian, Urbanowski, Paweł, Budrewicz, Sławomir, Guziński, Maciej, Świtońska, Milena, Rutkowska, Iwona, Sobieszak-Skura, Paulina, Łabuz-Roszak, Beata, Dębiec, Aleksander, Staszewski, Jacek, Stępień, Adam, Zwiernik, Jacek, Wasilewski, Grzegorz, Tiu, Cristina, Terecoasă, Elena-Oana, Radu, Razvan-Alexandru, Negrila, Anca, Dorobat, Bogdan, Panea, Cristina, Tiu, Vlad, Petrescu, Simona, Özcan-Özdemir, Atilla, Mahmoud, Mostafa, El-Samahy, Hussam, Abdelkhalek, Hazem, Al-Hashel, Jasem, Ibrahim Ismail, Ismail, Salmeen, Athari, Ghoreishi, Abdoreza, Sabetay, Sergiu, Gross, Hana, Klein, Piers, Abdalkader, Mohamad, Jabbour, Pascal, El Naamani, Kareem, Tjoumakaris, Stavropoula, Abbas, Rawad, Mohamed, Ghada-A., Chebl, Alex, Min, Jiangyong, Hovingh, Majesta, Tsai, Jenny, Khan, Muhib-A., Nalleballe, Krishna, Onteddu, Sanjeeva, Masoud, Hesham E., Michael, Mina, Kaur, Navreet, Maali, Laith, Abraham, Michael, Khandelwal, Priyank, Bach, Ivo, Ong, Melody, Babici, Denis, Khawaja, Ayaz-M., Hakemi, Maryam, Rajamani, Kumar, Cano-Nigenda, Vanessa, Arauz, Antonio, Amaya, Pablo, Llanos, Natalia, Arango, Akemi, Vences, Miguel A., Barrientos, José-Domingo, Caetano, Rayllene, Targa, Rodrigo, Scollo, Sergio, Yalung, Patrick, Nagendra, Shashank, Gaikwad, Abhijit, and Seo, Kwon-Duk

Published
2024
Full Text
View/download PDF

24. Thrombolysis in stroke patients with elevated inflammatory markers

Author

Altersberger, Valerian L., Enz, Lukas S., Sibolt, Gerli, Hametner, Christian, Nannoni, Stefania, Heldner, Mirjam R., Stolp, Jeffrey, Jovanovic, Dejana R., Zini, Andrea, Pezzini, Alessandro, Wegener, Susanne, Cereda, Carlo W., Ntaios, George, Räty, Silja, Gumbinger, Christoph, Heyse, Miriam, Polymeris, Alexandros A., Zietz, Annaelle, Schaufelbuehl, Anna, Strambo, Davide, Padlina, Giovanna, Slavova, Nedelina, Tiainen, Marjaana, Valkonen, Kati, Velzen, Twan J. van, Bigliardi, Guido, Stanarcevic, Predrag, Magoni, Mauro, Luft, Andreas, Bejot, Yannick, Vandelli, Laura, Padjen, Visnja, Nederkoorn, Paul J., Arnold, Marcel, Michel, Patrik, Ringleb, Peter A., Curtze, Sami, Engelter, Stefan T., and Gensicke, Henrik

Published
2022
Full Text
View/download PDF

26. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial

Author

Polymeris, Alexandros A., Karwacki, Grzegorz M., Siepen, Bernhard M., Schaedelin, Sabine, Tsakiris, Dimitrios A., Stippich, Christoph, Guzman, Raphael, Nickel, Christian H., Sprigg, Nikola, Kägi, Georg, Vehoff, Jochen, Barinka, Filip, Thilemann, Sebastian, Maurer, Marina, Wagner, Benjamin, Traenka, Christopher, Gensicke, Henrik, De Marchis, Gian Marco, Bonati, Leo H., Fischer, Urs, Z’Graggen, Werner J., Nedeltchev, Krassen, Wegener, Susanne, Baumgartner, Philipp, Engelter, Stefan T., Seiffge, David J., Peters, Nils, Lyrer, Philippe A., Clarke, Sandra, Falcao, Martina, Avramiotis, Nikolaos S, Dittrich, Tolga, Fisch, Urs, Fladt, Joachim, Hert, Lisa, Schneider, Iris, Wiegert, Martina, Zietz, Annaelle, Beyeler, Morin, Goeldlin, Martina, Kormann, Marianne, Maamari, Basel, McEvoy, Liselotte, Meinel, Thomas R, Müller, Madlaina, Vynckier, Jan, Ardila, Elena, Feuerstein, Ingrid, Gantenbein, Claudine, Müller, Anna, Seljmani, Vjosa, Wagner, Benedikt, Anders, Bettina, Backhaus, Roland, Paliantonis, Asterios, Taheri, Shadi, Thumm, Dennis, van Duinen, Jannie, and Von Bieberstein, Lita

Published
2023
Full Text
View/download PDF

28. Prevalence and Distribution of Intracranial Vessel Occlusion on Angiography and Its Association with Functional Outcome in Patients with Atrial Fibrillation Presenting with Ischemic Stroke.

