Prognostic Value of Venous Outflow Profiles on Multiphase CT Angiography for the Patients with Acute Ischemic Stroke After Endovascular Thrombectomy.

To evaluate the prognostic value of venous outflow (VO) profiles evaluated on multiphase CTA (mCTA) for the patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). We retrospectively collected 150 patients with AIS who underwent pre-treatment CT perfusion (CTP) evaluation and subsequent EVT from April 2018 to April 2022. Three-phases (peak arterial phase, peak venous phase, late venous phase) CTA was reconstructed from CTP raw data, and VO was evaluated on three-phases CTA, respectively. Favorable VO was regarded as a cortical vein opacification score of 3-6, and unfavorable VO as a score of 0-2. Good outcome was defined as modified Rankin Scale score of 0-2 at 90 days after EVT. Multivariate logistic regression analysis was performed to explore the predictors of good outcome. Prognostic value was assessed and compared using receiver operating characteristic (ROC) curves and Delong test. We found that good outcome was achieved in 85 (56.7%) patients. Among the mCTA-derived VO profiles, only favorable peak venous phase VO was found to be independently associated with good outcome (P < 0.001). After integrating favorable peak venous phase VO with lower post-treatment National Institute of Health Stroke Scale score at 24 hours, successful recanalization and favorable hypoperfusion intensity ratio, the predictive ability for a good outcome was significantly improved than before (area under the ROC curve; 0.947 vs 0.881; P = 0.002). This study supports that favorable peak venous VO profiles on mCTA might be a promising biomarker in predicting the good outcome in patients with AIS after EVT.

Potential Approach to Quantifying the Volume of the Ischemic Core in Truncated Computed Tomography Perfusion Scans: A Preliminary Study.

OBJECTIVE: This study aimed to provide an alternative approach for quantifying the volume of the ischemic core (IC) if truncation of computed tomography perfusion (CTP) occurs in clinical practice. METHODS: Baseline CTP and follow-up diffusion-weighted imaging (DWI) data from 88 patients with stroke were retrospectively collected. CTP source images (CTPSI) from the unenhanced phase to the peak arterial phase (CTPSI-A) or the peak venous phase (CTPSI-V) were collected to simulate the truncation of CTP in the arterial or venous phases, respectively. The volume of IC on CTPSI-A (VCTPSI-A) or CTPSI-V (VCTPSI-V) was defined as the volume of the brain tissue with >65% reduction in attenuation compared with that of the normal tissue. The volume of IC on the baseline CTP (VCTP) was defined as a relative cerebral blood flow of <30% of that in the normal tissue. The volume of the posttreatment infarct on the follow-up DWI (VDWI) image was manually delineated and calculated. One-way analysis of variance, Bland-Altman plots, and Spearman correlation analyses were used for the statistical analysis. RESULTS: VCTPSI-A was significantly higher than VDWI (P < 0.001); however, no significant difference was observed between VCTP and VDWI (P = 0.073) or between VCTPSI-V and VDWI (P > 0.999). The mean differences between VDWI and VCTPSI-V, VDWI and VCTP, and VDWI and VCTPSI-A were 1.70 mL (limits of agreement [LoA], -56.40 to 59.70), 8.30 mL (LoA, -40.70 to 57.30), and -68.10 mL (LoA, -180.90 to 44.70), respectively. Significant correlations were observed between VDWI and VCTP (r = 0.68, P < 0.001) and between VDWI and VCTPSI-V (r = 0.39, P < 0.001); however, no significant correlation was observed between VDWI and VCTPSI-A (r = 0.20, P = 0.068). CONCLUSIONS: VCTPSI-V may be a promising method for quantifying the volume of the IC if truncation of CTP occurs.

ANXA1 Promotes Tumor Immune Evasion by Binding PARP1 and Upregulating Stat3-Induced Expression of PD-L1 in Multiple Cancers.

