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
Clinical 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 volumeCT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching.
Tu L, Navaratnam D, Melnick E, Forman H, Venkatesh A, Malhotra A, Yaesoubi R, Sureshanand S, Sheth K, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. American Journal Of Roentgenology 2023, 221: 836-845. PMID: 37404082, DOI: 10.2214/ajr.23.29617.Peer-Reviewed Original ResearchConceptsSecondary stroke prevention medicationsStroke prevention medicationsEmergency departmentPrevention medicationsEchocardiography evaluationPosterior circulation strokeProportion of patientsGroup of patientsPhysical examination findingsNeuroimaging resultsUse of MRIReview of systemsGreater frequencyPropensity-score matchingExamination findingsRetrospective studyED readmissionMedical historyHead CTClinical impactMRI examinationsBrain MRINeck CTADizzinessPatients
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 patientsEffects 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 imagingPosterior Reversible Encephalopathy Syndrome Caused by Induced Hypertension to Treat Cerebral Vasospasm Secondary to Aneurysmal Subarachnoid Hemorrhage
Elsamadicy AA, Koo AB, Reeves BC, Sujijantarat N, David WB, Malhotra A, Gilmore EJ, Matouk CC, Hebert R. Posterior Reversible Encephalopathy Syndrome Caused by Induced Hypertension to Treat Cerebral Vasospasm Secondary to Aneurysmal Subarachnoid Hemorrhage. World Neurosurgery 2020, 143: e309-e323. PMID: 32721559, DOI: 10.1016/j.wneu.2020.07.135.Peer-Reviewed Original ResearchConceptsPosterior reversible encephalopathy syndromeSystolic blood pressure goalBlood pressure goalsReversible encephalopathy syndromeAneurysmal subarachnoid hemorrhageSubarachnoid hemorrhageEncephalopathy syndromeCerebral vasospasmClinical statusFluid-attenuated inversion recovery hyperintensityMiddle cerebral artery syndromeAcute-onset headachePossible ischemic eventsClinical examination findingsInversion recovery hyperintensityPatient's clinical statusTransient clinical improvementArtery aneurysm ruptureMiddle cerebral arteryLevel of arousalMagnetic resonance imagingDigital subtraction angiographyInduced hypertensionClinical improvementIschemic eventsSeptic 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 ResearchMeSH KeywordsAgedAged, 80 and overComputed Tomography AngiographyCost-Benefit AnalysisHumansMiddle AgedStrokeTriageConceptsLarge 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
Higher Plaque Burden of Middle Cerebral Artery Is Associated With Recurrent Ischemic Stroke
Ran Y, Wang Y, Zhu M, Wu X, Malhotra A, Lei X, Zhang F, Wang X, Xie S, Zhou J, Zhu J, Cheng J, Zhu C. Higher Plaque Burden of Middle Cerebral Artery Is Associated With Recurrent Ischemic Stroke. Stroke 2019, 51: 659-662. PMID: 31856694, DOI: 10.1161/strokeaha.119.028405.Peer-Reviewed Original ResearchConceptsRecurrent ischemic strokeMiddle cerebral arteryMagnetic resonance vessel wall imagingPlaque burdenIschemic strokeVessel wall imagingAcute strokeCerebral arteryRecurrent strokeChronic strokeStroke patientsPlaque characteristicsMiddle cerebral artery plaqueRecurrent acute strokeRecurrent stroke groupRecurrent stroke patientsAcute stroke patientsHigher plaque burdenMethods One hundredDegree of stenosisClinical factorsStroke groupArtery plaquesFemale sexImaging featuresScreening for Intracranial Aneurysms in Patients with Thoracic Aortic Aneurysms
