Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction
Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction
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DOI：
10.1161/strokeaha.119.024882
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发表时间：
2019-06-01
期刊：
影响因子：
8.3
通讯作者：
van der Graaf, Y.
中科院分区：
文献类型：
--
作者：
Kauw, Frans;Bennink, Edwin;van der Graaf, Y.
背景和目的预测恶性大脑中动脉（MCA）梗死有助于识别可能受益于预防性减压手术的患者。我们的目的是探讨颅内脑脊液（CSF）的体积颅内体积（ICV）和恶性MCA infarction.Methods闭塞近端的MCA段的患者之间的比例之间的关联被选中从DUST（荷兰急性中风研究）。入院影像学检查包括非造影计算机断层扫描（CT）、CT灌注和CT血管造影。收集患者特征和CT结果。在入院时进行薄层CT平扫，定量颅内CSF体积与ICV的比值（CSF/ICV）。恶性MCA梗死定义为卒中后3天或临床恶化情况下进行的随访非增强CT中线移位>5 mm。为了检验CSF/ICV与恶性MCA梗死之间的相关性，使用二元logistic回归计算3个多变量模型的比值比和95%CI。结果286例患者中，35例（12%）发生了恶性MCA梗死。在3个多变量模型中，CSF/ICV与恶性MCA梗死独立相关：（1）与年龄和入院国立卫生研究院卒中量表（比值比，3.3; 95%CI，1.1-11.1），（2）入院时美国国立卫生研究院卒中量表评分和侧支评分较差（比值比，7.0; 95%CI，2.6-21.3），（3）颈内动脉末端或近端M1闭塞且侧支评分较差（比值比，7.7; 95%CI，2.8-23.9）。模型1（受试者工作特征曲线下面积，0.795对0.824; P=0.033）、模型2（受试者工作特征曲线下面积，0.813对0.850; P
Background and Purpose Predicting malignant middle cerebral artery (MCA) infarction can help to identify patients who may benefit from preventive decompressive surgery. We aimed to investigate the association between the ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) and malignant MCA infarction.Methods Patients with an occlusion proximal to the M3 segment of the MCA were selected from the DUST (Dutch Acute Stroke Study). Admission imaging included noncontrast computed tomography (CT), CT perfusion, and CT angiography. Patient characteristics and CT findings were collected. The ratio of intracranial CSF volume to ICV (CSF/ICV) was quantified on admission thin-slice noncontrast CT. Malignant MCA infarction was defined as a midline shift of >5 mm on follow-up noncontrast CT, which was performed 3 days after the stroke or in case of clinical deterioration. To test the association between CSF/ICV and malignant MCA infarction, odds ratios and 95% CIs were calculated for 3 multivariable models by using binary logistic regression. Model performances were compared by using the likelihood ratio test.Results Of the 286 included patients, 35 (12%) developed malignant MCA infarction. CSF/ICV was independently associated with malignant MCA infarction in 3 multivariable models: (1) with age and admission National Institutes of Health Stroke Scale (odds ratio, 3.3; 95% CI, 1.1-11.1), (2) with admission National Institutes of Health Stroke Scale and poor collateral score (odds ratio, 7.0; 95% CI, 2.6-21.3), and (3) with terminal internal carotid artery or proximal M1 occlusion and poor collateral score (odds ratio, 7.7; 95% CI, 2.8-23.9). The performance of model 1 (areas under the receiver operating characteristic curves, 0.795 versus 0.824; P=0.033), model 2 (areas under the receiver operating characteristic curves, 0.813 versus 0.850; P