The deregulation of Annexin A1 (ANXA1), a regulator of inflammation and immunity, leads to cancer growth and metastasis. However, whether ANXA1 is involved in cancer immunosuppression is still unclear. Here, we report that ANXA1 knockdown (i) dramatically downregulates programmed cell death-ligand 1 (PD-L1) expression in breast cancer, lung cancer, and melanoma cells; (ii) promotes T cell-mediated killing of cancer cells in vitro; and (iii) inhibits cancer immune escape in immune-competent mice via downregulating PD-L1 expression and increasing the number and killing activity of CD8+ T cells. Mechanistically, ANXA1 functioned as a sponge molecule for interaction of PARP1 and Stat3. Specifically, binding of ANXA1 to PARP1 decreased PARP1's binding to Stat3, which reduced poly(ADP-ribosyl)ation and dephosphorylation of Stat3 and thus, increased Stat3's transcriptional activity, leading to transcriptionally upregulated expression of PD-L1 in multiple cancer cells. In clinical samples, expression of ANXA1 and PD-L1 was significantly higher in breast cancer, non-small cell lung cancer, and skin cutaneous melanoma compared with corresponding normal tissues and positively correlated in cancer tissues. Moreover, using both ANXA1 and PD-L1 proteins for predicting efficacy of anti-PD-1 immunotherapy and patient prognosis was superior to using individual proteins. Our data suggest that ANXA1 promotes cancer immune escape via binding PARP1 and upregulating Stat3-induced expression of PD-L1, that ANXA1 is a potential new target for cancer immunotherapy, and combination of ANXA1 and PD-L1 expression is a potential marker for predicting efficacy of anti-PD-1 immunotherapy in multiple cancers.

Effect of sleep ambient music on sleep quality and mental health in college students: a self-controlled study.

To verify the effect of sleep ambient music intervention (SAMI) on sleep quality and mental status of college students, and to further explore the minimum effective duration of SAMI, this study was designed as a pre-and post-intervention self-controlled exploratory study. Participants were subjected to a one-week no-intervention test, then 4 weeks of music intervention followed. Subjective sleep quality data were collected using the Pittsburgh Sleep Quality Index (PSQI); objective sleep quality data were collected with Actigraphy; and mental status data were collected using the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory-II (BDI-II). Data were analyzed and processed using mixed-effects models and repeated measures. The results showed that compared with the no-intervention week, college students' subjective sleep quality, objective sleep onset latency (SOL), trait anxiety, and depression symptom were reduced at week 1; week 2; week 3; week 4 under SAMI; state anxiety of college students at week 3 and week 4 under SAMI were also reduced. And there were differences in sleep quality among college students of different genders too. Compared with females, males had worse sleep efficiency (SE), shorter total sleep time (TST), and more awaking times (AT). In addition, 3 days was the minimum effective length for SAMI to shorten objective SOL, and 2 days was the minimum effective length to shorten the subjective SOL of college students. The findings of this study suggest that SAMI can improve subjective sleep quality, shorten objective SOL, and reduce anxiety and depression in college students. Interventions for more than 3 days had a significant effect on shortening SOL and long-term effects seemed to emerge after 3 weeks.

ASPECTS-based net water uptake outperforms target mismatch for outcome prediction in patients with acute ischemic stroke and late therapeutic window.

OBJECTIVE: To compare the prognostic value of net water uptake (NWU) and target mismatch (TM) on CT perfusion (CTP) in acute ischemic stroke (AIS) patients with late time window. METHODS: One hundred and nine consecutive AIS patients with anterior-circulation large vessel occlusion presenting within 6-24 h from onset/last seen well were enrolled. Automated Alberta Stroke Program Early CT Score-based NWU (ASPECTS-NWU) was calculated from admission CT. The correlation between ASPECTS-NWU and CTP parameters was assessed. Predictors for favorable outcome (modified Rankin Scale score ≤ 2) at 90 days were assessed using logistic regression analysis. The ability of outcome prediction between ASPECTS-NWU and TM (an ischemic core < 70 mL, a mismatch ratio ≥ 1.8, and an absolute difference ≥ 15 mL) was compared using receiver operating characteristic (ROC) curve. RESULTS: A higher level of ASPECTS-NWU was associated with a larger ischemic core (r = 0.66, p < 0.001) and a larger hypoperfusion volume (r = 0.38, p < 0.001). ASPECTS-NWU performed better than TM for outcome stratification (area under the curve [AUC], 0.738 vs 0.583, p = 0.004) and was the only independent neuroimaging marker associated with favorable outcomes compared with CTP parameters (odds ratio, 0.73; 95% confidence interval [CI] 0.62-0.87, p < 0.001). An outcome prediction model including ASPECTS-NWU and clinical variables (National Institutes of Health Stroke Scale scores and age) yielded an AUC of 0.828 (95% CI 0.744-0.893; sensitivity 65.4%; specificity 87.7%). CONCLUSION: ASPECTS-NWU performed better than TM for outcome prediction in AIS patients with late time window and might be an alternative imaging biomarker to CTP for patient selection. CLINICAL RELEVANCE STATEMENT: Automated Alberta Stroke Program Early CT Score-based net water uptake outperforms target mismatch on CT perfusion for the outcome prediction in patients with acute ischemic stroke and can be an alternative imaging biomarker for patient selection in late therapeutic window. KEY POINTS: • A higher ASPECTS-based net water uptake was associated with larger ischemic cores and hypoperfusion volumes on CT perfusion. • ASPECTS-based net water uptake outperformed target mismatch for outcome prediction in acute ischemic stroke with extended therapeutic window. • ASPECTS-based net water uptake can be an alternative biomarker to target mismatch for selecting acute ischemic stroke patients with late therapeutic window.