Malhotra A, Seifert K, Wu X, Matouk C, Elefteriades JA. Screening for Intracranial Aneurysms in Patients with Thoracic Aortic Aneurysms. Cerebrovascular Diseases 2019, 47: 253-259. PMID: 31412341, DOI: 10.1159/000501194.Peer-Reviewed Original ResearchConceptsPrevalence of IAsThoracic aortic aneurysmIntracranial aneurysmsRetrospective studyAortic aneurysmRisk factorsPrevious retrospective studySignificant risk factorsPotential risk factorsMagnetic resonance angiogramStudent's t-testPatient demographicsUnivariate analysisHigh prevalenceLarge cohortGeneral populationPatientsAneurysmsPrevalenceCategorical variablesΧ2 testHypertensionT-testContinuous variablesIA locationCost-Effectiveness of Computed Tomography Angiography in Management of Tiny Unruptured Intracranial Aneurysms in the United States
Wu X, Matouk CC, Mangla R, Forman HP, Gandhi D, Sanelli P, Malhotra A. Cost-Effectiveness of Computed Tomography Angiography in Management of Tiny Unruptured Intracranial Aneurysms in the United States. Stroke 2019, 50: 2396-2403. PMID: 31340732, DOI: 10.1161/strokeaha.119.025600.Peer-Reviewed Original ResearchConceptsComputed tomography angiographyUnruptured intracranial aneurysmsIntracranial aneurysmsTomography angiographyCancer riskCTA surveillanceCost-effective strategyRadiation-induced brain tumorsRadiation-induced cancer riskSubsequent magnetic resonanceBrain cancer riskBetter health outcomesAnnual rupture riskProbabilistic sensitivity analysesRupture riskLower healthcare spendingAggressive managementPatients 30Subarachnoid hemorrhageIncidental detectionPrior historyHigh riskBrain tumorsAneurysmsHealth outcomesA 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 tomographyPatientsVertigoQuantitative diffusion magnetic resonance imaging for prediction of human papillomavirus status in head and neck squamous-cell carcinoma: A systematic review and meta-analysis
Payabvash S, Chan A, Maralani P, Malhotra A. Quantitative diffusion magnetic resonance imaging for prediction of human papillomavirus status in head and neck squamous-cell carcinoma: A systematic review and meta-analysis. The Neuroradiology Journal 2019, 32: 232-240. PMID: 31084347, PMCID: PMC6639646, DOI: 10.1177/1971400919849808.Peer-Reviewed Original ResearchConceptsNeck squamous cell carcinomaDiffusion-weighted imagingHPV-positive HNSCCSquamous cell carcinomaHPV-negative HNSCCPrimary tumor lesionsStandardized mean differenceQuantitative diffusion magnetic resonancePrimary lesionHPV statusTumor lesionsAverage ADCDiffusion magnetic resonanceMean differenceHiggins' inconsistency indexHuman papillomavirus (HPV) statusHuman papillomavirus infectionApparent diffusion coefficient (ADC) valuesRandom-effects modelNoninvasive imaging biomarkerComprehensive literature searchAverage ADC valueEcho-planar diffusion-weighted imagingFixed-effects modelPapillomavirus infectionComparative effectiveness analysis of Pipeline device versus coiling in unruptured aneurysms smaller than 10 mm.
Malhotra A, Wu X, Miller T, Matouk CC, Sanelli P, Gandhi D. Comparative effectiveness analysis of Pipeline device versus coiling in unruptured aneurysms smaller than 10 mm. Journal Of Neurosurgery 2019, 132: 42-50. PMID: 30641830, DOI: 10.3171/2018.8.jns181080.Peer-Reviewed Original ResearchConceptsPipeline Embolization DeviceStent-assisted coilingRetreatment rateSmall unruptured aneurysmsComparative effectiveness analysisProbabilistic sensitivity analysesUnruptured aneurysmsEndovascular coilingHealth benefitsUse of PEDHigher health benefitsRate of recurrenceFavorable treatment strategyDecision-analytical studyStent-assisted techniquePED placementTreatment modalitiesEffectiveness analysisTreatment strategiesSmall aneurysmsEmbolization DeviceSimple coilingOutcome riskAneurysmsRetreatment
2018
Management of Small Unruptured Intracranial Aneurysms: A Survey of Neuroradiologists
Malhotra A, Wu X, Geng B, Hersey D, Gandhi D, Sanelli P. Management of Small Unruptured Intracranial Aneurysms: A Survey of Neuroradiologists. American Journal Of Neuroradiology 2018, 39: 875-880. PMID: 29650787, PMCID: PMC7410652, DOI: 10.3174/ajnr.a5631.Peer-Reviewed Original Research