目的:缺血性水肿与较差的临床结局相关,尤其是在大梗死区.基于计算机断层扫描(CT)的密度测定法可以直接量化绝对水肿体积(EV)。这挑战了间接生物标志物,如中线移位(MLS)。我们比较了大梗死患者早期随访CT中EV和MLS作为缺血性水肿的成像生物标志物和恶性梗死(MI)和非常差的临床结局(VPCO)的预测因子。
方法:前循环卒中患者,大血管闭塞,包括Alberta卒中计划早期CT评分(ASPECTS)≤5。VPCO定义为出院时改良Rankin量表(mRS)≥5。MLS和EV在入院时和入院后24小时的随访CT中进行量化。分析了MLS之间的相关性,EV,和总梗死体积(TIV)。进行了多变量逻辑回归和受试者工作特征曲线分析,以比较MLS和EV作为MI和VPCO的预测因子。
结果:分析了70例患者(中位TIV110mL)。EV显示出与TIV的强相关性(r=0.91,p<0.001)和良好的诊断准确性来分类MI(EVAUC0.74[95CI0.61-0.88]与MLSAUC0.82[95CI0.71-0.94];p=0.48)和VPCO(EVAUC0.72[95CI0.60-0.84]与MLSAUC0.69[95CI0.57-0.81];p=0.5)与MLS相比无显着差异,与TIV<110mL无关(r=0.17,p=0.33)。
结论:EV可能作为缺血性水肿的影像学生物标志物,因为它适用于所有体积的梗死,并预测大梗死患者的MI和VPCO,准确性与MLS相同。
结论:利用水肿体积而不是中线移位作为水肿参数,可以根据水肿程度区分大梗死和小梗死患者,在预测治疗效果方面可能具有优势,并发症,和结果。
结论:•基于CT光密度测定的绝对水肿体积挑战中线偏移作为当前缺血性水肿的金标准测量。•与MLS相比,水肿体积可预测大梗塞患者的恶性梗塞和不良临床结局,准确性相似,而与病变程度无关。•水肿体积可作为急性卒中分诊中缺血性水肿的可靠定量成像生物标志物,而与病变大小无关。
OBJECTIVE: Ischemic edema is associated with worse clinical outcomes, especially in large infarcts. Computed tomography (CT)-based densitometry allows direct quantification of absolute edema volume (EV), which challenges indirect biomarkers like midline shift (MLS). We compared EV and MLS as imaging biomarkers of ischemic edema and predictors of malignant infarction (MI) and very poor clinical outcome (VPCO) in early follow-up CT of patients with large infarcts.
METHODS: Patients with anterior circulation stroke, large vessel occlusion, and Alberta Stroke Program Early CT Score (ASPECTS) ≤ 5 were included. VPCO was defined as modified Rankin scale (mRS) ≥ 5 at discharge. MLS and EV were quantified at admission and in follow-up CT 24 h after admission. Correlation was analyzed between MLS, EV, and total infarct volume (TIV). Multivariable logistic regression and receiver operating characteristics curve analyses were performed to compare MLS and EV as predictors of MI and VPCO.
RESULTS: Seventy patients (median TIV 110 mL) were analyzed. EV showed strong correlation to TIV (r = 0.91, p < 0.001) and good diagnostic accuracy to classify MI (EV AUC 0.74 [95%CI 0.61-0.88] vs. MLS AUC 0.82 [95%CI 0.71-0.94]; p = 0.48) and VPCO (EV AUC 0.72 [95%CI 0.60-0.84] vs. MLS AUC 0.69 [95%CI 0.57-0.81]; p = 0.5) with no significant difference compared to MLS, which did not correlate with TIV < 110 mL (r = 0.17, p = 0.33).
CONCLUSIONS: EV might serve as an imaging biomarker of ischemic edema in future studies, as it is applicable to infarcts of all volumes and predicts MI and VPCO in patients with large infarcts with the same accuracy as MLS.
CONCLUSIONS: Utilization of edema volume instead of midline shift as an edema parameter would allow differentiation of patients with large and small infarcts based on the extent of edema, with possible advantages in the prediction of treatment effects, complications, and outcome.
CONCLUSIONS: • CT densitometry-based absolute edema volume challenges midline shift as current gold standard measure of ischemic edema. • Edema volume predicts malignant infarction and poor clinical outcome in patients with large infarcts with similar accuracy compared to MLS irrespective of the lesion extent. • Edema volume might serve as a reliable quantitative imaging biomarker of ischemic edema in acute stroke triage independent of lesion size.