Combined texture analysis of dynamic contrast-enhanced MRI with histogram analysis of diffusion kurtosis imaging for predicting IDH mutational status in gliomas.

BACKGROUND: Non-invasive detection of isocitrate dehydrogenase (IDH) mutational status in gliomas is clinically meaningful for molecular stratification of glioma; however, it remains challenging. PURPOSE: To investigate the usefulness of texture analysis (TA) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and histogram analysis of diffusion kurtosis imaging (DKI) maps for evaluating IDH mutational status in gliomas. MATERIAL AND METHODS: This retrospective study enrolled 84 patients with histologically confirmed gliomas, comprising IDH-mutant (n = 34) and IDH-wildtype (n = 50). TA was performed for the quantitative parameters derived by DCE-MRI. Histogram analysis was performed for the quantitative parameters derived by DKI. Unpaired Student's t-test was used to identify IDH-mutant and IDH-wildtype gliomas. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to compare the diagnostic performance of each parameter and their combination for predicting the IDH mutational status in gliomas. RESULTS: Significant statistical differences in the TA of DCE-MRI and histogram analysis of DKI were observed between IDH-mutant and IDH-wildtype gliomas (all P < 0.05). Using multivariable logistic regression, the entropy of Ktrans, skewness of Ve, and Kapp-90th had higher prediction potential for IDH mutations with areas under the ROC curve (AUC) of 0.915, 0.735, and 0.830, respectively. A combination of these analyses for the identification of IDH mutation improved the AUC to 0.978, with a sensitivity and specificity of 94.1% and 96.0%, respectively, which was higher than the single analysis (P < 0.05). CONCLUSION: Integrating the TA of DCE-MRI and histogram analysis of DKI may help to predict the IDH mutational status.

Effect of Truncal-Type Occlusion Based on Multiphase or Single-Phase Computed Tomographic Angiography in Predicting Intracranial Atherosclerotic Stenosis-Related Acute Middle Cerebral Artery Occlusion.

OBJECTIVE: To investigate whether truncal-type occlusion based on multiphase computed tomographic angiography (mpCTA) was more effective for predicting intracranial atherosclerotic stenosis-related occlusion (ICAS-O) than occlusion type based on single-phase computed tomographic angiography (spCTA) in patients with acute ischemic stroke with large-vessel occlusion (AIS-LVO) in the middle cerebral artery (MCA). METHODS: Data were retrospectively collected from 72 patients with AIS-LVO in the MCA between January 2018 and December 2019. The occlusion types included truncal-type and branching-site occlusions. The association between ICAS-O and occlusion type based on the 2 computed tomographic angiography patterns was analyzed, and receiver operating characteristic curves were plotted for assessment. The areas under the curve were compared to determine the difference between the predictive powers of truncal-type occlusion based on mpCTA and spCTA. RESULTS: Among the 72 patients, 16 were classified as having ICAS-O and 56 as having embolisms. In univariate analysis, truncal-type occlusion was significantly associated with ICAS-O ( P < 0.001 for mpCTA and P = 0.001 for spCTA). After multivariable analysis, truncal-type occlusion based on both mpCTA and spCTA remained independently associated with ICAS-O ( P = 0.002 for mpCTA and P = 0.029 for spCTA). The areas under the curve were 0.821 for mpCTA and 0.683 for spCTA; this difference was statistically significant ( P = 0.024). CONCLUSIONS: In patients with AIS-LVO in the MCA, truncal-type occlusion based on mpCTA enables more accurate detection of ICAS-O than that based on spCTA.

Diffusion-relaxation correlation spectrum imaging for predicting tumor consistency and gross total resection in patients with pituitary adenomas: a preliminary study.