Author

Benz, Alexander P., Meinel, Thomas R., Salerno, Alexander, Beyeler, Morin, Strambo, Davide, Kaesmacher, Johannes, Polymeris, Alexandros A., Kahles, Timo, Katan, Mira, Engelter, Stefan T., Carrera, Emmanuel, Dirren, Elisabeth, Peters, Nils, Cereda, Carlo W., Kägi, Georg, Renaud, Susanne, Wegener, Susanne, Bolognese, Manuel, Bonati, Leo H., and Fischer, Urs

Subjects
ISCHEMIC stroke, CEREBRAL circulation, ANTICOAGULANTS, ATRIAL fibrillation, COMPUTED tomography
Abstract

Objectives: To determine the prevalence and distribution of intracranial vessel occlusion identified on computed tomography (CT) or magnet resonance (MR) angiography and to explore its association with functional outcome in patients with atrial fibrillation (AF) and ischemic stroke. Methods: Multicenter cohort study enrolling consecutive patients with AF with imaging‐confirmed ischemic stroke who underwent CT‐ or MR‐angiography on admission (2014–2022). Multivariable regression was used to explore the association between intracranial vessel occlusion and poor functional outcome (modified Rankin Scale score 3–6) at 90 days. Results: The analysis included 10,164 patients (median age 81.5 years, 47.8% female, median National Institutes of Health Stroke Scale score on admission 6; 14.7% on a vitamin K antagonist [VKA], 27.5% on a direct oral anticoagulant [DOAC], 57.8% not receiving oral anticoagulation). Angiography showed intracranial vessel occlusion in 5,190 patients (51.1%), affecting the anterior cerebral circulation in 87.4%. Overall, 29.2% and 29.4% of patients received thrombolysis and mechanical thrombectomy, respectively. The proportion of patients with poor functional outcome at 90 days was 60.6% and 42.7% in those with and without vessel occlusion, respectively. In multivariable analyses, vessel occlusion was associated with poor functional outcome (adjusted odds ratio [aOR]: 1.95, 95% confidence interval [CI]: 1.71–2.22) with consistent results in subgroups according to oral anticoagulation use (VKA, aOR: 1.98, 95% CI: 1.40–2.80; DOAC, aOR: 2.35, 95% CI: 1.83–3.03; none, aOR: 1.76, 95% CI: 1.49–2.09). Interpretation: Intracranial vessel occlusion is common in patients with AF with ischemic stroke, mainly affects the anterior circulation and is associated with poor functional outcome. ANN NEUROL 2024;96:1115–1123 [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

32. Imaging of the brain–heart axis: prognostic value in a European setting

Author

Mikail, Nidaa, primary, Sager, Dominik F, additional, Gebert, Pimrapat, additional, Haider, Ahmed, additional, Todorov, Atanas, additional, Bengs, Susan, additional, Sablonier, Noemi, additional, Glarner, Isabelle, additional, Vinzens, Adriana, additional, Sang Bastian, Nastaran, additional, Epprecht, Gioia, additional, Sütsch, Claudia, additional, Delcò, Alessia, additional, Fiechter, Michael, additional, Portmann, Angela, additional, Treyer, Valerie, additional, Wegener, Susanne, additional, Gräni, Christoph, additional, Pazhenkottil, Aju, additional, Gebhard, Caroline E, additional, Regitz-Zagrosek, Vera, additional, Tanner, Felix C, additional, Kaufmann, Philipp A, additional, Buechel, Ronny R, additional, Rossi, Alexia, additional, and Gebhard, Catherine, additional

