Yuko Goto1, Eiji Kumura2, Tadashi Watabe3, Hajime Nakamura4, Akio Nishino5, Takashi Koyama5, Koichi Taniwaki5, Takamichi Yuguchi6, Toshiki Yoshimine4. 1. Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. 2. Department of Neurosurgery, Osaka Neurological Institute, Osaka, Japan. Electronic address: ekumura@nyc.odn.ne.jp. 3. Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Osaka, Japan. 4. Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. 5. Department of Neurosurgery, Hanwa Memorial Hospital, Japan. 6. Yuguchi Neurosurgical and Spine Clinic, Japan.
Abstract
BACKGROUND: We evaluated the clinical outcomes of malignant middle cerebral artery (MCA) infarction (MMI) and determined an infarcted brain volume (BV) threshold value for accurate MMI prediction in elderly patients. METHODS: We analyzed 69 consecutive patients (mean, 75.6 ± 11.7) with internal carotid artery or MCA infarction within 48 hours from onset. Diffusion-weighted high-intensity volume (DHV) and BV were measured in all patients. The percentage of DHV within BV (DHV/BV ratio) was calculated to standardize the DHV difference for each individual BV. Patients were stratified based upon their MMI status and age, compared with the following: (1) MMI versus non-MMI groups and (2) age ≥75 years group versus age <75 years group, based on DHV values, DHV/BV ratio, Glasgow Coma Scale (GCS) scores on admission, and modified Rankin Scale (mRS) scores at 3 months after onset. RESULTS: The MMI group (n = 14) showed significantly larger DHV values (P < .001), larger DHV/BV ratios (P < .001), lower GCS scores on admission (P < .01), and higher mRS scores at 3 months (P < .001) than the non-MMI group. The DHV threshold value predicting MMI was 102 cm(3) (sensitivity 85%, specificity 91%, P < .01) and DHV/BV threshold ratio was 7.8% (sensitivity 86%, specificity 87%, P < .01). Both the age ≥75 years group and the age <75 years group with MMI showed equally poor outcomes (mRS 5.7 ± .7 versus 5.3 ± 1.3). CONCLUSIONS: DHV and DHV/BV can provide reliable information for MMI prediction in elderly patients.
BACKGROUND: We evaluated the clinical outcomes of malignant middle cerebral artery (MCA) infarction (MMI) and determined an infarcted brain volume (BV) threshold value for accurate MMI prediction in elderly patients. METHODS: We analyzed 69 consecutive patients (mean, 75.6 ± 11.7) with internal carotid artery or MCA infarction within 48 hours from onset. Diffusion-weighted high-intensity volume (DHV) and BV were measured in all patients. The percentage of DHV within BV (DHV/BV ratio) was calculated to standardize the DHV difference for each individual BV. Patients were stratified based upon their MMI status and age, compared with the following: (1) MMI versus non-MMI groups and (2) age ≥75 years group versus age <75 years group, based on DHV values, DHV/BV ratio, Glasgow Coma Scale (GCS) scores on admission, and modified Rankin Scale (mRS) scores at 3 months after onset. RESULTS: The MMI group (n = 14) showed significantly larger DHV values (P < .001), larger DHV/BV ratios (P < .001), lower GCS scores on admission (P < .01), and higher mRS scores at 3 months (P < .001) than the non-MMI group. The DHV threshold value predicting MMI was 102 cm(3) (sensitivity 85%, specificity 91%, P < .01) and DHV/BV threshold ratio was 7.8% (sensitivity 86%, specificity 87%, P < .01). Both the age ≥75 years group and the age <75 years group with MMI showed equally poor outcomes (mRS 5.7 ± .7 versus 5.3 ± 1.3). CONCLUSIONS:DHV and DHV/BV can provide reliable information for MMI prediction in elderly patients.
Authors: Kevin N Sheth; Nils H Petersen; Ken Cheung; Jordan J Elm; Holly E Hinson; Bradley J Molyneaux; Lauren A Beslow; Gordon K Sze; J Marc Simard; W Taylor Kimberly Journal: Stroke Date: 2018-05-22 Impact factor: 7.914