OBJECTIVE: To evaluate the ability of diffusion-relaxation correlation spectrum imaging (DR-CSI) to predict the consistency and extent of resection (EOR) of pituitary adenomas (PAs). METHODS: Forty-four patients with PAs were prospectively enrolled. Tumor consistency was evaluated at surgery as either soft or hard, followed by histological assessment. In vivo DR-CSI was performed and spectra were segmented following to a peak-based strategy into four compartments, designated A (low ADC), B (mediate ADC, short T2), C (mediate ADC, long T2), and D (high ADC). The corresponding volume fractions ([Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text]) along with the ADC and T2 values were calculated and assessed using univariable analysis for discrimination between hard and soft PAs. Predictors of EOR > 95% were analyzed using logistic regression model and receiver-operating-characteristic analysis. RESULTS: Tumor consistency was classified as soft (n = 28) or hard (n = 16). Hard PAs presented higher [Formula: see text] (p = 0.001) and lower [Formula: see text] (p = 0.013) than soft PAs, while no significant difference was found in other parameters. [Formula: see text] significantly correlated with the level of collagen content (r = 0.448, p = 0.002). Knosp grade (odds ratio [OR], 0.299; 95% confidence interval [CI], 0.124-0.716; p = 0.007) and [Formula: see text] (OR, 0.834, per 1% increase; 95% CI, 0.731-0.951; p = 0.007) were independently associated with EOR > 95%. A prediction model based on these variables yielded an AUC of 0.934 (sensitivity, 90.9%; specificity, 90.9%), outperforming the Knosp grade alone (AUC, 0.785; p < 0.05). CONCLUSION: DR-CSI may serve as a promising tool to predict the consistency and EOR of PAs. CLINICAL RELEVANCE STATEMENT: DR-CSI provides an imaging dimension for characterizing tissue microstructure of PAs and may serve as a promising tool to predict the tumor consistency and extent of resection in patients with PAs. KEY POINTS: • DR-CSI provides an imaging dimension for characterizing tissue microstructure of PAs by visualizing the volume fraction and corresponding spatial distribution of four compartments ([Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text]). • [Formula: see text] correlated with the level of collagen content and may be the best DR-CSI parameter for discrimination between hard and soft PAs. • The combination of Knosp grade and [Formula: see text] achieved an AUC of 0.934 for predicting the total or near-total resection, outperforming the Knosp grade alone (AUC, 0.785).

ANXA1-derived peptide for targeting PD-L1 degradation inhibits tumor immune evasion in multiple cancers.

BACKGROUND: Immune checkpoint inhibitors (ICIs) therapy targeting programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) shows promising clinical benefits. However, the relatively low response rate highlights the need to develop an alternative strategy to target PD-1/PD-L1 immune checkpoint. Our study focuses on the role and mechanism of annexin A1 (ANXA1)-derived peptide A11 degrading PD-L1 and the effect of A11 on tumor immune evasion in multiple cancers. METHODS: Binding of A11 to PD-L1 was identified by biotin pull-down coupled with mass spectrometry analysis. USP7 as PD-L1's deubiquitinase was found by screening a human deubiquitinase cDNA library. The role and mechanism of A11 competing with USP7 to degrade PD-L1 were analyzed. The capability to enhance the T cell-mediated tumor cell killing activity and antitumor effect of A11 via suppressing tumor immune evasion were investigated. The synergistic antitumor effect of A11 and PD-L1 mAb (monoclonal antibody) via suppressing tumor immune evasion were also studied in mice. The expression and clinical significance of USP7 and PD-L1 in cancer tissues were evaluated by immunohistochemistry. RESULTS: A11 decreases PD-L1 protein stability and levels by ubiquitin proteasome pathway in breast cancer, lung cancer and melanoma cells. Mechanistically, A11 competes with PD-L1's deubiquitinase USP7 for binding PD-L1, and then degrades PD-L1 by inhibiting USP7-mediated PD-L1 deubiquitination. Functionally, A11 promotes T cell ability of killing cancer cells in vitro, inhibits tumor immune evasion in mice via increasing the population and activation of CD8+ T cells in tumor microenvironment, and A11 and PD-1 mAb possess synergistic antitumor effect in mice. Moreover, expression levels of both USP7 and PD-L1 are significantly higher in breast cancer, non-small cell lung cancer and skin melanoma tissues than those in their corresponding normal tissues and are positively correlated in cancer tissues, and both proteins for predicting efficacy of PD-1 mAb immunotherapy and patient prognosis are superior to individual protein. CONCLUSION: Our results reveal that A11 competes with USP7 to bind and degrade PD-L1 in cancer cells, A11 exhibits obvious antitumor effects and synergistic antitumor activity with PD-1 mAb via inhibiting tumor immune evasion and A11 can serve as an alternative strategy for ICIs therapy in multiple cancers.

Impact on etiology diagnosis by high-resolution vessel wall imaging in young adults with ischemic stroke or transient ischemic attack.