Published
2024
Full Text
View/download PDF

36. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study

Author

Dittrich, Tolga D., Sporns, Peter B., Kriemler, Lilian F., Rudin, Salome, Nguyen, Anh, Zietz, Annaelle, Polymeris, Alexandros A., Tränka, Christopher, Thilemann, Sebastian, Wagner, Benjamin, Altersberger, Valerian L., Piot, Ines, Barinka, Filip, Müller, Susanne, Hänsel, Martin, Gensicke, Henrik, Engelter, Stefan T., Lyrer, Philippe A., Sutter, Raoul, Nickel, Christian H., Katan, Mira, Peters, Nils, Kulcsár, Zsolt, Karwacki, Grzegorz M., Pileggi, Marco, Cereda, Carlo, Wegener, Susanne, Bonati, Leo H., Fischer, Urs, Psychogios, Marios, and De Marchis, Gian Marco

Published
2023
Full Text
View/download PDF

37. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial

Author

Kahles, Timo, Nedeltchev, Krassen, Altersberger, Valerian, Bonati, Leo H, Brehm, Alex, Bruni, Nicole, De Marchis, Gian Marco, Engelter, Stefan T, Fabbro, Thomas, Fisch, Urs, Fladt, Joachim, Gensicke, Henrik, Hert, Lisa, Lyrer, Philippe A, Maurer, Marina, Peters, Nils, Polymeris, Alexandros, Psychogios, Marios-Nikos, Schaedelin, Sabine, Stippich, Christoph, Thilemann, Sebastian, Traenka, Christopher, Wagner, Benjamin, Arnold, Marcel, Fischer, Urs, Goeggel Simonetti, Barbara, Gralla, Jan, Heldner, Mirjam, Jung, Simon, Leib, Stephen L, Seiffge, David J, Mueller, Hubertus, Sveikata, Lukas, Sztajzel, Roman, Correia, Pamela, Eskandari, Ashraf, Meyer, Ivo, Michel, Patrik, Nannoni, Stefania, Remillard, Suzette, Sirimarco, Gaia, Zachariadis, Alexandros, Kaegi, Georg, Mueller, Anna, Vehoff, Jochen, Hamann, Janne, Luft, Andreas R, Steiner, Levke, Wegener, Susanne, Erdur, Hebun J, Nolte, Christian H, von Rennenberg, Regina, Scheitz, Jan F, Feil, Katharina, Kellert, Lars, Christensen, Hanne, Rosenbaum, Sverre, Schaedelin, Sabine A, Simonetti, Barbara Goeggel, Kägi, Georg, Seiffge, David, Polymeris, Alexandros A, and Lyrer, Philippe

Published
2021
Full Text
View/download PDF

38. The volume of steal phenomenon is associated with neurological deterioration in patients with large-vessel occlusion minor stroke not eligible for thrombectomy

Author

Bellomo, Jacopo; https://orcid.org/0009-0005-8945-4838, Sebök, Martina; https://orcid.org/0000-0002-7246-3421, van Niftrik, Christiaan Hb, Stumpo, Vittorio; https://orcid.org/0000-0002-8175-0035, Schubert, Tilman; https://orcid.org/0000-0003-2373-5870, Madjidyar, Jawid, Thurner, Patrick, Globas, Christoph; https://orcid.org/0000-0002-2355-1150, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Luft, Andreas R; https://orcid.org/0000-0001-9865-7382, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Regli, Luca; https://orcid.org/0000-0003-4639-4474, Fierstra, Jorn; https://orcid.org/0000-0001-6220-0727, Bellomo, Jacopo; https://orcid.org/0009-0005-8945-4838, Sebök, Martina; https://orcid.org/0000-0002-7246-3421, van Niftrik, Christiaan Hb, Stumpo, Vittorio; https://orcid.org/0000-0002-8175-0035, Schubert, Tilman; https://orcid.org/0000-0003-2373-5870, Madjidyar, Jawid, Thurner, Patrick, Globas, Christoph; https://orcid.org/0000-0002-2355-1150, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Luft, Andreas R; https://orcid.org/0000-0001-9865-7382, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Regli, Luca; https://orcid.org/0000-0003-4639-4474, and Fierstra, Jorn; https://orcid.org/0000-0001-6220-0727

