Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology: results of the MR CLEAN Registry

Hajo Hund; Nikki Boodt; MR CLEAN Registry Investigators; Nerea Arrarte Terreros; Aladdin Taha; Henk A. Marquering; Adriaan C.G.M. van Es; Reinoud P.H. Bokkers; Geert J. Lycklama à Nijeholt; Charles B.L.M. Majoie; Diederik W.J. Dippel; Hester F. Lingsma; Heleen M.M. van Beusekom; Aad van der Lugt

doi:10.1007/s00330-022-08762-y

Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology: results of the MR CLEAN Registry

Hajo Hund, Nikki Boodt^*, MR CLEAN Registry Investigators, Nerea Arrarte Terreros, Aladdin Taha, Henk A. Marquering, Adriaan C.G.M. van Es, Reinoud P.H. Bokkers, Geert J. Lycklama à Nijeholt, Charles B.L.M. Majoie, Diederik W.J. Dippel, Hester F. Lingsma, Heleen M.M. van Beusekom, Aad van der Lugt

^*Corresponding author for this work

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Abstract

Objectives: Thrombus computed tomography (CT) characteristics might be used to assess histopathologic thrombus composition in patients treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). We aimed to assess the variability in thrombus composition that could be predicted with combined thrombus CT characteristics. Methods: Thrombi of patients enrolled in the MR CLEAN Registry between March 2014 and June 2016 were histologically analyzed with hematoxylin-eosin staining and quantified for percentages of red blood cells (RBCs) and fibrin/platelets. We estimated the association between general qualitative characteristics (hyperdense artery sign [HAS], occlusion location, clot burden score [CBS]) and thrombus composition with linear regression, and quantified RBC variability that could be explained with individual and combined characteristics with R². For patients with available thin-slice (≤ 2.5 mm) imaging, we performed similar analyses for general and quantitative characteristics (HAS, occlusion location, CBS, [relative] thrombus density, thrombus length, perviousness, distance from ICA-terminus). Results: In 332 included patients, the presence of HAS (aβ 7.8 [95% CI 3.9–11.7]) and shift towards a more proximal occlusion location (aβ 3.9 [95% CI 0.6–7.1]) were independently associated with increased RBC and decreased fibrin/platelet content. With general characteristics, 12% of RBC variability could be explained; HAS was the strongest predictor. In 94 patients with available thin-slice imaging, 30% of RBC variability could be explained; thrombus density and thrombus length were the strongest predictors. Conclusions: Quantitative thrombus CT characteristics on thin-slice admission CT improve prediction of thrombus composition and might be used to further guide clinical decision-making in patients treated with EVT for AIS in the future. Key Points: • With hyperdense artery sign and occlusion location, 12% of variability in thrombus RBC content can be explained. • With hyperdense artery sign, occlusion location, and quantitative thrombus characteristics on thin-slice (≤ 2.5 mm) non-contrast CT and CTA, 30% of variability in thrombus RBC content can be explained. • Absolute thrombus density and thrombus length were the strongest predictors for thrombus composition.

Original language	English
Pages (from-to)	7811-7823
Number of pages	13
Journal	European Radiology
Volume	32
Issue number	11
Early online date	30 Apr 2022
DOIs	https://doi.org/10.1007/s00330-022-08762-y
Publication status	Published - Nov 2022

Bibliographical note

Funding Information:
This study was funded and carried out by the Erasmus University Medical Center, the Academic Medical Center Amsterdam, and the Maastricht University Medical Center. The study was additionally funded by the European Union’s Horizon 2020 research and innovation program under grant agreement no. 777072 (IN-SIlico trials for treatment of acute Ischemic STroke; INSIST), which played no role in trial design and patient enrolment, nor in data collection, analysis, or writing of the manuscript.

Publisher Copyright:
© 2022, The Author(s).

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Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathologyFinal published version, 1.48 MBLicence: CC BY

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Hund, H., Boodt, N., MR CLEAN Registry Investigators, Arrarte Terreros, N., Taha, A., Marquering, H. A., van Es, A. C. G. M., Bokkers, R. P. H., Lycklama à Nijeholt, G. J., Majoie, C. B. L. M., Dippel, D. W. J., Lingsma, H. F., van Beusekom, H. M. M., & van der Lugt, A. (2022). Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology: results of the MR CLEAN Registry. European Radiology, 32(11), 7811-7823. https://doi.org/10.1007/s00330-022-08762-y

