SVD와 Bayesian 알고리즘을 이용한 뇌경색 부피 측정에 관한 연구

김도훈(Do-Hun Kim),이효영(Hyo-Young Lee) 한국방사선학회 2021 한국방사선학회 논문지 Vol.15 No.5

급성 허혈성 뇌졸중(Acute ischemic stroke; AIS) 환자는 증상발현 수 시간 이내 영상의학 검사를 통해 뇌경색(Infarction)을 조기 진단하여야 한다. 본 연구에서 SVD와 Bayesian 알고리즘을 이용한 뇌경색의 부피 측정을 관류 전산화단층촬영(Computed tomography perfusion; CTP)과 확산 강조 자기공명영상(Magnetic resonance diffusion weighted image; MR DWI)을 비교하여 임상적 유용성을 알고자 하였다. 2017년 9월부터 2020년 9월까지 급성 허혈성 뇌졸중 증상으로 응급실을 내원한 환자 중 50명(남 : 여 = 33 : 17)의 영상의학 검사 정보를 후향적으로 이용하였다. SVD와 Bayesian 알고리즘으로 측정된 뇌경색 부피는 윌콕슨 부호순위 검정(Wilcoxon signed rank test) 통계분석을 하여 중앙값(Median)과 사분위수(Iter quartile range; IQR) 25 - 75 % 범위로 나타내었다. CTP 검사로 측정한 core volume(단위 : cc)은 SVD가 18.07 (7.76 - 33.98), Bayesian은 47.3 (23.76 - 79.11)으로 측정되었고 penumbra volume은 SVD가 140.24 (117.8 - 176.89), Bayesian은 105.05 (72.52 - 141.98)로 측정되었다. Mismatch ratio (%)는 SVD가 7.56 (4.36 - 15.26), Bayesian은 2.08 (1.68 - 2.77)로 측정되었으며 모든 측정값은 통계적으로 유의미한 차이가 있었다(p < 0.05). 스피어만 상관 분석(Spearman’s correlation analysis) 결과는 CT Bayesian과 MR로 측정한 뇌경색 부피의 상관계수(r = 0.915)가 CT SVD와 MR의 상관계수(r = 0.763)보다 더욱 높은 양의 상관관계를 보였다(p < 0.01). 블랜드 알트만 산점도(Bland altman plot) 분석 결과는 CT Bayesian과 MR로 측정한 뇌경색 부피의 산점도 기울기(y = – 0.065)가 CT SVD와 MR의 산점도 기울기(y = – 0.749)보다 완만하게 측정되어 Bayesian이 더 높은 신뢰성을 나타내었다. 따라서 뇌경색 부피의 측정에서 Bayesian 알고리즘이 SVD보다 높은 정확도를 보였으므로 임상에서 유용하게 사용될 것으로 사료된다. Acute ischemic stroke(AIS) should be diagnosed within a few hours of onset of cerebral infarction symptoms using diagnostic radiology. In this study, we evaluated the clinical usefulness of SVD and the Bayesian algorithm to measure the volume of cerebral infarction using computed tomography perfusion(CTP) imaging and magnetic resonance diffusion-weighted imaging(MR DWI). We retrospectively included 50 patients (male : female = 33 : 17) who visited the emergency department with symptoms of AIS from September 2017 to September 2020. The cerebral infarct volume measured by SVD and the Bayesian algorithm was analyzed using the Wilcoxon signed rank test and expressed as a median value and an interquartile range of 25 - 75 %. The core volume measured by SVD and the Bayesian algorithm using was CTP imaging was 18.07 (7.76 - 33.98) cc and 47.3 (23.76 - 79.11) cc, respectively, while the penumbra volume was 140.24 (117.8 - 176.89) cc and 105.05 (72.52 - 141.98) cc, respectively. The mismatch ratio was 7.56 % (4.36 - 15.26 %) and 2.08 % (1.68 - 2.77 %) for SVD and the Bayesian algorithm, respectively, and all the measured values ​​had statistically significant differences (p < 0.05). Spearman’s correlation analysis showed that the correlation coefficient of the cerebral infarct volume measured by the Bayesian algorithm using CTP imaging and MR DWI was higher than that of the cerebral infarct volume measured by SVD using CTP imaging and MR DWI (r = 0.915 vs. r = 0.763 ; p < 0.01). Furthermore, the results of the Bland Altman plot analysis demonstrated that the slope of the scatter plot of the cerebral infarct volume measured by the Bayesian algorithm using CTP imaging and MR DWI was more steady than that of the cerebral infarct volume measured by SVD using CTP imaging and MR DWI (y = -0.065 vs. y = -0.749), indicating that the Bayesian algorithm was more reliable than SVD. In conclusion, the Bayesian algorithm is more accurate than SVD in measuring cerebral infarct volume. Therefore, it can be useful in clinical utility.