Abstract

INTRODUCTION A significant number of patients who present with mild symptoms following large-vessel occlusion acute ischemic stroke (LVO-AIS) are currently considered ineligible for EVT. However, they frequently experience neurological deterioration during hospitalization. This study aimed to investigate the association between neurological deterioration and hemodynamic impairment by assessing steal phenomenon derived from blood oxygenation-level dependent cerebrovascular reactivity (BOLD-CVR) in this specific patient cohort. PATIENTS AND METHODS From the database of our single-center BOLD-CVR observational cohort study (June 2015-October 2023) we retrospectively identified acute ischemic stroke patients with admission NIHSS < 6, a newly detected large vessel occlusion of the anterior circulation and ineligible for EVT. Neurological deterioration during hospitalization as well as outcome at hospital discharge were rated with NIHSS score. We analyzed the association between these two outcomes and BOLD-CVR-derived steal phenomenon volume through regression analysis. Additionally, we investigated the discriminatory accuracy of steal phenomenon volume for predicting neurological deterioration. RESULTS Forty patients were included in the final analysis. Neurological deterioration occurred in 35% of patients. In the regression analysis, a strong association between steal phenomenon volume and neurological deterioration (OR 4.80, 95% CI 1.32-31.04, p = 0.04) as well as poorer NIHSS score at hospital discharge (OR 3.73, 95% CI 1.52-10.78, p = 0.007) was found. The discriminatory accuracy of steal phenomenon for neurological deterioration prediction had an AUC of 0.791 (95% CI 0.653-0.930). DISCUSSION Based on our results we may distinguish two groups of patients with minor stroke currently ineligible for EVT, however, showing hemodynamic impairment and exhibiting neurological deterioration during hospitalization: (1) patients exhibiting steal phenomenon on BOLD-CVR imaging

Published
2024

39. Imaging of the brain-heart axis: prognostic value in a European setting

Author

Mikail, Nidaa; https://orcid.org/0000-0003-4896-1428, Sager, Dominik F, Gebert, Pimrapat, Haider, Ahmed; https://orcid.org/0000-0002-5204-4473, Todorov, Atanas; https://orcid.org/0000-0002-1225-4302, Bengs, Susan; https://orcid.org/0000-0003-2424-3894, Sablonier, Noemi, Glarner, Isabelle, Vinzens, Adriana, Sang Bastian, Nastaran, Epprecht, Gioia, Sütsch, Claudia, Delcò, Alessia, Fiechter, Michael; https://orcid.org/0000-0002-7293-0704, Portmann, Angela, Treyer, Valerie; https://orcid.org/0000-0002-4584-3031, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Gräni, Christoph; https://orcid.org/0000-0001-6029-0597, Pazhenkottil, Aju; https://orcid.org/0000-0002-8847-2154, Gebhard, Caroline E; https://orcid.org/0000-0003-4975-2679, Regitz-Zagrosek, Vera; https://orcid.org/0000-0002-3566-3467, Tanner, Felix C; https://orcid.org/0000-0002-4315-2667, Kaufmann, Philipp A; https://orcid.org/0000-0002-9451-5210, Buechel, Ronny R; https://orcid.org/0000-0001-8064-8904, Rossi, Alexia; https://orcid.org/0000-0001-6845-1199, Gebhard, Catherine; https://orcid.org/0000-0001-7240-5822, Mikail, Nidaa; https://orcid.org/0000-0003-4896-1428, Sager, Dominik F, Gebert, Pimrapat, Haider, Ahmed; https://orcid.org/0000-0002-5204-4473, Todorov, Atanas; https://orcid.org/0000-0002-1225-4302, Bengs, Susan; https://orcid.org/0000-0003-2424-3894, Sablonier, Noemi, Glarner, Isabelle, Vinzens, Adriana, Sang Bastian, Nastaran, Epprecht, Gioia, Sütsch, Claudia, Delcò, Alessia, Fiechter, Michael; https://orcid.org/0000-0002-7293-0704, Portmann, Angela, Treyer, Valerie; https://orcid.org/0000-0002-4584-3031, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Gräni, Christoph; https://orcid.org/0000-0001-6029-0597, Pazhenkottil, Aju; https://orcid.org/0000-0002-8847-2154, Gebhard, Caroline E; https://orcid.org/0000-0003-4975-2679, Regitz-Zagrosek, Vera; https://orcid.org/0000-0002-3566-3467, Tanner, Felix C; https://orcid.org/0000-0002-4315-2667, Kaufmann, Philipp A; https://orcid.org/0000-0002-9451-5210, Buechel, Ronny R; https://orcid.org/0000-0001-8064-8904, Rossi, Alexia; https://orcid.org/0000-0001-6845-1199, and Gebhard, Catherine; https://orcid.org/0000-0001-7240-5822

