• Yuko Goto, Eiji Kumura, Tadashi Watabe, Hajime Nakamura, Akio Nishino, Takashi Koyama, Koichi Taniwaki, Takamichi Yuguchi, and Toshiki Yoshimine.
• Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
• J Stroke Cerebrovasc Dis. 2016 Jun 1; 25 (6): 1389-95.

BackgroundWe 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.MethodsWe 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.ResultsThe 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).ConclusionsDHV and DHV/BV can provide reliable information for MMI prediction in elderly patients.Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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