Cerebral infarct volume measurements to improve patient selection for endovascular treatment

Han, Miran,Choi, Jin Wook,Rim, Nae-Jung,Kim, Sun Yong,Suh, Hong-Il,Lee, Kyu Sun,Hong, Ji Man,Lee, Jin Soo Williams & Wilkins Co 2016 Medicine Vol.95 No.35

<▼1><P>Supplemental Digital Content is available in the text</P></▼1><▼2><P><B>Abstract</B></P><P>Patients who have large cerebral infarctions may not be good candidates for endovascular treatment. Various methods for determining infarct volume have been used in clinical studies. We evaluated the effectiveness of several methods for measuring infarct volume, especially regarding futile outcomes despite endovascular treatment.</P><P>Patients with acute ischemic stroke in unilateral anterior circulation territory who were treated with intra-arterial thrombectomy were included. For assessing infarct volume, the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) scoring system was applied to images obtained by noncontrast computed tomography (NCCT), postcontrast CT (PCCT), and diffusion-weighted imaging (DWI). DWI stroke volume was semiquantitatively measured with the manually outlined hyperintense lesion. Infarct core volume was calculated with a threshold apparent diffusion coefficient value of 600 × 10<SUP>–6</SUP> mm<SUP>2</SUP>/s. Intraclass correlation coefficients (ICC) were estimated to assess inter-reader reliability for ASPECTS scoring and DWI stroke volume. Receiver operating characteristic (ROC) curve analyses, and univariable and multivariable comparative analyses, were performed with each evaluation method to predict futile outcome (modified Rankin Scale score 5–6).</P><P>The mean age of the included 79 patients was 65.1 ± 15.7 years. Among them, 55 (69.6%) patients demonstrated successful reperfusion after intra-arterial thrombectomy, but 34 (43.0%) patients had futile outcomes. Inter-reader agreement was excellent for measurement of the DWI stroke volume (ICC, 0.973), DWI ASPECTS (0.940), and PCCT ASPECTS (0.859), but was moderate for NCCT ASPECTS (0.694). Regarding prediction of futile outcomes, area under ROC curve was 0.551 on NCCT ASPECTS and it was significantly smaller than that in PCCT ASPECTS (area under ROC 0.651, <I>P</I> = 0.030), DWI ASPECTS (0.733, <I>P</I> = 0.003), DWI stroke volume (0.702, <I>P</I> = 0.022), and infarct core volume (0.702, <I>P</I> = 0.021). Besides old age and high National Institutes of Health Stroke Scale score on admission, MRI parameters such as DWI ASPECTS and infarct core volume indicating large volumes were independently associated with futile outcomes in multivariable analyses.</P><P>DWI ASPECTS can be a good parameter predicting futility, which is easily measured and has high prediction power.</P></▼2>

Semi-Quantitative Analyses of Hippocampal Heat Shock Protein-70 Expression Based on the Duration of Ischemia and the Volume of Cerebral Infarction in Mice

Choi, Jong-Il,Kim, Sang-Dae,Kim, Se-Hoon,Lim, Dong-Jun,Ha, Sung-Kon The Korean Neurosurgical Society 2014 Journal of Korean neurosurgical society Vol.55 No.6

