Publications by authors named "Lauranne Scheldeman"

5 Publications

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Added Value of Quantitative Apparent Diffusion Coefficient Values for Neuroprognostication After Cardiac Arrest.

Neurology 2021 Apr 9. Epub 2021 Apr 9.

Anke Wouters, Department of Neurology, University Hospitals Leuven, Leuven, Belgium - VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium - Department of Neurosciences, Experimental Neurology and Leuven Brain Institute, University of Leuven, Leuven, Belgium - Department of Neurology, Academic Medical Center, University of Amsterdam, The Netherlands; Lauranne Scheldeman, Department of Neurology, University Hospitals Leuven, Leuven, Belgium - VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium - Department of Neurosciences, Experimental Neurology and Leuven Brain Institute, University of Leuven, Leuven, Belgium; Sam Plessers, Department of Neurology, University Hospitals Leuven, Leuven, Belgium; Ronald Peeters, Department of Radiology, University Hospitals Leuven, Leuven, Belgium -Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Sarah Capelle, Department of Radiology, University Hospitals Leuven, Leuven, Belgium -Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Philippe Demaerel, Department of Radiology, University Hospitals Leuven, Leuven, Belgium -Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium; Wim Van Paesschen, Laboratory for Epilepsy Research, Department of Neurosciences, KU Leuven, Leuven, Belgium; Bert Ferdinande, Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Matthias Dupont, Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Jo Dens, Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium - Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium; Stefan Janssens, Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Koen Ameloot, Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium - Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium - Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Robin Lemmens, Department of Neurology, University Hospitals Leuven, Leuven, Belgium - VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium - Department of Neurosciences, Experimental Neurology and Leuven Brain Institute, University of Leuven, Leuven, Belgium.

Objective: To test the prognostic value of brain MRI in addition to clinical and electrophysiological variables in post-cardiac arrest (CA) patients, we explored data from the randomized Neuroprotect post-CA trial (NCT02541591).

Methods: In this trial brain MRI's were prospectively obtained. We calculated receiver operating characteristic curves for the average Apparent Diffusion Coefficient (ADC) value and percentage of brain voxels with an ADC value < 650 x 10 mm/s and < 450 x 10 mm/s. We constructed multivariable logistic regression models with clinical characteristics, electroencephalogram (EEG), somatosensory evoked potentials (SSEP) and ADC value as independent variables, to predict good neurological recovery.

Results: In 79/102 patients MRI data were available and in 58/79 patients all other data were available. At 180 days post-CA, 25/58 (43%) patients had good neurological recovery. In univariable analysis of all tested MRI parameters, average ADC value in the postcentral cortex had the highest accuracy to predict good neurological recovery with an AUC of 0.78. In the most optimal multivariate model which also included corneal reflexes and EEG, this parameter remained an independent predictor of good neurological recovery (AUC = 0.96, false positive = 27%). This model provided a more accurate prediction compared to the most optimal combination of EEG, corneal reflexes and SSEP (p=0.03).

Conclusion: Adding information on brain MRI in a multivariate model may improve the prediction of good neurological recovery in post-CA patients.

Classification Of Evidence: "This study provides Class III evidence that MRI ADC features predict neurological recovery in post-cardiac arrest patients."
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http://dx.doi.org/10.1212/WNL.0000000000011991DOI Listing
April 2021

Different Mismatch Concepts for Magnetic Resonance Imaging-Guided Thrombolysis in Unknown Onset Stroke.

Ann Neurol 2020 06 20;87(6):931-938. Epub 2020 Apr 20.

Department of Neurology, University Hospitals Leuven, Leuven, Belgium.

Objective: To explore the prevalence of the perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch and response to intravenous thrombolysis in the WAKE-UP trial.

Methods: We performed a prespecified post hoc analysis of ischemic stroke patients screened for DWI-fluid-attenuated inversion recovery (FLAIR) mismatch in WAKE-UP who underwent PWI. We defined PWI-DWI mismatch as ischemic core volume < 70ml, mismatch volume > 10ml, and mismatch ratio > 1.2. Primary efficacy end point was a modified Rankin Scale score of 0-1 at 90 days, adjusted for age and symptom severity.

