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Abstract Details

Enhanced Detection of Reversible Acute Ischemic Stroke: High-resolution Mapping of Net Water Uptake as a Tissue Clock in Non-contrast Computed Tomography Scans
Cerebrovascular Disease and Interventional Neurology
P11 - Poster Session 11 (5:30 PM-6:30 PM)
5-022

Non-contrast computed tomography (NCCT) is typically the initial imaging study for suspected acute ischemic stroke but lacks sensitivity for detecting early ischemia. Net water uptake (NWU) measurement can characterize the ischemic core but is limited by the need CT perfusion. This study introduces an innovative artificial intelligence (AI) method to generate high-resolution NWU maps from NCCT and demonstrates its utility in visualizing potentially reversible acute ischemic stroke.

Evaluate the efficacy of AI-generated net water uptake (NWU) maps in early detection of ischemic stroke and prediction of lesion reversal.

From a mechanical thrombectomy (MT) registry, patients with TICI 2b-3 recanalization were included. Z-score and NWU maps were derived from AI-denoised NCCT scans and visible ischemic tissue was labeled. For each lesion, reversal after intervention was determined and a NWU value was calculated by the difference in median lesion NWU with contralateral healthy tissue. The association of NWU with lesion reversal was assessed through univariate and multivariate analysis.

This study analyzed 116 distinct ischemic lesions from 52 patients. 29 lesions became undetectable on post-intervention imaging and 81 of the lesions were only detectable with the addition of NWU map compared to NCCT alone. In reversed lesions, NWU values were significantly lower (6.95% vs. 8.64%, p = 0.03) with the highest NWU observed being 15.7%. In multivariate analysis, higher NWU values were negatively associated with lesion reversal (Odds Ratio: 0.04 [0.00 – 0.66]), when adjusted for tPA administration and time delay between NCCT and MT (c-index: 0.66). Shapley analysis of the random forest classifier found that NWU was the most significant predictive feature for lesion reversal.

High-resolution NWU maps significantly improve visualization of early ischemia that is challenging to detect on NCCT. Lesion-specific NWU values suggest reversibility of ischemic lesions at higher values than previously reported. Validation in large patient cohorts is ongoing. 

Authors/Disclosures
Timea M. Hodics, MD (Houston Methodist Hospital)
PRESENTER
An immediate family member of Dr. Hodics has received personal compensation for serving as an employee of CRG. An immediate family member of Dr. Hodics has stock in Approximately 40 public and private companies . An immediate family member of Dr. Hodics has received intellectual property interests from a discovery or technology relating to health care.
No disclosure on file
Jonathon Cummock Dr. Cummock has nothing to disclose.
No disclosure on file
John J. Volpi, MD Dr. Volpi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovaSignal. Dr. Volpi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for W.L. Gore. Dr. Volpi has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Diamedica. Dr. Volpi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Janssen. Dr. Volpi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Amgen. Dr. Volpi has received intellectual property interests from a discovery or technology relating to health care.
Stephen T. Wong, PhD (Houston Methodist Hospital) Prof. Wong has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elservier. The institution of Prof. Wong has received research support from NIH. The institution of Prof. Wong has received research support from Cure Alzheimer's Fund. The institution of Prof. Wong has received research support from Ting Tsung And Wei Fong Chao Foundation. The institution of Prof. Wong has received research support from John S Dunn Research Foundation. Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Chair of Review Panel with Canada Biomedical Research Fund and Biosciences Research Infrastructure Fund . Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Review Panel Member with DOD, CDMRP Prostate Cancer Research Program, . Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Review Panel Member with American Institute of Biological Science (AIBS) . Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Review Panel Member with DOD CDMRP Breast Cancer Research Program. Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Review Panel Member with DOD Combat Readiness-Medical Research Program (CRRP) Combat Care Delivery. Prof. Wong has received personal compensation in the range of $0-$499 for serving as a ERC Starting Grant review panel with European Commission. Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Grant Review Panel member with American Association for Cancer Research. Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Grant reviewer with Cure Alzheimer's Fund. Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Grant reviewer with Cancer Research Society, Canada. Prof. Wong has received personal compensation in the range of $0-$499 for serving as a Center Grant reviewer with Science Foundation Ireland .