Objective : We investigated the expression of hippocampal heat shock protein 70 (HSP-70) infarction volume after different durations of experimental ischemic stroke in mice. Methods : Focal cerebral ischemia was induced in mice by occluding the middle cerebral artery with the modified intraluminal filament technique. Twenty-four hours after ischemia induction, both hippocampi were extracted for HSP-70 protein analyses. Slices from each hemisphere were stained with 2,3,5-triphenyltetrazolium chloride (2%), and infarction volumes were calculated. HSP-70 levels were evaluated using western blot and enzyme-linked immunosorbent assay (ELISA). HSP-70 subtype (hsp70.1, hspa1a, hspa1b) mRNA levels in the hippocampus were measured using reverse transcription-polymerase chain reaction (RT-PCR). Results : Cerebral infarctions were found ipsilateral to the occlusion in 10 mice exposed to transient ischemia (5 each in the 30-min and 60-min occlusion groups), whereas no focal infarctions were noted in any of the sham mice. The average infarct volumes of the 2 ischemic groups were $22.28{\pm}7.31mm^3$ [30-min group${\times}$standard deviation (SD)] and $38.06{\pm}9.53mm^3$ (60-min group${\times}$SD). Western blot analyses and ELISA showed that HSP-70 in hippocampal tissues increased in the infarction groups than in the sham group. However, differences in HSP-70 levels between the 2 infarction groups were statistically insignificant. Moreover, RT-PCR results demonstrated no relationship between the mRNA expression of HSP-70 subtypes and occlusion time or infarction volume. Conclusion : Our results indicated no significant difference in HSP-70 expression between the 30- and 60-min occlusion groups despite the statistical difference in infarction volumes. Furthermore, HSP-70 subtype mRNA expression was independent of both occlusion duration and cerebral infarction volume.

Impact of Hospital Volume of Percutaneous Coronary Intervention (PCI) on In-Hospital Outcomes in Patients with Acute Myocardial Infarction: Based on the 2014 Cohort of the Korean Percutaneous Coronary Intervention (K-PCI) Registry

Byong-Kyu Kim,Deuk-Young Nah,Kang Un Choi,Jun-Ho Bae,Moo-Yong Rhee,Jae-Sik Jang,Keon-Woong Moon,Jun-Hee Lee,Hee-Yeol Kim,Seung-Ho Kang,Woo hyuk Song,Seung-Uk Lee,Byung-Ju Shim,Hangjae Chung,Min Su Hyo 대한심장학회 2020 Korean Circulation Journal Vol.50 No.11

Background and Objectives: The relationship between the hospital percutaneous coronary intervention (PCI) volumes and the in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) remains the subject of debate. This study aimed to determine whether the in-hospital clinical outcomes of patients with AMI in Korea are significantly associated with hospital PCI volumes. Methods: We selected and analyzed 17,121 cases of AMI, that is, 8,839 cases of non-ST-segment elevation myocardial infarction and 8,282 cases of ST-segment elevation myocardial infarction, enrolled in the 2014 Korean percutaneous coronary intervention (K-PCI) registry. Patients were divided into 2 groups according to hospital annual PCI volume, that is, to a high-volume group (≥400/year) or a low-volume group (<400/year). Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as composites of death, cardiac death, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and need for urgent PCI during index admission after PCI. Results: Rates of MACCE and non-fatal MI were higher in the low-volume group than in the high-volume group (MACCE: 10.9% vs. 8.6%, p=0.001; non-fatal MI: 4.8% vs. 2.6%, p=0.001, respectively). Multivariate regression analysis showed PCI volume did not independently predict MACCE. Conclusions: Hospital PCI volume was not found to be an independent predictor of in-hospital clinical outcomes in patients with AMI included in the 2014 K-PCI registry.