Abstract

BACKGROUND AND AIMS Increasing data suggest that stress-related neural activity (SNA) is associated with subsequent major adverse cardiovascular events (MACE) and may represent a therapeutic target. Current evidence is exclusively based on populations from the U.S. and Asia where limited information about cardiovascular disease risk was available. This study sought to investigate whether SNA imaging has clinical value in a well-characterized cohort of cardiovascular patients in Europe. METHODS In this single-centre study, a total of 963 patients (mean age 58.4 ± 16.1 years, 40.7% female) with known cardiovascular status, ranging from 'at-risk' to manifest disease, and without active cancer underwent 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography between 1 January 2005 and 31 August 2019. Stress-related neural activity was assessed with validated methods and relations between SNA and MACE (non-fatal stroke, non-fatal myocardial infarction, coronary revascularization, and cardiovascular death) or all-cause mortality by time-to-event analysis. RESULTS Over a maximum follow-up of 17 years, 118 individuals (12.3%) experienced MACE, and 270 (28.0%) died. In univariate analyses, SNA significantly correlated with an increased risk of MACE (sub-distribution hazard ratio 1.52, 95% CI 1.05-2.19; P = .026) or death (hazard ratio 2.49, 95% CI 1.96-3.17; P < .001). In multivariable analyses, the association between SNA imaging and MACE was lost when details of the cardiovascular status were added to the models. Conversely, the relationship between SNA imaging and all-cause mortality persisted after multivariable adjustments. CONCLUSIONS In a European patient cohort where cardiovascular status is known, SNA imaging is a robust and independent predictor of all-cause mortality, but its prognostic value for MACE is less evident. Further studies should define specific patient populations that might profit from SNA imaging.

Published
2024

40. Leptomeningeal collaterals regulate reperfusion in ischemic stroke and rescue the brain from futile recanalization

Author

Binder, Nadine Felizitas; https://orcid.org/0000-0001-8484-5550, El Amki, Mohamad; https://orcid.org/0000-0003-1245-5283, Glück, Chaim; https://orcid.org/0000-0002-8754-9965, Middleham, William; https://orcid.org/0000-0002-3786-6284, Reuss, Anna Maria; https://orcid.org/0000-0003-1096-3030, Bertolo, Adrien, Thurner, Patrick, Deffieux, Thomas, Lambride, Chryso, Epp, Robert; https://orcid.org/0000-0002-8951-1987, Handelsmann, Hannah-Lea, Baumgartner, Philipp; https://orcid.org/0000-0003-1525-2019, Orset, Cyrille, Bethge, Philipp; https://orcid.org/0000-0003-4022-0844, Kulcsar, Zsolt; https://orcid.org/0000-0002-6805-5150, Aguzzi, Adriano; https://orcid.org/0000-0002-0344-6708, Tanter, Mickael, Schmid, Franca; https://orcid.org/0000-0002-0689-9366, Vivien, Denis, Wyss, Matthias Tasso; https://orcid.org/0000-0002-2037-3424, Luft, Andreas; https://orcid.org/0000-0001-9865-7382, Weller, Michael; https://orcid.org/0000-0002-1748-174X, Weber, Bruno; https://orcid.org/0000-0002-9089-0689, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Binder, Nadine Felizitas; https://orcid.org/0000-0001-8484-5550, El Amki, Mohamad; https://orcid.org/0000-0003-1245-5283, Glück, Chaim; https://orcid.org/0000-0002-8754-9965, Middleham, William; https://orcid.org/0000-0002-3786-6284, Reuss, Anna Maria; https://orcid.org/0000-0003-1096-3030, Bertolo, Adrien, Thurner, Patrick, Deffieux, Thomas, Lambride, Chryso, Epp, Robert; https://orcid.org/0000-0002-8951-1987, Handelsmann, Hannah-Lea, Baumgartner, Philipp; https://orcid.org/0000-0003-1525-2019, Orset, Cyrille, Bethge, Philipp; https://orcid.org/0000-0003-4022-0844, Kulcsar, Zsolt; https://orcid.org/0000-0002-6805-5150, Aguzzi, Adriano; https://orcid.org/0000-0002-0344-6708, Tanter, Mickael, Schmid, Franca; https://orcid.org/0000-0002-0689-9366, Vivien, Denis, Wyss, Matthias Tasso; https://orcid.org/0000-0002-2037-3424, Luft, Andreas; https://orcid.org/0000-0001-9865-7382, Weller, Michael; https://orcid.org/0000-0002-1748-174X, Weber, Bruno; https://orcid.org/0000-0002-9089-0689, and Wegener, Susanne; https://orcid.org/0000-0003-4369-7023

