• World Neurosurg · Aug 2024

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

    • Haoli Xu, Mo Zheng, Wenhui Liu, Weili Peng, Jiamei Qiu, Wangle Huang, Jiaqi Zhang, Enhui Xin, Nengzhi Xia, Ru Lin, Chaomin Qiu, Guoquan Cao, Weijian Chen, Yunjun Yang, Yinfeng Qian, and Jun Chen.
    • Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China; Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
    • World Neurosurg. 2024 Aug 1; 188: e312e319e312-e319.

    BackgroundMalignant 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).MethodsWe 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.ResultsNWU 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).ConclusionsThis 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.Copyright © 2024 Elsevier Inc. All rights reserved.

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