Enhanced Prediction of Malignant Cerebral Edema in Large Vessel Occlusion with Successful Recanalization Through Automated Weighted Net Water Uptake

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY World neurosurgery Pub Date : 2024-05-23 DOI:10.1016/j.wneu.2024.05.101
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Abstract

Background

Malignant cerebral edema (MCE) is associated with both net water uptake (NWU) and infarct volume. We hypothesized that NWU weighted by the affected Alberta Stroke Program Early Computed Tomography Score (ASPECTS) regions could serve as a quantitative imaging biomarker of aggravated edema development in acute ischemic stroke with large vessel occlusion (LVO). The aim of this study was to evaluate the performance of weighted NWU (wNWU) to predict MCE in patients with mechanical thrombectomy (MT).

Methods

We retrospectively analyzed consecutive patients who underwent MT due to LVO. NWU was computed from nonenhanced computed tomography scans upon admission using automated ASPECTS software. wNWU was derived by multiplying NWU with the number of affected ASPECTS regions in the ischemic hemisphere. Predictors of MCE were assessed through multivariate logistic regression analysis and receiver operating characteristic curves.

Results

NWU and wNWU were significantly higher in MCE patients than in non-MCE patients. Vessel recanalization status influenced the performance of wNWU in predicting MCE. In patients with successful recanalization, wNWU was an independent predictor of MCE (adjusted odds ratio 1.61; 95% confidence interval [CI] 1.24–2.09; P < 0.001). The model integrating wNWU, National Institutes of Health Stroke Scale, and collateral score exhibited an excellent performance in predicting MCE (area under the curve 0.80; 95% CI 0.75–0.84). Among patients with unsuccessful recanalization, wNWU did not influence the development of MCE (adjusted odds ratio 0.99; 95% CI 0.60–1.62; P = 0.953).

Conclusions

This study revealed that wNWU at admission can serve as a quantitative predictor of MCE in LVO with successful recanalization after MT and may contribute to the decision for early intervention.

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通过自动加权净摄水量增强对成功再通畅的大血管闭塞中恶性脑水肿的预测能力
背景 恶性脑水肿(MCE)与净摄水量(NWU)和梗死体积有关。我们假设,根据受影响的阿尔伯塔省卒中计划早期计算机断层扫描评分(ASPECTS)区域加权的净摄水量可作为大血管闭塞(LVO)急性缺血性卒中水肿加重的定量成像生物标志物。本研究旨在评估加权NWU(wNWU)预测机械性血栓切除术(MT)患者MCE的性能。用缺血半球受影响的 ASPECTS 区域数量乘以 NWU 得出 wNWU。结果MCE患者的NWU和wNWU明显高于非MCE患者。血管再通状态影响了 wNWU 预测 MCE 的性能。在成功再通的患者中,wNWU 是 MCE 的独立预测因子(调整后的几率比 1.61;95% 置信区间 [CI] 1.24-2.09;P <;0.001)。整合了 wNWU、美国国立卫生研究院卒中量表和侧支评分的模型在预测 MCE 方面表现出色(曲线下面积为 0.80;95% CI 为 0.75-0.84)。结论这项研究表明,入院时的 wNWU 可作为 MT 后再通成功的 LVO 患者 MCE 的定量预测指标,并有助于做出早期干预的决定。
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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