Published
2024

41. The prevalence of head and face pain decreased from 1997 to 2017 in Switzerland

Author

Pohl, Heiko; https://orcid.org/0000-0002-2778-6790, Neumeier, Maria Susanne; https://orcid.org/0000-0001-6410-5547, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Pohl, Heiko; https://orcid.org/0000-0002-2778-6790, Neumeier, Maria Susanne; https://orcid.org/0000-0001-6410-5547, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, and Wegener, Susanne; https://orcid.org/0000-0003-4369-7023

Abstract

Background: Pain in the head and the face is highly prevalent but may have changed during the past years. This study aimed to analyze changes in the prevalence of pain in the head and the face in Switzerland from 1997 to 2017. Methods: This is a secondary analysis of data collected in the Swiss Health Surveys of 1997–2017. Included persons were 15 years and older. Besides studying demographic data, we analyze the item assessing the presence of “headache, pressure in the head, or facial pain” during the past 4 weeks. Percentages with their Wilson confidence intervals are reported for each response option of categorical variables. Moreover, we calculate the age‐standardized number of persons affected by the pain. Results: While 41% reported head and face pain in 1997, the proportion dropped to 31% in 2017. There was a decrease of 19.5% in women and 29.4% in men; after age standardization, the decrease was 16.5% in women and 25.4% in men. The most considerable numerical changes in the percentages of women with pain occurred in those aged 55–69 and 85 and above. In men, the changes were not limited to specific age groups. Conclusions: The proportion of people reporting headaches, pressure in the head, or facial pain has dropped in Switzerland from 1997 to 2017. However, in women, the prevalence diminished more strongly and consistently in the middle‐aged and the elderly than in the young.

Published
2024

42. CADMUS

Author

Goeldlin, Martina B; https://orcid.org/0000-0001-5800-116X, Mueller, Madlaine; https://orcid.org/0000-0002-1142-9633, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Zhang, Wenpeng; https://orcid.org/0000-0001-8748-3962, Ozkan, Hatice; https://orcid.org/0000-0003-1656-4559, Locatelli, Martina, Du, Yang; https://orcid.org/0000-0002-0805-6282, Valenzuela, Waldo; https://orcid.org/0000-0002-6629-3366, Radojewski, Piotr; https://orcid.org/0000-0002-1062-8622, Hakim, Arsany; https://orcid.org/0000-0001-9431-1069, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Clénin, Leander; https://orcid.org/0000-0001-8993-0770, Branca, Mattia; https://orcid.org/0000-0002-8063-7882, Strambo, Davide; https://orcid.org/0000-0003-4429-2714, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Medlin, Friedrich; https://orcid.org/0000-0002-8477-899X, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Carrera, Emmanuel; https://orcid.org/0000-0003-0045-5382, Lovblad, Karl-Olof; https://orcid.org/0000-0003-2768-9779, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Cereda, Carlo W; https://orcid.org/0000-0002-6479-1476, Niederhauser, Julien; https://orcid.org/0000-0002-6543-7989, Mono, Marie-Luise, Mueller, Achim; https://orcid.org/0009-0009-4597-3440, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Sartoretti, Sabine, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Katan, Mira; https://orcid.org/0000-0002-9265-8066, et al, Goeldlin, Martina B; https://orcid.org/0000-0001-5800-116X, Mueller, Madlaine; https://orcid.org/0000-0002-1142-9633, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Zhang, Wenpeng; https://orcid.org/0000-0001-8748-3962, Ozkan, Hatice; https://orcid.org/0000-0003-1656-4559, Locatelli, Martina, Du, Yang; https://orcid.org/0000-0002-0805-6282, Valenzuela, Waldo; https://orcid.org/0000-0002-6629-3366, Radojewski, Piotr; https://orcid.org/0000-0002-1062-8622, Hakim, Arsany; https://orcid.org/0000-0001-9431-1069, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Clénin, Leander; https://orcid.org/0000-0001-8993-0770, Branca, Mattia; https://orcid.org/0000-0002-8063-7882, Strambo, Davide; https://orcid.org/0000-0003-4429-2714, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Medlin, Friedrich; https://orcid.org/0000-0002-8477-899X, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Carrera, Emmanuel; https://orcid.org/0000-0003-0045-5382, Lovblad, Karl-Olof; https://orcid.org/0000-0003-2768-9779, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Cereda, Carlo W; https://orcid.org/0000-0002-6479-1476, Niederhauser, Julien; https://orcid.org/0000-0002-6543-7989, Mono, Marie-Luise, Mueller, Achim; https://orcid.org/0009-0009-4597-3440, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Sartoretti, Sabine, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Katan, Mira; https://orcid.org/0000-0002-9265-8066, and et al

Abstract

BACKGROUND AND OBJECTIVES Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. METHODS We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013-2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. RESULTS The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62-80] years, baseline NIH Stroke Scale 6 [2-12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145-185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. DISCUSSION CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.

