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Prediction of Intracranial Atherosclerotic Disease in Emergent Large Vessel Occlusion
- Subtitle
- Based on Novel Perfusion Imaging Parameters
- Author(s)
- 고승연
- Alternative Author(s)
- Seungyon Koh
- Advisor
- 이진수, 박범희
- Department
- 일반대학원 의학과
- Publisher
- The Graduate School, Ajou University
- Publication Year
- 2022-02
- Language
- eng
- Keyword
- cerebral blood volume; emergent large vessel occlusion; intracranial atherosclerotic disease; perfusion map
- Alternative Abstract
- Background and purpose In this era of endovascular treatment (EVT) as a standard of care for emergent large vessel occlusion (ELVO), identifying the underlying etiologies of ELVO has become essential in regards to the diagnostic and therapeutic strategies. The current study explores the clinical and radiological point-of-care factors observed in ELVO, with particular attention to the cerebral blood volume (CBV) state in the pre-treatment perfusion map. This study focuses on the magnetic resonance perfusion map (MRP) CBV as an imaging biomarker to predict the underlying intracranial atherosclerotic disease (ICAD) as the occlusion etiology, on the hypothesis that CBV can represent the distinctive vascular reservoir and infarct burden in ICAD ELVO. Materials and Methods From a prospectively collected stroke registry, anterior circulation unilateral ELVO were selected and analyzed. Clinical, laboratory and imaging variables were extracted from the registry. The MRP CBV variables were classified into two categories: increased CBV and decreased CBV. Increased CBV variables were then classified into two subcategories: CBV within the oligemic area (CBVolig) and within the occluded vessel's ipsilateral hemisphere (CBVhemi). The CBVolig and CBVhemi variables were respectively graded as increased or not increased. In PART I, the clinical, radiological, and etiological characteristics of the patients with different CBV states are discussed. A comparative analysis between the ICAD and no-ICAD groups was performed to determine whether the features extracted from the analysis on the CBV states reflect the actual characteristics of the ICAD group in our patient cohort. PART II addresses the generation of prediction models for ICAD in anterior circulation ELVO using the above discussed point-of-care characteristics. For the generation of the prediction models, two different statistical approaches were utilized: Conventional logistic regression analysis and machine learning technique (least absolute shrinkage and selection operator, LASSO). PART III provides the role of CBV beyond the classifier of occlusion etiology. In the subgroups of the stroke population, the association on the CBV and various clinically important variables, including the neurological state and functional outcome of stroke treatment, are discussed. Results In PART I, ELVO with increased CBVolig, increased CBVhemi, and no-change in decreased CBV share multiple characteristics that are suggestive of ICAD ELVO: Less A-fib, more smokers, milder neurological deficit, lower infarct volume, and truncal-type occlusions. In our patient cohort, the ICAD ELVO group shows higher frequencies of above CBV states. Univariable diagnostic performance for ICAD is strongest in no-change in decreased CBV. Independent association with ICAD is seen in increased CBVolig and no-change in decreased CBV. In PART II, utilizing the clinical, laboratory, radiological parameters including the newly collected CBV variables, three prediction models could be generated. These models showed good to excellent prediction performances for ICAD ELVO. There was no significant difference among the models. In PART III, the role of increased CBVolig and no-change in decreased CBV within the subgroups of ELVO were explored. In the ICAD group, the increased CBVolig group showed a higher rate of smokers. Increased CBVolig groups showed milder neurological deficits and better functional outcomes. In the cardioembolic group, no difference in demographical, laboratory parameters was seen between groups. Discussion The current study showed that pre-treatment CBV state identified in MRP, along with other clinical point-of-care factors, is significantly associated with ICAD ELVO. Also, using the CBV state as an imaging biomarker, prediction of ICAD as the ELVO etiology can be successfully achieved. The role of CBV within the etiological subgroups of ELVO provides hints on the collateralization in stroke. Future studies focusing on the objective measurement of CBV and conceptual validation are warranted.
- Fulltext
- Appears in Collections:
- Graduate School of Ajou University > Department of Medicine > 3. Theses(Master)
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