PURPOSE: The etiological features of stroke in young adults are different from those in older adults. We aimed to investigate the impact of high-resolution vessel wall imaging (HRVWI) on etiologic diagnosis in young adults with ischemic stroke or transient ischemic attack (TIA). METHODS: A total of 253 young adults (aged 18-45 years) who consecutively underwent HRVWI for clarifying stroke etiology were retrospectively recruited. Two experienced neurologists classified stroke etiology for each patient using Trial of Org 10,172 in Acute Stroke Treatment categories with and without the inclusion of HRVWI diagnosis. Multivariate logistic regression was performed to determine which etiologic category would be significantly impacted after including HRVWI. RESULTS: The etiologic classification was altered in 39.1% (99/253) of patients after including HRVWI in the conventional investigations. The proportion of patients classified as having stroke of undetermined etiology (SUE) and the proportion of patients classified as having small-artery occlusion (SAO) both significantly decreased (36.4 to 13.8% and 9.1 to 2.0%), whereas the proportion of patients classified as having large artery atherosclerosis (LAA) significantly increased (28.5 to 58.1%) (all P < 0.001). The inclusion of HRVWI had a significant diagnostic impact on young adults who were primarily classified as SAO (odds ratio [OR] 14.4, 95% confidence interval [CI] [2.9, 71.8], P < 0.001) or SUE (OR 8.3, 95% CI [2.2, 31.5], P < 0.01). CONCLUSIONS: HRVWI had a substantial impact on etiologic classification in young adults with ischemic stroke or TIA, particularly for those primarily classified as having SAO or SUE. This impact of HRVWI will be beneficial for therapeutic decision-making.

Spatial accuracy of computed tomography perfusion to estimate the follow-up infarct on diffusion-weighted imaging after successful mechanical thrombectomy.

BACKGROUND: Volumetric accuracy of using computed tomography perfusion (CTP) to estimate the post-treatment infarct in stroke patients with successful recanalization after mechanical thrombectomy (MT) has been studied a lot, however the spatial accuracy and its influence factors has not been fully investigated. METHODS: This retrospective study reviewed the data from consecutive anterior large vessel occlusion (LVO) patients who had baseline CTP, successful recanalization after MT, and post-treatment diffusion-weighed imaging (DWI). Ischemic core on baseline CTP was estimated using relative cerebral blood flood (CBF) of < 30%. The infarct area was outlined manually on post-treatment DWI, and registered to CTP. Spatial agreement was assessed using the Dice similarity coefficient (DSC) and average Hausdorff distance. According to the median DSC, the study population was dichotomized into high and low Dice groups. Univariable and multivariable regression analyses were used to determine the factors independently associated with the spatial agreement. RESULTS: In 72 included patients, the median DSC was 0.26, and the median average Hausdorff distance was 1.77 mm. High Dice group showed significantly higher median ischemic core volume on baseline CTP (33.90 mL vs 3.40 mL, P < 0.001), lower proportion of moderate or severe leukoaraiosis [27.78% vs 52.78%, P = 0.031], and higher median infarct volume on follow-up DWI (51.17 mL vs 9.42 mL, P < 0.001) than low Dice group. Ischemic core volume on baseline CTP was found to be independently associated with the spatial agreement (OR, 1.092; P < 0.001). CONCLUSIONS: CTP could help to spatially locate the post-treatment infarct in anterior LVO patients who achieving successful recanalization after MT. Ischemic core volume on baseline CTP was independently associated with the spatial agreement.

Use of ABC/2 method for rapidly estimating the target mismatch on computed tomography perfusion imaging in patients with acute ischemic stroke.

BACKGROUND: Target mismatch (ischemic core, mismatch volume and mismatch ratio) in patients with acute ischemic stroke (AIS) highly relies on the automated perfusion analysis software. PURPOSE: To evaluate the feasibility and accuracy of using the ABC/2 method to rapidly estimate the target mismatch on computed tomography perfusion (CTP) imaging in patients with AIS, using RAPID results as a reference. MATERIAL AND METHODS: In total, 243 patients with anterior circulation AIS who underwent CTP imaging were retrospectively reviewed. Target mismatch associated perfusion parameters were derived from RAPID results and calculated using the ABC/2 method. Paired t-test was used to assess the difference of volumetric parameters between the two methods. The ability of using the ABC/2 method to predict the important cutoff volumetric metrics was also evaluated. RESULT: There was no significant difference in the volumes of ischemic core (P = 0.068), ischemic area (P = 0.209), and mismatch volume (P = 0.518) between ABC/2 and RAPID. Using RAPID results as reference, the ABC/2 method showed high accuracy for predicting perfusion parameters (70 mL and 90 mL: sensitivity=98.5% and 98.5%, specificity=100% and 100%, positive predictive value [PPV]=100% and 100%, negative predictive value [NPV]=93.8% and 92.9%; 10 mL and 15mL: sensitivity=99.6% and 99.5%, specificity=55.6% and 50.0%, PPV=96.6% and 94.8%, NPV=90.9% and 92.3%; 1.2 and 1.8: sensitivity=99.6% and 94.8%, specificity=75.0% and 96.9%, PPV=98.7% and 99.5%, NPV=90.0% and 73.8%). CONCLUSION: The ABC/2 method may be a feasible alternative to RAPID for estimation of target mismatch parameters on CTP in patients with AIS.