Published
2024

43. Flow-augmentation STA-MCA bypass for acute and subacute ischemic stroke due to internal carotid artery occlusion and the role of advanced neuroimaging with hemodynamic and flow-measurement in the decision-making: preliminary data

Author

Sebök, Martina, Höbner, Lara Maria, Fierstra, Jorn, Schubert, Tilman, Wegener, Susanne, Kulcsár, Zsolt, Luft, Andreas R, Regli, Luca, Esposito, Giuseppe, Sebök, Martina, Höbner, Lara Maria, Fierstra, Jorn, Schubert, Tilman, Wegener, Susanne, Kulcsár, Zsolt, Luft, Andreas R, Regli, Luca, and Esposito, Giuseppe

Abstract

Symptomatic patients with ischemic stroke due to internal carotid artery (ICA) occlusion often present with compromised brain hemodynamic status involving substantially larger parts of the affected vascular territory than the ischemic core itself (1-3). Despite the fact that the “Extracranial-Intracranial” (EC-IC) Bypass Study Group and the “Carotid Occlusion Surgery Study” (COSS) failed to demonstrate a benefit of bypass in comparison to medical therapy (4,5), several studies showed a significant improvement in hemodynamic parameters after superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery was performed in carefully selected patients (6-9) and even a reduction in stroke recurrence (6). Analysis showed that the failure of the COSS trial (5) to show a benefit regarding ipsilateral 2-year stroke recurrence in patients undergoing cerebral bypass revascularization was likely caused by a failure of the semiquantitative, hemispheric oxygen extraction fraction (OEF) ratio method used in the trial than by the selection of the patients for bypass based on hemodynamic compromise (10). Therefore, alternative and especially quantitative imaging techniques are needed to assess hemodynamic status in patients with ischemic stroke due to ICA occlusion.

Published
2024

44. Integrating uncertainty in deep neural networks for MRI based stroke analysis

Author

Herzog, Lisa, Murina, Elvis, Dürr, Oliver, Wegener, Susanne, Sick, Beate, Herzog, Lisa, Murina, Elvis, Dürr, Oliver, Wegener, Susanne, and Sick, Beate

Abstract

At present, the majority of the proposed Deep Learning (DL) methods provide point predictions without quantifying the model's uncertainty. However, a quantification of the reliability of automated image analysis is essential, in particular in medicine when physicians rely on the results for making critical treatment decisions. In this work, we provide an entire framework to diagnose ischemic stroke patients incorporating Bayesian uncertainty into the analysis procedure. We present a Bayesian Convolutional Neural Network (CNN) yielding a probability for a stroke lesion on 2D Magnetic Resonance (MR) images with corresponding uncertainty information about the reliability of the prediction. For patient-level diagnoses, different aggregation methods are proposed and evaluated, which combine the individual image-level predictions. Those methods take advantage of the uncertainty in the image predictions and report model uncertainty at the patient-level. In a cohort of 511 patients, our Bayesian CNN achieved an accuracy of 95.33% at the image-level representing a significant improvement of 2% over a non-Bayesian counterpart. The best patient aggregation method yielded 95.89% of accuracy. Integrating uncertainty information about image predictions in aggregation models resulted in higher uncertainty measures to false patient classifications, which enabled to filter critical patient diagnoses that are supposed to be closer examined by a medical doctor. We therefore recommend using Bayesian approaches not only for improved image-level prediction and uncertainty estimation but also for the detection of uncertain aggregations at the patient-level.

Published
2024

45. Hemodynamic Evaluation of Paradoxical Blood Oxygenation Level-Dependent Cerebrovascular Reactivity with Transcranial Doppler and MR Perfusion in Patients with Symptomatic Cerebrovascular Steno-occlusive Disease

Author

van Niftrik, Christiaan Hendrik Bas, primary, Sebök, Martina, additional, Muscas, Giovanni, additional, Hiller, Aimée, additional, Halter, Matthias, additional, Wegener, Susanne, additional, Regli, Luca, additional, and Fierstra, Jorn, additional

Published
2021
Full Text
View/download PDF

48. Absent leptomeningeal collateralization is associated with greatest benefit from mechanical thrombectomy in the 6-24 hour time window.

