Brain edema predicts outcome after nonlacunar ischemic stroke.
Brain edema predicts outcome after nonlacunar ischemic stroke.
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DOI：
10.1161/strokeaha.114.006884
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发表时间：
2014-12
期刊：
影响因子：
8.3
通讯作者：
Kimberly WT
中科院分区：
文献类型：
--
作者：
Battey TW;Karki M;Singhal AB;Wu O;Sadaghiani S;Campbell BC;Davis SM;Donnan GA;Sheth KN;Kimberly WT
在恶性脑梗死中，脑水肿导致继发性神经功能恶化和预后不良。我们试图确定肿胀是否与小体积卒中的结局相关。分析了两个研究队列的急性卒中受试者的连续脑磁共振成像（MRI）。通过比较基线和随访扫描，在弥散加权成像（DWI）上评估肿胀和/或梗死生长的分类存在。然后使用感兴趣区域分析将每搏输出量（ΔDWI）的增加细分为肿胀和梗死生长体积。在单变量和多变量回归中评估这些影像学标记物与结果的关系。校正年龄、NIH卒中量表、入院血糖和基线DWI体积后，肿胀的存在独立预测预后较差（OR 4.55，95%CI 1.21 -18.9，p < 0.02）。容积分析证实ΔDWI与预后相关（OR 4.29，95%CI 2.00-11.5，p < 0.001）。将ΔDWI分为肿胀和梗死体积增长后，肿胀仍然是预后不良的独立预测因子（OR 1.09，95%CI 1.03-1.17，p < 0.005）。较大的梗死生长也与不良预后相关（OR 7.05，95%CI 1.04-143，p < 0.045），尽管较小的梗死生长与此无关。在表观扩散系数图上测量的细胞毒性损伤的严重程度与肿胀相关，而灌注缺损体积与梗死生长相关。肿胀和梗死生长各自促进卒中后数天内的总卒中病变生长。肿胀是不良结局的独立预测因子，其中过度肿胀体积≥ 11 mL被确定为预测不良结局的最高敏感性和特异性阈值。
In malignant infarction, brain edema leads to secondary neurological deterioration and poor outcome. We sought to determine whether swelling is associated with outcome in smaller volume strokes. Two research cohorts of acute stroke subjects with serial brain magnetic resonance imaging (MRI) were analyzed. The categorical presence of swelling and/or infarct growth was assessed on diffusion weighted imaging (DWI) by comparing baseline and follow-up scans. The increase in stroke volume (ΔDWI) was then subdivided into swelling and infarct growth volumes using region-of-interest analysis. The relationship of these imaging markers with outcome was evaluated in univariable and multivariable regression. The presence of swelling independently predicted worse outcome after adjustment for age, NIH stroke scale, admission glucose, and baseline DWI volume(OR4.55, 95%CI1.21-18.9, p < 0.02). Volumetric analysis confirmed ΔDWI was associated with outcome (OR4.29, 95%CI 2.00-11.5, p < 0.001). After partitioning ΔDWI into swelling and infarct growth volumetrically, swelling remained an independent predictor of poor outcome (OR1.09, 95%CI 1.03-1.17, p < 0.005). Larger infarct growth was also associated with poor outcome (OR7.05, 95%CI 1.04-143, p < 0.045), although small infarct growth was not. The severity of cytotoxic injury measured on apparent diffusion coefficient maps was associated with swelling, whereas the perfusion deficit volume was associated with infarct growth. Swelling and infarct growth each contribute to total stroke lesion growth in the days following stroke. Swelling is an independent predictor of poor outcome, with abrain swelling volume of ≥11mL identified as the threshold with greatest sensitivity and specificity for predicting poor outcome.