Predictors of ghost infarct core on baseline computed tomography perfusion in stroke patients with successful recanalization after mechanical thrombectomy.

OBJECTIVES: To assess the predictors of ghost infarct core (GIC) in stroke patients achieving successful recanalization after mechanical thrombectomy (MT), based on final infarct volume (FIV) calculated from follow-up diffusion-weighted imaging (DWI). METHODS: A total of 115 consecutive stroke patients who had undergone baseline computed tomography perfusion (CTP) scan, achieved successful recanalization after MT, and finished follow-up DWI evaluation were retrospectively enrolled. Ischemic core volume was automatically generated from baseline CTP, and FIV was determined manually based on follow-up DWI. Stroke-related risk factors and demographic, clinical, imaging, and procedural data were collected and assessed. Univariate and multivariate analyses were applied to identify the predictors of GIC. RESULTS: Of the 115 included patients (31 women and 84 men; median age, 66 years), 18 patients (15.7%) showed a GIC. The GIC group showed significantly shorter time interval from stroke onset to CTP scan and that from stroke onset to recanalization (both p < 0.001), but higher ischemic core volume (p < 0.001), hypoperfused area volume (p < 0.001), mismatch area volume (p = 0.006), and hypoperfusion ratio (p = 0.001) than the no-GIC group. In multivariate analysis, time interval from stroke onset to CTP scan (odds ratio [OR], 0.983; p = 0.005) and ischemic core volume (OR, 1.073; p < 0.001) were independently associated with the occurrence of GIC. CONCLUSIONS: In stroke patients achieving successful recanalization after MT, time interval from stroke onset to CTP and ischemic core volume are associated with the occurrence of GIC. Patients cannot be excluded from MT solely based on baseline CTP-derived ischemic core volume, especially for patients with a shorter onset time. KEY POINTS: • Ghost infarct core (GIC) was found in 15.7% of patients with acute ischemic stroke (AIS) in our study cohort. • GIC was associated with stroke onset time, volumetric parameters derived from CTP, and collateral status indicated by HIR. • Time interval from stroke onset to CTP scan and ischemic core volume were independent predictors of GIC.

CT perfusion with increased temporal sampling interval to predict target mismatch status in patients with acute ischemic stroke.

PURPOSE: To evaluate the feasibility of using CT perfusion (CTP) with increased temporal sampling interval to predict the target mismatch status in acute ischemic stroke (AIS) patients with anterior circular large-vessel occlusion (LVO). METHODS: CTP with a sampling interval of 1.7 s (CTP1.7 s) was scanned in 77 AIS patients for pre-treatment evaluation. Simulated CTP data with sampling interval of 3.4 s (CTP3.4 s) or 5.1 s (CTP5.1 s) were reconstructed, respectively. Target mismatch was defined according to the EXTEND-IA (Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial) and DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke) trial criteria, respectively. Pearson correlation analysis, Mann-Whitney U test, Bland-Altman analysis, and chi-square test were used for statistical analysis as appropriate. RESULTS: Significant correlations were found on the volume of ischemic core, hypo-perfused area, mismatch area, and ratio between CTP1.7 s and CTP3.4 s or CTP5.1 s (all p < 0.001). There was no significant difference on the volume of ischemic core, hypo-perfused area, mismatch area, and mismatch ratio between CTP1.7 s and CTP3.4 s or CTP5.1 s (all p > 0.05). Compared with CTP1.7 s, CTP3.4 s or CTP5.1 s showed comparable performance in predicting the target mismatch status in the AIS patients with LVO (both p > 0.05). CONCLUSIONS: CTPs with increased temporal sampling intervals that lead to reduced radiation doses are feasible and may provide comparable performance in predicting target mismatch status in AIS patients with LVO.

High-resolution magnetic resonance imaging for predicting successful recanalization in patients with chronic internal carotid artery occlusion.

