2024
Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion
Mak A, Matouk C, Avery E, Behland J, Haider S, Frey D, Madai V, Vajkoczy P, Griessenauer C, Zand R, Hendrix P, Abedi V, Sanelli P, Falcone G, Petersen N, Sansing L, Sheth K, Payabvash S, Malhotra A. Automated detection of early signs of irreversible ischemic change on CTA source images in patients with large vessel occlusion. PLOS ONE 2024, 19: e0304962. PMID: 38870240, PMCID: PMC11175522, DOI: 10.1371/journal.pone.0304962.Peer-Reviewed Original ResearchConceptsDiffusion-weighted imagingLarge vessel occlusionIrreversible ischemic changesPoor functional outcomeFunctional outcomesIschemic changesInfarct volumeAlberta Stroke Program Early CT ScorePredicting poor functional outcomeVessel occlusionFollow-up diffusion-weighted imagingAnterior circulation LVO strokeCTA source imagesReceiver operating characteristic curveExpert human readersPredicting final infarctionASPECTS regionsAdmission CTANon-inferior performanceBaseline CTACT scoreFinal infarctEndovascular therapyHU attenuationValidation cohort
2023
Intravenous thrombolysis prior to endovascular thrombectomy in elderly stroke patients: An analysis of the National Inpatient Sample database
Chen H, Khunte M, Colasurdo M, Malhotra A, Gandhi D. Intravenous thrombolysis prior to endovascular thrombectomy in elderly stroke patients: An analysis of the National Inpatient Sample database. Journal Of The Neurological Sciences 2023, 454: 120842. PMID: 37856997, DOI: 10.1016/j.jns.2023.120842.Peer-Reviewed Original ResearchConceptsNational Inpatient Sample databaseHospital mortalityHemorrhagic complicationsIntravenous thrombolysisEndovascular thrombectomyEVT patientsIVT treatmentThrombectomy centreElderly patientsMultivariable logistic regression modelSample databaseStroke risk factorsElderly stroke patientsCross-sectional studyLarge-scale cross-sectional studyOutcomes of interestHigh rateLogistic regression modelsPatients 80Medical comorbiditiesOnly patientsPatient demographicsStroke etiologyThrombolytic treatmentHemorrhagic riskClinical implications of Peri-hematomal edema microperfusion fraction in intracerebral hemorrhage intravoxel incoherent motion imaging – A pilot study
Abou Karam G, Tharmaseelan H, Aboian M, Malhotra A, Gilmore E, Falcone G, de Havenon A, Sheth K, Payabvash S. Clinical implications of Peri-hematomal edema microperfusion fraction in intracerebral hemorrhage intravoxel incoherent motion imaging – A pilot study. Journal Of Stroke And Cerebrovascular Diseases 2023, 32: 107375. PMID: 37738914, PMCID: PMC10591892, DOI: 10.1016/j.jstrokecerebrovasdis.2023.107375.Peer-Reviewed Original ResearchConceptsModified Rankin ScaleSecondary brain injuryIntracerebral hemorrhagePerihematomal edemaSubacute intracerebral hemorrhageIntravoxel incoherent motion imagingAdmission NIHSSBrain injuryMedian baseline National InstitutesPilot studyBaseline National InstitutesHealth Stroke ScalePerfusion fractionSupratentorial intracerebral hemorrhageIVIM metricsIncoherent motion imagingStroke ScaleNeuroprotective therapiesParenchymal injuryRankin ScaleRisk patientsConsecutive patientsUnivariable analysisPoor outcomeICH volumeDistribution and Disparities of Industry Payments to Radiologists (2016-2020)
Khunte M, Zhong A, Wu X, Payabvash S, Gandhi D, Forman H, Malhotra A. Distribution and Disparities of Industry Payments to Radiologists (2016-2020). Academic Radiology 2023, 30: 3056-3063. PMID: 37210267, DOI: 10.1016/j.acra.2023.04.020.Peer-Reviewed Original Research
2020
Assessment of Intracranial Atherosclerotic Plaques Using 3D Black‐Blood MRI: Comparison With 3D Time‐of‐Flight MRA and DSA