급성 심근경색후 좌심실 기능과 용적의 변화

심완주(Wan Joo Shim),안태훈(Tae Hoon Ahn),김영훈(Young Hoon Kim),노영무(Young Moo Ro) 대한내과학회 1991 대한내과학회지 Vol.41 No.6

To assess changes of left ventricular size and function after acute myocardial infarction, 15 patients with acute myocardial infarction were studied by 2-D echocardiogram. The left ventricular volume and extent of regional wall motion abnormality were calculated using measurements from the 2-D echocardiogram at entry and at 7 days and 2 months after acute myocardial infarction. The left ventricular volume increased from 124+40ml at entry to 143+24ml at 2 months after acute myocardial infarction in 5 patients (33.3%). The location of the infarction was the anterior wall in all of these 5 patients, who had a greater infarct area than those who had normal left ventricular volume at 2 months (p=0.07). The timing of the left ventricular dilatation after acute myocardial infarction was different in each of these 5 patients. The rest of the 10 patients (66.7%) exhibited either no change of a decrease in left ventricular volume. The wall motion score decreased from 6.2+2.9 at entry to 5.2+2.8 at 2 months (p<0.05) with no con-comitent improvement of gloval left ventricular function. No relation was demonstrated between the ejection fraction at entry and the left ventricular dilation at 2 months, Thus, left ventricular dilation after acute myocardial infarction occurs mainly in anterior wall infarction and is related to the extent of the infarct area at entry. Initial left ventricular function (ejection fraction) does not predict left ventricular dilatation 2 months after acute myocardial infarction.

Estimation of Acute Infarct Volume with Reference Maps: A Simple Visual Tool for Decision Making in Thrombectomy Cases

Kim, Dong-Eog,Ryu, Wi-Sun,Schellingerhout, Dawid,Jeong, Han‐,Gil,Kim, Paul,Jeong, Sang-Wuk,Park, Man-Seok,Choi, Kang-Ho,Kim, Joon-Tae,Kim, Beom Joon,Han, Moon-Ku,Lee, Jun,Cha, Jae-Kwan,Kim, Dae- Korean Stroke Society 2019 Journal of stroke Vol.21 No.1

<P><B>Background and Purpose</B></P><P>Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. </P><P><B>Methods</B></P><P>We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. </P><P><B>Results</B></P><P>The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis –15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes (<21, <31, and <51 mL) were very high (all about >90%). </P><P><B>Conclusions</B></P><P>We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.</P>

Effect of Operator Volume on In-Hospital Outcomes Following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction: Based on the 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry

Jung-Hee Lee,엄상용,Ung Kim,Chan-Hee Lee,Jang-Won Son,Dong Woon Jeon,Jang-Ho Bae,Seok Kyu Oh,Kwang Soo Cha,Yongsung Suh,Young Youp Koh,Tae-Hyun Yang,Dae keun Shim,Jang-Whan Bae,JongSeonPark 대한심장학회 2020 Korean Circulation Journal Vol.50 No.2

Background and Objectives: The relationship between operator volume and outcomes of percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) has not been fully investigated. We aimed to investigate the relationship between operator PCI volume and in-hospital outcomes after primary PCI for STEMI. Methods: Among the total of 44,967 consecutive cases of PCI enrolled in the Korean nationwide, retrospective registry (K-PCI registry), 8,282 patients treated with PCI for STEMI by 373 operators were analyzed. PCI volumes above the 75th percentile (>30 cases/year), between the 75th and 25th percentile (10–30 cases/year), and below the 25th percentile (<10 cases/year) were defined as high, moderate, and low-volume operators, respectively. In-hospital outcomes including mortality, non-fatal myocardial infarction (MI), stent thrombosis, stroke, and urgent repeat PCI were analyzed. Results: The average number of primary PCI cases performed by 373 operators was 22.2 in a year. In-hospital mortality after PCI for STEMI was 571 cases (6.9%). In-hospital outcomes by operator volume showed no significant differences in the death rate, cardiac death, non-fatal MI, and stent thrombosis. However, the rate of urgent repeat PCI tended to be lower in the high-volume operator (0.6%) than in the moderate-(0.7%)/low-(1.5%) volume operator groups (p=0.095). The adjusted odds ratios for adverse in-hospital outcomes were similar in the 3 groups. Multivariate analysis also showed that operator volume was not a predictor for adverse in-hospital outcomes. Conclusions: In-hospital outcomes after primary PCI for STEMI were not associated with operator volume in the K-PCI registry.

