Quantitative Lesion Water Uptake in Acute Stroke Computed Tomography Is a Predictor of Malignant Infarction
Quantitative Lesion Water Uptake in Acute Stroke Computed Tomography Is a Predictor of Malignant Infarction
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DOI：
10.1161/strokeaha.118.020507
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发表时间：
2018-08-01
期刊：
影响因子：
8.3
通讯作者：
Kemmling, Andre
中科院分区：
文献类型：
--
作者：
Broocks, Gabriel;Flottmann, Fabian;Kemmling, Andre
背景与目的早期选择有恶性水肿危险的急性大脑中动脉梗死患者是及时开展减压手术的关键。每脑容量净摄水量（NWU）是占位性缺血性水肿的定量成像生物标志物，可在计算机断层扫描中测量。我们假设早期梗死灶的NWU可以预测恶性水肿的发展。目的是比较急性脑梗死的NWU与其他常见的恶性水肿预测因子。方法经单中心登记资料连续筛选，153例急性大脑中动脉近端闭塞患者符合纳入标准。共有29例（18.2%）患者出现恶性水肿，在随访影像中被定义为终点，导致减压手术和死亡，这是肿块效应的直接含义。在多模态入院计算机断层扫描中量化早期梗死灶体积和NWU；记录从症状出现到入院显像的时间。结果恶性梗死患者和非恶性梗死患者从发病到入院显像的平均时间相等（平均时间间隔分别为3.3 +/- 1.4小时和3.3 +/- 1.7小时）。在该队列中，所有患者都发生了梗死灶内NWU引起的水肿组织扩张（NWU: 9.1%+/- 6.8%，中位数为7.9%，四分位数间距为8.8%，范围为0.1%-35.6%）；非恶性梗死7.0%(+/- 5.2)，恶性梗死18.0%（+/- 5.7）。基于单变量受试者工作特征曲线分析，NWU >12.7%或水肿率>3.7% NWU/h对恶性梗死具有较高的判别能力（曲线下面积0.93 +/- 0.02）。在多元二元logistic回归中，恶性梗死的概率与早期梗死体积和NWU显著相关。结论基于ct的早期梗死灶定量NWU是恶性水肿发生的重要替代标志物。除了早期梗死的体积外，病变水摄取的测量可以进一步支持识别有恶性梗死风险的患者。
Background and Purpose Early selection of patients with acute middle cerebral artery infarction at risk for malignant edema is critical to initiate timely decompressive surgery. Net water uptake (NWU) per brain volume is a quantitative imaging biomarker of space-occupying ischemic edema which can be measured in computed tomography. We hypothesize that NWU in early infarct lesions can predict development of malignant edema. The aim was to compare NWU in acute brain infarct against other common predictors of malignant edema.Methods After consecutive screening of single-center registry data, 153 patients with acute proximal middle cerebral artery occlusion fulfilled the inclusion criteria. A total of 29 (18.2%) patients developed malignant edema defined as end point in follow-up imaging leading to decompressive surgery and death as a direct implication of mass effect. Early infarct lesion volume and NWU were quantified in multimodal admission computed tomography; time from symptom onset to admission imaging was recorded.Results Mean time from onset to admission imaging was equivalent between patients with and without malignant infarcts (meanSD: 3.3 +/- 1.4 hours and 3.3 +/- 1.7 hours, respectively). Edematous tissue expansion by NWU within infarct lesions occurred across all patients in this cohort (NWU: 9.1%+/- 6.8%; median, 7.9%; interquartile range, 8.8%; range, 0.1%-35.6%); 7.0% (+/- 5.2) in nonmalignant and 18.0% (+/- 5.7) in malignant infarcts. Based on univariate receiver operating characteristic curve analysis, NWU >12.7% or an edema rate >3.7% NWU/h identified malignant infarcts with high discriminative power (area under curve, 0.93 +/- 0.02). In multivariate binary logistic regression, the probability of malignant infarct was significantly associated with early infarct volume and NWU.Conclusions Computed tomography-based quantitative NWU in early infarct lesions is an important surrogate marker for developing malignant edema. Besides volume of early infarct, the measurements of lesion water uptake may further support identifying patients at risk for malignant infarction.