Tian X, Tian B, Shi Z, Wu X, Peng W, Zhang X, Malhotra A, Mossa‐Basha M, Sekhar L, Liu Q, Lu J, Hu C, Zhu C. Assessment of Intracranial Atherosclerotic Plaques Using 3D Black‐Blood MRI: Comparison With 3D Time‐of‐Flight MRA and DSA. Journal Of Magnetic Resonance Imaging 2020, 53: 469-478. PMID: 32864816, DOI: 10.1002/jmri.27341.Peer-Reviewed Original ResearchConceptsTransient ischemic attackDigital subtraction angiographyMagnetic resonance angiographyPosterior circulation strokeInterclass correlation coefficientDegree of stenosisBlack blood MRINonstenotic plaquesIntracranial stenosisPlaque assessmentIntracranial vessel wall imagingIschemic stroke patientsIntracranial artery stenosisIntracranial atherosclerotic plaquesFlight magnetic resonance angiographyMann-Whitney U testAtherosclerotic plaque assessmentStage 2 J. MagnT-testStudent's t-testVessel wall imagingIschemic attackCohort studyArtery stenosisStroke patientsLetter regarding: “Elderly Patients With Cervical Spine Fractures After Ground Level Falls Are at Risk for Blunt Cerebrovascular Injury”
Malhotra A, Wu X, Khunte M. Letter regarding: “Elderly Patients With Cervical Spine Fractures After Ground Level Falls Are at Risk for Blunt Cerebrovascular Injury”. Journal Of Surgical Research 2020, 256: 696-697. PMID: 32861424, DOI: 10.1016/j.jss.2020.06.064.Peer-Reviewed Original ResearchEffects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke
Al-Dasuqi K, Payabvash S, Torres-Flores GA, Strander SM, Nguyen CK, Peshwe KU, Kodali S, Silverman A, Malhotra A, Johnson MH, Matouk CC, Schindler JL, Sansing LH, Falcone GJ, Sheth KN, Petersen NH. Effects of Collateral Status on Infarct Distribution Following Endovascular Therapy in Large Vessel Occlusion Stroke. Stroke 2020, 51: e193-e202. PMID: 32781941, PMCID: PMC7484023, DOI: 10.1161/strokeaha.120.029892.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overArterial Occlusive DiseasesCerebral InfarctionCohort StudiesCollateral CirculationComputed Tomography AngiographyEndovascular ProceduresFemaleHumansInfarction, Middle Cerebral ArteryLinear ModelsMagnetic Resonance AngiographyMaleMiddle AgedReperfusionRetrospective StudiesStrokeThrombectomyTreatment OutcomeWhite MatterConceptsLarge vessel occlusion strokeFinal infarct volumeCollateral statusPoor collateral statusFavorable outcomeInfarct distributionInfarct volumeReperfusion successIndependent predictorsOcclusion strokeInternal capsuleAnterior circulation large vessel occlusion ischemic strokeLarge vessel occlusion ischemic strokeDeep white matter tractsBaseline collateral statusBorder-zone infarctionEarly favorable outcomeEarly functional outcomesRankin Scale scoreCohort of patientsDegree of reperfusionLarge vessel occlusionComputed tomography angiographyDeep white matterMagnetic resonance imagingSeptic cavernous sinus thrombosis—Case series and review of the literature
Geng B, Wu X, Malhotra A. Septic cavernous sinus thrombosis—Case series and review of the literature. Clinical Neurology And Neurosurgery 2020, 197: 106092. PMID: 32693341, DOI: 10.1016/j.clineuro.2020.106092.Peer-Reviewed Original ResearchConceptsCavernous sinus thrombosisAcademic tertiary care centerSeptic cavernous sinus thrombosisExtension of thrombosisTertiary care centerInternal jugular veinTransverse-sigmoid sinusLife-threatening diseaseSource of infectionCST patientsInfectious thrombosisSinus thrombosisPatient demographicsPseudo aneurysmReported complicationsIntracranial complicationsSubdural empyemaBilateral narrowingHigh morbidityTreatment coursePersistent narrowingRadiology databaseCare centerUnilateral narrowingJugular veinReduced 2-year aneurysm retreatment and costs among patients treated with flow diversion versus non-flow diversion embolization: A Premier Healthcare Database retrospective cohort study