Objective: The main aim of the study was to investigate the predictive factors of high-resolution magnetic resonance imaging (HR-MRI) for successful recanalization in patients with chronic internal carotid artery occlusion (CICAO). Methods: We included 41 consecutive patients who had CICAO and underwent recanalization attempts. The demographics, clinical data, and HR-MRI features in relation to the technique success were collected and analyzed using univariate and multivariate analyses. A score-based prediction model was constructed using a regression coefficient-based scoring method. Results: Technical success was achieved in 26 (63.4%) patients, with a complication rate of 12.2% (5/41). Based on multivariate analysis, occlusions involving ophthalmic artery segment (C6) or above (OR: 0.036; 95% confidence interval [CI]: 0.004-0.336) and nontapered stump (OR: 0.064; 95% CI: 0.007-0.591) were identified as independent negative predictors of successful recanalization in patients with CICAO. Point scores were assigned according to the model coefficients, and the patients who scored 0, 1, or 2 points had success rates of 93.33% (14/15), 66.67% (12/18), or 0% (0/8), respectively. Conclusion: HR-MRI characteristics may be valuable in identifying candidates for endovascular recanalization in patients with CICAO. Occlusions involving the C6 segment or higher, as well as nontapered stumps, were independent negative predictors of technical success.

Temporal changes in plaque characteristics after treatment and their relationship with stroke recurrence: a quantitative study using magnetic resonance imaging.

Background: Intracranial atherosclerotic disease (ICAD) is the major cause of ischemic stroke. Despite aggressive medical therapy, around 15% of patients with ICAD experience recurrence. The aim of the present study was to evaluate the temporal changes in intracranial arteriosclerotic plaques after medical treatment based on vessel wall magnetic resonance imaging (VWMRI) and to explore their relationship with stroke recurrence. Methods: A total of 67 symptomatic patients with ICAD who underwent initial and follow-up VWMRI were recruited into this retrospective cohort study. Stroke recurrence was defined as an ipsilateral stroke symptom after the initial attack. The clinical characteristics and plaque features, including stenosis ratio (measured based on luminal diameter or area), plaque thickness, plaque burden (PB), enhancement ratio (ER), and enhancement grade, were evaluated and compared between the initial and follow-up examinations. Changes in plaque characteristics were compared between patients with or without recurrence by univariable analyses. Multivariable regression was performed to investigate imaging markers for recurrent stroke. Results: The median interval between baseline and follow-up VWMRI was 334 days. A total of 13 cases (19.4%) experienced a stroke recurrence. After treatment, significant decreases in the stenosis ratio (area), PB, and ER were observed in cases without recurrence (all P<0.05), while no significant difference in plaque features was found for cases with recurrence. Univariable analyses showed that changes in stenosis ratio (area), plaque thickness, PB, and ER were significantly different between patients with and without recurrence (all P<0.05). Multivariable regression indicated that PB change was the only significant marker associated with stroke recurrence [odds ratio (OR) =1.112 per 1% increase, 95% confidence interval (CI): 1.010 to 1.224, P=0.031]. Conclusions: Patients with arteriosclerotic plaques who benefit from medical treatment show obvious decreases in stenosis (area), PB, and ER. The progression of PB may serve as an independent marker for predicting stroke recurrence.

ASPECTS-based net water uptake predicts poor reperfusion and poor clinical outcomes in patients with ischemic stroke.

OBJECTIVE: To investigate the value of automated Alberta Stroke Program Early CT Score (ASPECTS)-based net water uptake (NWU) to predict tissue-level reperfusion status and 90-day functional outcomes in acute ischemic stroke (AIS) patients after reperfusion therapy. METHODS: One hundred and twelve patients with AIS who received reperfusion therapy were enrolled. ASPECTS-NWU was calculated from admission CT (NWUadmission) and follow-up CT (NWUFCT), and the difference (ΔNWU) was calculated. Tissue-level reperfusion status was evaluated via follow-up arterial spin labeling imaging. The relationship between ASPECTS-NWU and tissue-level reperfusion was evaluated. Predictors of 90-day unfavorable outcomes (modified Rankin Scale score > 2) were assessed by multivariate logistic regression analysis and receiver operating characteristic (ROC) curves. RESULTS: Poor reperfusion was observed in 40 patients (35.7%) after therapy. Those patients had significantly elevated NWUFCT (median, 14.15% vs. 8.08%, p = 0.018) and higher ΔNWU (median, 4.12% vs. -2.03%, p < 0.001), compared to patients with good reperfusion. High ΔNWU was a significant marker of poor reperfusion despite successful recanalization. National Institutes of Health Stroke Scale score at admission (odds ratio [OR], 1.11; 95% confidence interval [CI] 1.03-1.20, p = 0.007) and ΔNWU (OR, 1.07; 95% CI 1.02-1.13, p = 0.008) were independently associated with unfavorable outcomes. An outcome prediction model including both parameters yields an area under the curve of 0.762 (sensitivity 70.3%, specificity, 84.2%). CONCLUSIONS: Elevated NWUFCT and higher ΔNWU were associated with poor tissue-level reperfusion after therapy. Higher ΔNWU was an independent predictor of poor reperfusion and unfavorable neurological outcomes despite successful recanalization. KEY POINTS: • ASPECTS-NWU may provide pathophysiological information about tissue-level reperfusion status and offer prognostic benefits for patients with AIS after reperfusion therapy. • Elevated NWUFCT and higher ΔNWU were correlated with poor tissue-level reperfusion after therapy. • A higher ΔNWU is an independent predictor of poor reperfusion and 90-day unfavorable outcomes despite successful recanalization.