Author

Dittrich, Tolga D, von Streng, Tennessee, Toebak, Anna M, Zietz, Annaelle, Wagner, Benjamin, Hänsel, Martin, Sutter, Raoul, Katan, Mira, Peters, Nils, Michels, Lars, Kulcsár, Zsolt, Karwacki, Grzegorz M, Pileggi, Marco, Cereda, Carlo W, Wegener, Susanne, Bonati, Leo H, Psychogios, Marios, and De Marchis, Gian Marco

Published
2024
Full Text
View/download PDF

49. BOLD Cerebrovascular Reactivity and NOVA Quantitative MR Angiography in Adult Patients with Moyamoya Vasculopathy Undergoing Cerebral Bypass Surgery.

Author

Garbani Nerini, Loris, Bellomo, Jacopo, Höbner, Lara Maria, Stumpo, Vittorio, Colombo, Elisa, van Niftrik, Christiaan Hendrik Bas, Schubert, Tilman, Kulcsár, Zsolt, Wegener, Susanne, Luft, Andreas, Regli, Luca, Fierstra, Jorn, Sebök, Martina, and Esposito, Giuseppe

Subjects
MAGNETIC resonance angiography, CEREBRAL revascularization, REVASCULARIZATION (Surgery), CEREBRAL hemispheres, PATIENT selection, CEREBRAL angiography
Abstract

Revascularization surgery for the symptomatic hemisphere with hemodynamic impairment is effective for Moyamoya vasculopathy patients. However, careful patient selection is crucial and ideally supported by advanced quantitative hemodynamic imaging. Recently, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) and quantitative magnetic resonance angiography with non-invasive optimal vessel analysis (qMRA-NOVA) have gained prominence in assessing these patients. This study aims to present the results of BOLD-CVR and qMRA-NOVA imaging along with the changes in cerebral hemodynamics and flow status following flow augmentation with superficial temporal artery–middle cerebral artery (STA-MCA) bypass in our Moyamoya vasculopathy patient cohort. Symptomatic patients with Moyamoya vasculopathy treated at the Clinical Neuroscience Center of the University Hospital Zurich who underwent hemodynamic and flow imaging (BOLD-CVR and qMRA-NOVA) before and after bypass were included in the analysis. Reduced hemispheric volume flow rates, as well as impaired BOLD-CVR, were measured in all 12 patients with Moyamoya vasculopathy before STA-MCA bypass surgery. Following the surgical procedure, post-operative BOLD-CVR demonstrated a non-significant increase in BOLD-CVR values within the revascularized, symptomatic middle cerebral artery territory and cerebral hemisphere. The results of the statistical tests should be viewed as indicative due to the small sample size. Additionally, post-operative qMRA-NOVA revealed a significant improvement in the hemispheric volume flow rate of the affected hemisphere due to the additional bypass flow rate. Our findings affirm the presence of hemodynamic and flow impairments in the symptomatic hemisphere of the Moyamoya vasculopathy patients. Bypass surgery proves effective in improving both BOLD-CVR impairment and the hemispheric volume flow rate in our patient cohort. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

50. Pia-FLOW: Deciphering hemodynamic maps of the pial vascular connectome and its response to arterial occlusion.

Author

Glück, Chaim, Quanyu Zhou, Droux, Jeanne, Zhenyue Chen, Glandorf, Lukas, Wegener, Susanne, Razansky, Daniel, Weber, Bruno, and El Amki, Mohamad

Subjects
ARTERIAL occlusions, HEMODYNAMICS, FLUID dynamics, FLOW velocity, BONE marrow
Abstract

The pial vasculature is the sole source of blood supply to the neocortex. The brain is contained within the skull, a vascularized bone marrow with a unique anatomical connection to the brain meninges. Recent developments in tissue clearing have enabled detailed mapping of the entire pial and calvarial vasculature. However, what are the absolute flow rate values of those vascular networks? This information cannot accurately be retrieved with the commonly used bioimaging methods. Here, we introduce Pia-FLOW, a unique approach based on large-scale transcranial fluorescence localization microscopy, to attain hemodynamic imaging of the whole murine pial and calvarial vasculature at frame rates up to 1,000 Hz and spatial resolution reaching 5.4 µm. Using Pia-FLOW, we provide detailed maps of flow velocity, direction, and vascular diameters which can serve as ground-truth data for further studies, advancing our understanding of brain fluid dynamics. Furthermore, Pia-FLOW revealed that the pial vascular network functions as one unit for robust allocation of blood after stroke. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results