Grandhi R, Karsy M, Taussky P, Ricker CN, Malhotra A. Reduced 2-year aneurysm retreatment and costs among patients treated with flow diversion versus non-flow diversion embolization: A Premier Healthcare Database retrospective cohort study. PLOS ONE 2020, 15: e0234478. PMID: 32555657, PMCID: PMC7302520, DOI: 10.1371/journal.pone.0234478.Peer-Reviewed Original ResearchConceptsPipeline Embolization DeviceEndovascular treatmentRetreatment ratePS matchingIntracranial aneurysmsRetrospective cohort studyRate of readmissionEmergency department visitsLength of stayLower retreatment rateInitial treatment costsUnruptured intracranial aneurysmsPropensity-score matchingTime of treatmentCumulative followCohort studyReadmission costsDepartment visitsPatient subgroupsPED placementCase selection biasSame hospitalAneurysm retreatmentEmbolization DevicePatientsUtility of routine follow-up imaging in patients with small paraflacine and/or paratentorial hemorrhages
Seifert KD, Wu X, Malhotra A. Utility of routine follow-up imaging in patients with small paraflacine and/or paratentorial hemorrhages. Clinical Neurology And Neurosurgery 2020, 196: 105956. PMID: 32526488, DOI: 10.1016/j.clineuro.2020.105956.Peer-Reviewed Original ResearchConceptsSubdural hemorrhageRoutine follow-up imagingSubsequent imagingImaging studiesSecond imaging studyAbsence of anticoagulationSubsequent imaging studiesFollow-up imagingAcute intracranial hemorrhageAnticoagulation useStable patientsRetrospective reviewClinical progressionIntracranial hemorrhageEmergency departmentClinical dataHemorrhage sizeHemorrhageRoutine imagingPatient statusPatientsParafalcineMultiple followSame protocolAverage numberImplications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis
Wu X, Khunte M, Gandhi D, Matouk C, Hughes DR, Sanelli P, Malhotra A. Implications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis. Journal Of NeuroInterventional Surgery 2020, 12: 1161-1165. PMID: 32457225, DOI: 10.1136/neurintsurg-2020-015873.Peer-Reviewed Original ResearchConceptsQuality-adjusted life yearsLarge vessel occlusionTICI 3 reperfusionEndovascular thrombectomyTICI 2bTICI 3Stroke patientsHealth benefitsAge groupsAcute stroke patientsDegree of recanalizationDegree of reperfusionLifetime quality-adjusted life yearsCost-effectiveness analysisDecision analytic studyUnited States settingsIncomplete reperfusionIschemic strokeComplete reperfusionPatient selectionReperfusionPatientsHealth outcomesLife yearsCost savingsThirty- and 90-Day Readmissions After Treatment of Traumatic Subdural Hematoma: National Trend Analysis
Koo AB, Elsamadicy AA, David WB, Zogg CK, Santarosa C, Sujijantarat N, Robert SM, Kundishora AJ, Cord BJ, Hebert R, Bahrassa F, Malhotra A, Matouk CC. Thirty- and 90-Day Readmissions After Treatment of Traumatic Subdural Hematoma: National Trend Analysis. World Neurosurgery 2020, 139: e212-e219. PMID: 32272271, PMCID: PMC7380544, DOI: 10.1016/j.wneu.2020.03.168.Peer-Reviewed Original ResearchConceptsTraumatic subdural hematomaSubdural hematomaRheumatoid arthritis/collagen vascular diseasesMultivariate logistic regression analysisCollagen vascular diseaseNationwide Readmissions DatabaseCongestive heart failureLikelihood of readmissionPrimary procedure codeTraumatic brain injuryLogistic regression analysisReadmission ratesRenal failureHeart failurePostoperative infectionNinth RevisionSurgical interventionPatient populationVascular diseaseCerebral meningesBrain injuryClinical ModificationPatient managementReadmissionInternational ClassificationDiagnostic Value of CT of Chest, Abdomen, and Pelvis in Patients With Solitary and Multiple Brain Lesions.
Rothman RK, Weinreb J, Zucconi W, Malhotra A. Diagnostic Value of CT of Chest, Abdomen, and Pelvis in Patients With Solitary and Multiple Brain Lesions. American Journal Of Roentgenology 2020, 214: 636-640. PMID: 31939701, DOI: 10.2214/ajr.19.22051.Peer-Reviewed Original ResearchConceptsPrimary neoplasmsBrain lesionsChest CTIntracranial lesionsCT CAPAncillary signsBrain neoplasmsNew intracranial lesionsPrimary brain neoplasmsMultiple brain lesionsMalignant brain neoplasmsLarge academic hospitalPresence of enhancementBrain metastasesLung primaryMetastatic workupSuch patientsPrimary cancerLesion characteristicsAcademic hospitalBenign entityCT scanPatientsMalignant casesNeoplasmsCT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis.