Results: Of 1,362 magnetic resonance imaging-screened patients, 431 underwent PWI. Of these, 57 (13%) had a double mismatch, 151 (35%) only a DWI-FLAIR mismatch, and 54 (13%) only a PWI-DWI mismatch. DWI-FLAIR mismatch was more prevalent than PWI-DWI mismatch (48%, 95% confidence interval [CI] = 43-53% vs 26%, 95% CI = 22-30%; p < 0.0001). Screening for either one of the mismatch profiles resulted in a yield of 61% (95% CI = 56-65%). Prevalence of PWI-DWI mismatch was similar in patients with (27%) or without (24%) DWI-FLAIR mismatch (p = 0.52). In an exploratory analysis in the small subgroup of 208 randomized patients with PWI, PWI-DWI mismatch status did not modify the treatment response (p for interaction = 0.73).

Interpretation: Evaluating both the DWI-FLAIR and PWI-DWI mismatch patterns in patients with unknown time of stroke onset will result in the highest yield of thrombolysis treatment. The treatment benefit of alteplase in patients with a DWI-FLAIR mismatch seems to be driven not merely by the presence of a PWI-DWI mismatch, although this analysis was underpowered. ANN NEUROL 2020;87:931-938.
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http://dx.doi.org/10.1002/ana.25730DOI Listing
June 2020

Crowned dens syndrome: a neurologist's perspective.

Acta Neurol Belg 2019 Dec 24;119(4):561-565. Epub 2019 May 24.

Department of Neurology, OLV Aalst, Aalst, Belgium.

Crowned dens syndrome is an under-recognized entity that can mimic neurological disease, in particular meningitis or giant-cell arteritis. We present a 48-year-old woman presenting with an inflammatory meningitis-like syndrome with headache and neck stiffness. Lumbar puncture was normal and computed tomography (CT) of the atlantoaxial joint showed abnormal calcifications around the odontoid process, leading to a tentative diagnosis of crowned dens syndrome. In addition, signs of active inflammation in and around the dens were present on cervical MR imaging. Since CDS can mimic meningitis or giant-cell arteritis, neurologists should be aware of this entity. If CDS is suspected, the bone window on the head CT scan can lead to the diagnosis. On the other hand, asymptomatic periodontoid calcifications are common and should not preclude further investigations.
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http://dx.doi.org/10.1007/s13760-019-01153-zDOI Listing
December 2019

Alberta Stroke Program Early CT Score Versus Computed Tomographic Perfusion to Predict Functional Outcome After Successful Reperfusion in Acute Ischemic Stroke.

Stroke 2018 10;49(10):2361-2367

From the Division of Experimental Neurology, Department of Neurosciences (J.D., A.W., R.L.), Catholic University (KU) Leuven-University of Leuven, Belgium.

Background and Purpose- We aimed to compare the ability of conventional Alberta Stroke Program Early CT Score (ASPECTS), automated ASPECTS, and ischemic core volume on computed tomographic perfusion to predict clinical outcome in ischemic stroke because of large vessel occlusion ≤18 hours after symptom onset. Methods- We selected patients with acute ischemic stroke from the CRISP study (Computed Tomographic Perfusion to Predict Response to Recanalization in Ischemic Stroke Project) with successful reperfusion (modified treatment in cerebral ischemia score 2b or 3). We used e-ASPECTS software to calculate automated ASPECTS and RAPID software to estimate ischemic core volumes. We studied associations between these imaging characteristics and good outcome (modified Rankin Scale score, 0-2) or poor outcome (modified Rankin Scale score, 4-6) in univariable and multivariable analysis, after adjustment for relevant clinical confounders. Results- We included 156 patients. Conventional and automated ASPECTS was not associated with good or poor outcome in univariable analysis ( P=nonsignificant for all). Automated ASPECTS was associated with good outcome in multivariable analysis ( P=0.02) but not with poor outcome. Ischemic core volume was associated with good ( P<0.01) and poor outcome ( P=0.04) in univariable and multivariable analysis ( P=0.03 and P=0.02, respectively). Computed tomographic perfusion predicted good outcome with an area under the curve of 0.62 (95% CI, 0.53-0.71) and optimal cutoff core volume of 15 mL. Conclusions- Ischemic core volume assessed on computed tomographic perfusion is a predictor of clinical outcome among patients in whom endovascular reperfusion is achieved ≤18 hours after symptom onset. In this population, conventional or automated ASPECTS did not predict outcome.
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http://dx.doi.org/10.1161/STROKEAHA.118.021961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207080PMC
October 2018