Ahmed Khalil

Charité Universitätsmedizin Berlin | Charité · Center for Stroke Research Berlin

Purpose Automated lesion segmentation is increasingly used in acute ischemic stroke magnetic resonance imaging (MRI). We explored in detail the performance of apparent diffusion coefficient (ADC) thresholding for delineating baseline diffusion-weighted imaging (DWI) lesions. Methods Retrospective, exploratory analysis of the prospective observatio...

BOLD delay is an emerging, noninvasive method for assessing cerebral perfusion that does not require the use of intravenous contrast agents and is thus particularly suited for longitudinal monitoring. In this study, we assess the reproducibility of BOLD delay using data from 136 subjects with normal cerebral perfusion scanned on two separate occasi...

Background: White matter hyperintensities (WMH) are the result of cerebral small vessel disease and may increase the risk of cognitive impairment (CI), recurrent stroke, and depression. We aimed to explore the association between selected cerebrovascular risk factors (CVRF) and WMH load as well as the effect of increased WMH burden on recurrent va...

Zusammenfassung Die Aquaporin-4-Antikörper-positive Neuromyelitis-optica-Spektrum-Erkrankung (engl. NMOSD) und die Myelin-Oligodendrozyten-Glykoprotein-Antikörper-assoziierte Erkrankung (engl. MOGAD) sind Autoimmunerkrankungen des zentralen Nervensystems. Typische Erstmanifestationen sind bei Erwachsenen Optikusneuritis und Myelitis. Eine Beteiligu...

Brain arteries are routinely imaged in the clinical setting by various modalities, e.g., time-of-flight magnetic resonance angiography (TOF-MRA). These imaging techniques have great potential for the diagnosis of cerebrovascular disease, disease progression, and response to treatment. Currently, however, only qualitative assessment is implemented i...

Sharing labeled data is crucial to acquire large datasets for various Deep Learning applications. In medical imaging, this is often not feasible due to privacy regulations. Whereas anonymization would be a solution, standard techniques have been shown to be partially reversible. Here, synthetic data using a Generative Adversarial Network (GAN) with...

Purpose Cerebral neoplasms of various histological origins may show comparable appearances on conventional Magnetic Resonance Imaging (MRI). Vessel size imaging (VSI) is an MRI technique that enables noninvasive assessment of microvasculature by providing quantitative estimates of microvessel size and density. In this study, we evaluated the potent...

Deep learning requires large labeled datasets that are difficult to gather in medical imaging due to data privacy issues and time-consuming manual labeling. Generative Adversarial Networks (GANs) can alleviate these challenges enabling synthesis of shareable data. While 2D GANs have been used to generate 2D images with their corresponding labels, t...

Neurological diseases such as ischemic stroke and dementia are associated with compromised blood-brain barrier (BBB) permeability. Knowledge about the time course of BBB leakage may have impact on therapeutic interventions and diagnostic measures such as testing for blood biomarkers. However, reports on the timeline and pattern of this leakage are...

Individualized treatment of acute stroke depends on the timely detection of ischemia and potentially salvageable tissue in the brain. Using functional MRI (fMRI), it is possible to characterize cerebral blood flow from blood‐oxygen‐level‐dependent (BOLD) signals without the administration of exogenous contrast agents. In this study, we applied spat...

Background Arterial brain vessel segmentation allows utilising clinically relevant information contained within the cerebral vascular tree. Currently, however, no standardised performance measure is available to evaluate the quality of cerebral vessel segmentations. Thus, we developed a performance measure selection framework based on manual visual...

Total perfusion-diffusion mismatch is a well-recognised phenomenon in patients with acute ischaemic stroke. We describe a case of total perfusion-diffusion mismatch detected using an emerging contrast-agent-free perfusion imaging technique in a young patient with acute cerebellar stroke.

MRI-based vessel size imaging (VSI) allows for in-vivo assessment of cerebral microvasculature and perfusion. This exploratory analysis of vessel size (VS) and density (Q; both assessed via VSI) in the subacute phase of ischemic stroke involved sixty-two patients from the BAPTISe cohort (‘Biomarkers And Perfusion--Training-Induced changes after Str...

Anonymization and data sharing are crucial for privacy protection and acquisition of large datasets for medical image analysis. This is a big challenge, especially for neuroimaging. Here, the brain’s unique structure allows for re-identification and thus requires non-conventional anonymization. Generative adversarial networks (GANs) have the potent...

Average Hausdorff distance is a widely used performance measure to calculate the distance between two point sets. In medical image segmentation, it is used to compare ground truth images with segmentations allowing their ranking. We identified, however, ranking errors of average Hausdorff distance making it less suitable for applications in segment...