Comparison of time consumption and success rate between CT angiography- and CT perfusion- based imaging assessment strategy for the patients with acute ischemic stroke.

BACKGROUND: Our study aimed to compare the time consumption and success rate between CTA- and CTP- based assessment strategy, and to clarify the risk factors associated with the CTP scan failure. METHODS: Clinical and radiological data of 437 consecutive AIS patients who underwent multiphase CTA or CTP for pre-treatment evaluation were retrospectively enrolled (CTA group, n = 302; CTP group, n = 135). Time consumption and success rate of CTA- and CTP- based assessment strategy were compared using Mann-Whitney U test and Chi-Squared Test. Univariate analysis and receiver operating curve analysis were used to clarify the risk factors, and their performance in predicting the CTP scan failure. RESULTS: Time consumption of CTP scan and reconstruction was significantly longer than that of CTA [775 s vs 263.5 s, P < 0.001]. CTP scan showed significantly higher failure rate than CTA (11% vs 1%, P < 0.001). Severe motion was the most common cause of CTP failure (n = 12, 80%). Baseline National Institute of Health Stroke Scale (NIHSS) score in CTP failure group was significantly higher than that in CTP success group [17 vs 13, P = 0.007]. Baseline NIHSS score of 11 was the optimal threshold value to predict CTP failure with an area under the curve of 0.715, a sensitivity of 86.7%, and a specificity of 45.0%. CONCLUSIONS: CTP- based strategy showed longer time consumption and higher failure rate than CTA- based strategy. High baseline NIHSS score was significantly associated with CTP scan failure in AIS patients.

Prognostic value of post-treatment fluid-attenuated inversion recovery vascular hyperintensity in ischemic stroke after endovascular thrombectomy.

OBJECTIVES: To explore the value of post-treatment fluid-attenuated inversion recovery vascular hyperintensity (FVH) in predicting clinical outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). METHODS: This retrospective study reviewed data from consecutive patients with large vessel occlusion of anterior circulation between July 2017 and February 2021. Together with other variables, status of post-treatment FVH was assessed for each patient. Good outcome was defined as a 3-month modified Rankin Scale score of 0-2. Chi-square test, Fisher's exact test, independent-samples t test, multivariate logistic regression analysis, and receiver operating characteristic analysis were used as appropriate. RESULTS: Among 84 included patients, 48 (57.1%) patients showed post-treatment FVH. Post-treatment FVH significantly correlated with incomplete recanalization (p < 0.05) and low Alberta Stroke Project Early CT Changes Score on post-treatment diffusion-weighted imaging (p < 0.05). Higher incidence of hemorrhage transformation was observed in patients with post-treatment FVH than those without (27.1% vs. 16.7%); however, the difference did not reach significance (p = 0.259). Successful recanalization (odds ratio [OR], 0.024; 95% confidence interval [CI] 0.003-0.194; p < 0.05), lower National Institutes of Health Stroke Scale scores at admission (NIHSSpre) (OR, 1.196; 95% CI, 1.017-1.406; p < 0.05), and no post-treatment FVH (OR, 74.690; 95% CI, 4.624-1206.421; p < 0.05) were found to be independent predictors of good outcomes. Combined models integrating all three independent predictors (recanalization+NIHSSpre+post-treatment FVH) significantly outperformed the combined model without post-treatment FVH (recanalization+NIHSSpre) in predicting clinical outcome (p = 0.004). CONCLUSIONS: Post-treatment FVH may be an effective prognostic marker associated with clinical outcome in patients with AIS after EVT. KEY POINTS: • Post-treatment FVH correlates with incomplete recanalization and higher infarct volume. • Post-treatment FVH is independently associated with an unfavorable outcome. • Post-treatment FVH may provide prognostic information in patients with AIS after EVT.