@article{e363f5baeea7403f9eac010f6ec5e5c3,

title = "Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology: results of the MR CLEAN Registry",

abstract = "Objectives: Thrombus computed tomography (CT) characteristics might be used to assess histopathologic thrombus composition in patients treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). We aimed to assess the variability in thrombus composition that could be predicted with combined thrombus CT characteristics. Methods: Thrombi of patients enrolled in the MR CLEAN Registry between March 2014 and June 2016 were histologically analyzed with hematoxylin-eosin staining and quantified for percentages of red blood cells (RBCs) and fibrin/platelets. We estimated the association between general qualitative characteristics (hyperdense artery sign [HAS], occlusion location, clot burden score [CBS]) and thrombus composition with linear regression, and quantified RBC variability that could be explained with individual and combined characteristics with R2. For patients with available thin-slice (≤ 2.5 mm) imaging, we performed similar analyses for general and quantitative characteristics (HAS, occlusion location, CBS, [relative] thrombus density, thrombus length, perviousness, distance from ICA-terminus). Results: In 332 included patients, the presence of HAS (aβ 7.8 [95\% CI 3.9–11.7]) and shift towards a more proximal occlusion location (aβ 3.9 [95\% CI 0.6–7.1]) were independently associated with increased RBC and decreased fibrin/platelet content. With general characteristics, 12\% of RBC variability could be explained; HAS was the strongest predictor. In 94 patients with available thin-slice imaging, 30\% of RBC variability could be explained; thrombus density and thrombus length were the strongest predictors. Conclusions: Quantitative thrombus CT characteristics on thin-slice admission CT improve prediction of thrombus composition and might be used to further guide clinical decision-making in patients treated with EVT for AIS in the future. Key Points: • With hyperdense artery sign and occlusion location, 12\% of variability in thrombus RBC content can be explained. • With hyperdense artery sign, occlusion location, and quantitative thrombus characteristics on thin-slice (≤ 2.5 mm) non-contrast CT and CTA, 30\% of variability in thrombus RBC content can be explained. • Absolute thrombus density and thrombus length were the strongest predictors for thrombus composition.",

author = "Hajo Hund and Nikki Boodt and \{MR CLEAN Registry Investigators\} and \{Arrarte Terreros\}, Nerea and Aladdin Taha and Marquering, \{Henk A.\} and \{van Es\}, \{Adriaan C.G.M.\} and Bokkers, \{Reinoud P.H.\} and \{Lycklama {\`a} Nijeholt\}, \{Geert J.\} and Majoie, \{Charles B.L.M.\} and Dippel, \{Diederik W.J.\} and Lingsma, \{Hester F.\} and \{van Beusekom\}, \{Heleen M.M.\} and \{van der Lugt\}, Aad",

note = "Funding Information: This study was funded and carried out by the Erasmus University Medical Center, the Academic Medical Center Amsterdam, and the Maastricht University Medical Center. The study was additionally funded by the European Union{\textquoteright}s Horizon 2020 research and innovation program under grant agreement no. 777072 (IN-SIlico trials for treatment of acute Ischemic STroke; INSIST), which played no role in trial design and patient enrolment, nor in data collection, analysis, or writing of the manuscript. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = nov,

doi = "10.1007/s00330-022-08762-y",

language = "English",

volume = "32",

pages = "7811--7823",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer-Verlag",

number = "11",

}

Hund, H , Boodt, N, MR CLEAN Registry Investigators, Arrarte Terreros, N, Taha, A, Marquering, HA, van Es, ACGM, Bokkers, RPH, Lycklama à Nijeholt, GJ, Majoie, CBLM, Dippel, DWJ , Lingsma, HF , van Beusekom, HMM & van der Lugt, A 2022, 'Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology: results of the MR CLEAN Registry', European Radiology, vol. 32, no. 11, pp. 7811-7823. https://doi.org/10.1007/s00330-022-08762-y

TY - JOUR

T1 - Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology

T2 - results of the MR CLEAN Registry

AU - Hund, Hajo

AU - Boodt, Nikki

AU - MR CLEAN Registry Investigators

AU - Arrarte Terreros, Nerea

AU - Taha, Aladdin

AU - Marquering, Henk A.

AU - van Es, Adriaan C.G.M.

AU - Bokkers, Reinoud P.H.

AU - Lycklama à Nijeholt, Geert J.

AU - Majoie, Charles B.L.M.

AU - Dippel, Diederik W.J.

AU - Lingsma, Hester F.

AU - van Beusekom, Heleen M.M.