Introduction: Arterial brain vessel assessment is crucial for the diagnostic process in patients with cerebrovascular disease. Non-invasive neuroimaging techniques, such as time-of-flight (TOF) magnetic resonance angiography (MRA) imaging are applied in the clinical routine to depict arteries. They are, however, only visually assessed. Fully automa...

Anonymization and data sharing are crucial for privacy protection and acquisition of large datasets for medical image analysis. This is a big challenge, especially for neuroimaging. Here, the brain's unique structure allows for re-identification and thus requires non-conventional anonymization. Generative adversarial networks (GANs) have the potent...

Average Hausdorff Distance (AVD) is a widely used performance measure to calculate the distance between two point sets. In medical image segmentation, AVD is used to compare ground truth images with segmentation results allowing their ranking. We identified, however, a ranking bias of AVD making it less suitable for segmentation ranking. To mitigat...

Objective To identify, characterize, and automatically classify hypoperfusion-related changes in the blood oxygenation level dependent (BOLD) signal in acute stroke using spatial independent component analysis of resting-state functional MRI data. Methods We applied spatial independent component analysis to resting-state functional MRI data of 37...

Objectives: To evaluate the impact of resting-state functional MRI scan length on the diagnostic accuracy, image quality and lesion volume estimation of BOLD delay maps used for brain perfusion assessment in acute ischemic stroke. Methods: Sixty-three acute ischemic stroke patients received a 340 s resting-state functional MRI within 24 h of stroke...

Introduction Arterial brain vessel assessment is crucial for the diagnostic process in patients with cerebrovascular disease. Noninvasive neuroimaging techniques such as time-of-flight (TOF) magnetic resonance angiography (MRA) imaging are applied in the clinical routine to depict arteries. They are, however, only visually assessed. Fully automated...

State-of-the-art machine learning (ML) artificial intelligence methods are increasingly leveraged in clinical predictive modeling to provide clinical decision support systems to physicians. Modern ML approaches such as artificial neural networks (ANNs) and tree boosting often perform better than more traditional methods like logistic regression. On...

Data driven methods are increasingly being adopted in the medical domain for clinical predictive modeling. Prediction of stroke outcome using machine learning could provide a decision support system for physicians to assist them in patient-oriented diagnosis and treatment. While patient-specific clinical parameters play an important role in outcome...

Background State-of-the-art machine learning (ML) artificial intelligence methods are increasingly leveraged in clinical predictive modeling to provide clinical decision support systems to physicians. Modern ML approaches such as artificial neural networks (ANNs) and tree boosting often perform better than more traditional methods like logistic reg...

Background: Collateral circulation in ischemic stroke patients plays an important role in infarct evolution und assessing patients' eligibility for endovascular treatment. By means of dynamic susceptibility contrast MRI, we aimed to investigate the effects of reperfusion, recanalization, and collateral flow on clinical and imaging outcomes after st...

The functional organization of the brain can be represented as a low-dimensional space that reflects its macroscale hierarchy. The dimensions of this space, described as connectivity gradients, capture the similarity of areas' connections along a continuous space. Studying how pathological perturbations with known effects on functional connectivity...

Neurodegenerative diseases are among the leading causes of disability and death worldwide. The disease-related socioeconomic burden is expected to increase with the steadily increasing life expectancy. In spite of decades of clinical and basic research, most strategies designed to manage degenerative brain diseases are palliative. This is not surpr...

Neuromodulatory non-invasive brain stimulation (NIBS) techniques are experimental therapies for improving motor function after stroke. The aim of neuromodulation is to enhance adaptive or suppress maladaptive processes of post-stroke reorganization. However, results on the effectiveness of these methods, which include transcranial magnetic stimulat...

Recent clinical trials of new revascularization therapies in acute ischemic stroke have highlighted the importance of physiological imaging to identify optimal treatments for patients. Oxygen extraction fraction (OEF) is a hallmark of at-risk tissue in stroke, and can be quantified from the susceptibility effect of deoxyhemoglobin molecules in veno...

Understanding the relationship between localized anatomical damage, reorganization, and functional deficits is a major challenge in stroke research. Previous work has shown that localized lesions cause widespread functional connectivity alterations in structurally intact areas, thereby affecting a whole network of interconnected regions. Recent adv...

Introduction We explored the use of a perfluoro-15-crown-5 ether nanoemulsion (PFC) for measuring tissue oxygenation using a mouse model of vascular cognitive impairment. Methods Seventeen C57BL/6 mice underwent stereotactic injection of PFC coupled to a fluorophore into the striatum and corpus callosum. Combined 1H/19F magnetic resonance imaging...