S100ß, Matrix Metalloproteinase-9, D-dimer, and Heat Shock Protein 70 Are Serologic Biomarkers of Acute Cerebral Infarction in a Mouse Model of Transient MCA Occlusion

Choi, Jong-Il,Ha, Sung-Kon,Lim, Dong-Jun,Kim, Sang-Dae,Kim, Se-Hoon The Korean Neurosurgical Society 2018 Journal of Korean neurosurgical society Vol.61 No.5

Objective : Diagnosing acute cerebral infarction is crucial in determining prognosis of stroke patients. Although many serologic tests for prompt diagnosis are available, the clinical application of serologic tests is currently limited. We investigated whether $S100{\beta}$, matrix metalloproteinase-9 (MMP-9), D-dimer, and heat shock protein 70 (HSP70) can be used as biomarkers for acute cerebral infarction. Methods : Focal cerebral ischemia was induced using the modified intraluminal filament technique. Mice were randomly assigned to 30-minute occlusion (n=10), 60-minute occlusion (n=10), or sham (n=5) groups. Four hours later, neurological deficits were evaluated and blood samples were obtained. Infarction volumes were calculated and plasma $S100{\beta}$, MMP-9, D-dimer, and HSP70 levels were measured using enzyme-linked immunosorbent assay. Results : The average infarction volume was $12.32{\pm}2.31mm^3$ and $46.9{\pm}7.43mm^3$ in the 30- and 60-minute groups, respectively. The mean neurological score in the two ischemic groups was $1.6{\pm}0.55$ and $3.2{\pm}0.70$, respectively. $S100{\beta}$, MMP-9, and HSP70 expressions significantly increased after 4 hours of ischemia (p=0.001). Furthermore, $S100{\beta}$ and MMP-9 expressions correlated with infarction volumes (p<0.001) and neurological deficits (p<0.001). There was no significant difference in D-dimer expression between groups (p=0.843). The area under the receiver operating characteristic curve (AUC) showed high sensitivity and specificity for MMP-9, HSP70 (AUC=1), and $S100{\beta}$ (AUC=0.98). Conclusion : $S100{\beta}$, MMP-9, and HSP70 can complement current diagnostic tools to assess cerebral infarction, suggesting their use as potential biomarkers for acute cerebral infarction.

양격산화탕(凉膈散火湯)이 고지혈증 흰쥐의 중대뇌동맥 폐쇄에 의한 뇌경색에 미치는 영향

오경환,이원철,Oh, Kyung-Hwan,Lee, Won-Chul 대한한방내과학회 2006 大韓韓方內科學會誌 Vol.27 No.4

Objectives : Yanggyuksanhwa-tang is a prescription used for cerebral infarction clinically it is known that this formula reduces body fat, serum cholesterol and triglyceride in hyperglycemia and obesity patients. According to previous research data, controlling these types of lipid is considered to decrease the risk of cerebral infarction. Based on this fact, we investigated the relationship between hyperlipidemia and cerebral infarction, and the effect of Yanggyuksanhwa-tang on hyperlipidemic cerebral infarction. Methods : We induced cerebral infarction by middle cerebral artery occlusion (MCAO) in high-fat diet rats, and the rats were administered Yanggyuksanhwa-tang. Results : Infarct area and serum lipid were measured, and the level of elements such as c-Fos, Bax and caspase-3 in penumbra of infarct were expressed by immunohistochemical staining. Conclusions : Yanggyuksanhwa-tang showed neuroprotective effect through preventing neuronal cell apoptosis as well as reducing serum lipid level in hyperlipidemic condition.

3.0T 심장 MRI검사에서 cardiac infarct volume 측정을 위한 검사기법과 측정 방법에 대한 고찰

손대영,정재윤,전현수,조성봉,민관홍 대한자기공명기술학회 2015 대한자기공명기술학회지 Vol.25 No.-