Wu X, Hughes DR, Gandhi D, Matouk CC, Sheth K, Schindler J, Wira C, Wintermark M, Sanelli P, Malhotra A. CT Angiography for Triage of Patients with Acute Minor Stroke: A Cost-effectiveness Analysis. Radiology 2020, 294: 580-588. PMID: 31934828, DOI: 10.1148/radiol.2019191238.Peer-Reviewed Original ResearchConceptsLarge vessel occlusionAcute minor strokeBest medical managementMinor strokeCT angiographyMedical managementProbabilistic sensitivity analysesLower health benefitsImmediate thrombectomyHealth benefitsHealth outcomesVascular imagingAcute ischemic strokeMarkov decision-analytic modelWorse health outcomesImproved health outcomesDecision analytic modelNet monetary benefitIntravenous thrombolysisIschemic strokeYounger patientsThrombectomy strategyPatientsAngiographyStroke
2019
A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness
Hanna J, Malhotra A, Brauer PR, Luryi A, Michaelides E. A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness. American Journal Of Otolaryngology 2019, 40: 102263. PMID: 31358317, DOI: 10.1016/j.amjoto.2019.07.007.Peer-Reviewed Original ResearchConceptsBenign paroxysmal positional vertigoStroke risk factorsCT/CTAEmergency departmentBPPV patientsNeurologic symptomsStroke patientsRisk factorsPositional vertigoCT headExam findingsNeurologic exam findingsPosterior circulation strokeProfile of patientsBenign positional vertigoParoxysmal positional vertigoCommon imaging modalityAcute strokeNeurologic examInitial imagingMRI brainDischarge diagnosisComputed tomographyPatientsVertigoManagement of Unruptured Intracranial Aneurysms in Older Adults: A Cost-effectiveness Analysis.
Malhotra A, Wu X, Forman HP, Matouk CC, Hughes DR, Gandhi D, Sanelli P. Management of Unruptured Intracranial Aneurysms in Older Adults: A Cost-effectiveness Analysis. Radiology 2019, 291: 411-417. PMID: 30888931, DOI: 10.1148/radiol.2019182353.Peer-Reviewed Original Research
2018
Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT
Malhotra A, Durand D, Wu X, Geng B, Abbed K, Nunez DB, Sanelli P. Utility of MRI for cervical spine clearance in blunt trauma patients after a negative CT. European Radiology 2018, 28: 2823-2829. PMID: 29450715, DOI: 10.1007/s00330-017-5285-y.Peer-Reviewed Original ResearchConceptsBlunt trauma evaluationCervical spine CTCervical spine MRIUnstable injuriesBlunt traumaTrauma evaluationSpine CTSpine MRIBlunt cervical spine traumaCervical spine clearanceCT cervical spineAbnormal neurological examinationBlunt trauma patientsPercent of patientsCervical spine traumaCervical spine studiesSoft tissue injuriesUtility of MRICervical CTSpine clearanceAdult patientsSubsequent MRINeurological examinationSpine traumaTrauma patients
2017
Semicircular canal dehiscence among idiopathic intracranial hypertension patients
Kuo P, Bagwell KA, Mongelluzzo G, Schutt CA, Malhotra A, Khokhar B, Kveton JF. Semicircular canal dehiscence among idiopathic intracranial hypertension patients. The Laryngoscope 2017, 128: 1196-1199. PMID: 28833207, DOI: 10.1002/lary.26795.Peer-Reviewed Original ResearchConceptsRadiographic superior semicircular canal dehiscenceSuperior semicircular canal dehiscenceIdiopathic intracranial hypertensionSemicircular canal dehiscenceOpening pressureCanal dehiscenceIdiopathic intracranial hypertension patientsLogistic regressionIntracranial hypertension patientsBody mass indexRetrospective pilot studyMultivariate logistic regressionComputed tomography (CT) imagingStudent's t-testAverage opening pressureRetrospective cohortConsecutive patientsIntracranial hypertensionHypertension patientsMass indexRetrospective studyLumbar punctureControl cohortTegmental defectsPatientsMulticentric Chordoma
Jones JR, Huttner A, Malhotra A. Multicentric Chordoma. Clinical Neuroradiology 2017, 28: 283-288. PMID: 28766007, DOI: 10.1007/s00062-017-0610-z.Peer-Reviewed Original Research
2016
Cerebral Microhemorrhages and Meningeal Siderosis in Infective Endocarditis
Malhotra A, Schindler J, Grory B, Chu SY, Youn TS, Matouk C, Greer DM, Schrag M. Cerebral Microhemorrhages and Meningeal Siderosis in Infective Endocarditis. Cerebrovascular Diseases 2016, 43: 59-67. PMID: 27871078, DOI: 10.1159/000452718.Peer-Reviewed Original ResearchConceptsCerebral amyloid angiopathyInfective endocarditisSusceptibility-weighted imaging (SWI) sequencesSmall subarachnoid hemorrhageGradient-echo T2Sensitive diagnostic techniquesSWI MRIMycotic aneurysmSevere hypertensionGroups of subjectsAmyloid angiopathyCerebral insultCerebral microhemorrhagesNeurological involvementWorse prognosisSubarachnoid hemorrhageSWI findingsAcademic hospitalSignificant predilectionMicrohemorrhagesPatientsGRE T2HypertensionSiderosisEndocarditis