Relative delays in blood-oxygen-level-dependent (BOLD) signal oscillations can be used to assess cerebral perfusion without using contrast agents. However, little is currently known about the utility of this method in detecting clinically relevant perfusion changes over time. We investigated the relationship between longitudinal BOLD delay changes,...

In response to recommendations to redefine statistical significance to P ≤ 0.005, we propose that researchers should transparently report and justify all choices they make when designing a study, including the alpha level.

In response to recommendations to redefine statistical significance to P ≤ 0.005, we propose that researchers should transparently report and justify all choices they make when designing a study, including the alpha level.

Background In acute ischemic stroke the status of collateral circulation is a critical factor in determining outcome. We propose a less invasive alternative to digital subtraction angiography for evaluating collaterals based on dynamic-susceptibility contrast magnetic resonance imaging. Methods Perfusion maps of Tmax and cerebral blood flow (CBF)...

In response to recommendations to redefine statistical significance to p ≤ .005, we propose that researchers should transparently report and justify all choices they make when designing a study, including the alpha level.

Background and purpose: Changes in the blood-oxygen-level-dependent (BOLD) signal provide a noninvasive measure of blood flow, but a detailed comparison with established perfusion parameters in acute stroke is lacking. We investigated the relationship between BOLD signal temporal delay and dynamic susceptibility contrast magnetic resonance imaging...

Objective: To quantitatively evaluate blood-brain barrier changes in ischemic stroke patients using dynamic contrast-enhanced (DCE) MRI. Methods: We examined 54 stroke patients (clinicaltrials.gov NCT00715533, NCT02077582) in a 3T MRI scanner within 48 hours after symptom onset. Twenty-eight patients had a follow-up examination on day 5-7. DCE T...

Objectives: To assess the sensitivity of stimulated echo acquisition mode diffusion weighted imaging (STEAM-DWI) to ischemic stroke in comparison to echo-planar imaging diffusion weighted imaging (EPI-DWI) in the infratentorial compartment. Methods: Fifty-seven patients presenting with clinical features of infratentorial stroke underwent STEAM-D...

STandards for the Reporting of Diagnostic accuracy studies (STARD) checklist. (DOC)

AS22-016 IMAGING - OTHER THAN HYPERACUTE Poster VALIDATION OF A NOVEL, AUTOMATED PERFUSION LESION-DETECTION ALGORITHM IN ACUTE ISCHEMIC STROKE J.Y. Hu1, A.A. Khalil1,2, R. Ganeshan1, K. Villringer1, A. Villringer3 and J.B. Fiebach1 1Charité Universitätsmedizin, Center for Stroke Research, Berlin, Germany 2Charité Universitätsmedizin, NeuroCure Cl...

Introduction / Hypothesis: Diffusion/perfusion mismatch (MM) is commonly used to assess tissue at risk in stroke patients. In small subcortical infarcts (SSI) the reverse pattern i.e. “inverse mismatch” (IM) has been shown [1]. We aimed to evaluate the frequency and characteristics of IM in a larger cohort using two different perfusion diffusion an...

Introduction / Hypothesis: Diffusion/perfusion mismatch (MM) is commonly used to assess tissue at risk in stroke patients. In small subcortical infarcts (SSI) the reverse pattern i.e. “inverse mismatch” (IM) has been shown [1]. We aimed to evaluate the frequency and characteristics of IM in a larger cohort using two different perfusion diffusion an...

Dietary deficiencies in folic acid result in elevated levels of plasma homocysteine, which has been asso-ciated with the development of dementia and other neurodegenerative disorders. Previously, we have shown that elevated levels of plasma homocysteine in mice deficient for a DNA repair enzyme, uracil–DNA glycosylase (UNG), result in neurodegenera...

Dietary deficiencies in folic acid result in elevated levels of plasma homocysteine, which has been associated with the development of dementia and other neurodegenerative disorders. Previously, we have shown that elevated levels of plasma homocysteine in mice deficient for a DNA repair enzyme, uracil-DNA glycosylase (UNG), result in neurodegenerat...

Governments engage with the private sector in several ways, one of which is through contractual agreements to provide services to the population on the governments’ behalf (the process of ‘contracting out’). The importance, feasibility and effectiveness of this contracting process in the health sector is disputed, particularly in states where the g...

To explore any association between paternal tobacco smoking and the offspring secondary sex ratio, as well as the effect of duration and intensity of smoking on gender ratio. The cross-sectional study was conducted around major public areas within Khartoum, Sudan, between August and September 2008 and involved 458 married Sudanese males with offspr...

Vesicovaginal fistula is a common complication of labor in some parts of the world, especially certain regions in Africa. Over the past few decades, several measures have been taken to reduce the global burden of this condition, and to treat patients already suffering from fistula. This article aims to describe the obstetric fistula situation in te...