AU - van der Lugt, Aad

N1 - Funding Information: This study was funded and carried out by the Erasmus University Medical Center, the Academic Medical Center Amsterdam, and the Maastricht University Medical Center. The study was additionally funded by the European Union’s Horizon 2020 research and innovation program under grant agreement no. 777072 (IN-SIlico trials for treatment of acute Ischemic STroke; INSIST), which played no role in trial design and patient enrolment, nor in data collection, analysis, or writing of the manuscript. Publisher Copyright: © 2022, The Author(s).

PY - 2022/11

Y1 - 2022/11

N2 - Objectives: Thrombus computed tomography (CT) characteristics might be used to assess histopathologic thrombus composition in patients treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). We aimed to assess the variability in thrombus composition that could be predicted with combined thrombus CT characteristics. Methods: Thrombi of patients enrolled in the MR CLEAN Registry between March 2014 and June 2016 were histologically analyzed with hematoxylin-eosin staining and quantified for percentages of red blood cells (RBCs) and fibrin/platelets. We estimated the association between general qualitative characteristics (hyperdense artery sign [HAS], occlusion location, clot burden score [CBS]) and thrombus composition with linear regression, and quantified RBC variability that could be explained with individual and combined characteristics with R2. For patients with available thin-slice (≤ 2.5 mm) imaging, we performed similar analyses for general and quantitative characteristics (HAS, occlusion location, CBS, [relative] thrombus density, thrombus length, perviousness, distance from ICA-terminus). Results: In 332 included patients, the presence of HAS (aβ 7.8 [95% CI 3.9–11.7]) and shift towards a more proximal occlusion location (aβ 3.9 [95% CI 0.6–7.1]) were independently associated with increased RBC and decreased fibrin/platelet content. With general characteristics, 12% of RBC variability could be explained; HAS was the strongest predictor. In 94 patients with available thin-slice imaging, 30% of RBC variability could be explained; thrombus density and thrombus length were the strongest predictors. Conclusions: Quantitative thrombus CT characteristics on thin-slice admission CT improve prediction of thrombus composition and might be used to further guide clinical decision-making in patients treated with EVT for AIS in the future. Key Points: • With hyperdense artery sign and occlusion location, 12% of variability in thrombus RBC content can be explained. • With hyperdense artery sign, occlusion location, and quantitative thrombus characteristics on thin-slice (≤ 2.5 mm) non-contrast CT and CTA, 30% of variability in thrombus RBC content can be explained. • Absolute thrombus density and thrombus length were the strongest predictors for thrombus composition.

AB - Objectives: Thrombus computed tomography (CT) characteristics might be used to assess histopathologic thrombus composition in patients treated with endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). We aimed to assess the variability in thrombus composition that could be predicted with combined thrombus CT characteristics. Methods: Thrombi of patients enrolled in the MR CLEAN Registry between March 2014 and June 2016 were histologically analyzed with hematoxylin-eosin staining and quantified for percentages of red blood cells (RBCs) and fibrin/platelets. We estimated the association between general qualitative characteristics (hyperdense artery sign [HAS], occlusion location, clot burden score [CBS]) and thrombus composition with linear regression, and quantified RBC variability that could be explained with individual and combined characteristics with R2. For patients with available thin-slice (≤ 2.5 mm) imaging, we performed similar analyses for general and quantitative characteristics (HAS, occlusion location, CBS, [relative] thrombus density, thrombus length, perviousness, distance from ICA-terminus). Results: In 332 included patients, the presence of HAS (aβ 7.8 [95% CI 3.9–11.7]) and shift towards a more proximal occlusion location (aβ 3.9 [95% CI 0.6–7.1]) were independently associated with increased RBC and decreased fibrin/platelet content. With general characteristics, 12% of RBC variability could be explained; HAS was the strongest predictor. In 94 patients with available thin-slice imaging, 30% of RBC variability could be explained; thrombus density and thrombus length were the strongest predictors. Conclusions: Quantitative thrombus CT characteristics on thin-slice admission CT improve prediction of thrombus composition and might be used to further guide clinical decision-making in patients treated with EVT for AIS in the future. Key Points: • With hyperdense artery sign and occlusion location, 12% of variability in thrombus RBC content can be explained. • With hyperdense artery sign, occlusion location, and quantitative thrombus characteristics on thin-slice (≤ 2.5 mm) non-contrast CT and CTA, 30% of variability in thrombus RBC content can be explained. • Absolute thrombus density and thrombus length were the strongest predictors for thrombus composition.

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JO - European Radiology

JF - European Radiology

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ER -

Quantitative thrombus characteristics on thin-slice computed tomography improve prediction of thrombus histopathology: results of the MR CLEAN Registry

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