Author(s): Thomalla G, Hartmann F, Juettler E, Singer OC, Lehnhardt FG, et al.
Objective:Early identification of patients at risk of space-occupying "malignant" middle cerebral artery (MCA) infarction (MMI) is needed to enable timely decision for potentially life-saving treatment such as decompressive hemicraniectomy. We tested the hypothesis that acute stroke magnetic resonance imaging (MRI) predicts MMI within 6 hours of stroke onset.
Methods:In a prospective, multicenter, observational cohort study patients with acute ischemic stroke and MCA main stem occlusion were studied by MRI including diffusion-weighted imaging (DWI), perfusion imaging (PI), and MR-angiography within 6 hours of symptom onset. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI.
Results:Of 140 patients included, 27 (19.3%) developed MMI. The following parameters were identified as independent predictors of MMI: larger acute DWI lesion volume (per 1 ml odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.06; p < 0.001), combined MCA + internal carotid artery occlusion (5.38, 1.55-18.68; p = 0.008), and severity of neurological deficit on admission assessed by the National Institutes of Health Stroke Scale score (per 1 point 1.16, 1.00-1.35; p = 0.053). The prespecified threshold of a DWI lesion volume >82 ml predicted MMI with high specificity (0.98, 95% CI 0.94-1.00), negative predictive value (0.90, 0.83-0.94), and positive predictive value (0.88, 0.62-0.98), but sensitivity was low (0.52, 0.32-0.71).
Interpretation:Stroke MRI on admission predicts malignant course in severe MCA stroke with high positive and negative predictive value and may help in guiding treatment decisions, such as decompressive surgery. In a subset of patients with small initial DWI lesion volumes, repeated diagnostic tests are required.
Referred From: https://www.ncbi.nlm.nih.gov/pubmed/20865766
Author(s): Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, et al.
Author(s): Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, et al.
Author(s): Jüttler E, Bösel J, Amiri H, Schiller P, Limprecht R, et al.
Author(s): Jüttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, et al.
Author(s): Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, et al.
Author(s): Vahedi K, Vicaut E, Mateo J, Kurz A, Orabi M, et al.
Author(s): Oppenheim C, Samson Y, Manaï R, Lalam T, Vandamme X, et al.
Author(s): Thomalla GJ, Kucinski T, Schoder V, Fiehler J, Knab R, et al.
Author(s): Dohmen C, Galldiks N, Bosche B, Kracht L, Graf R
Author(s): Rieke K, Schwab S, Krieger D, von Kummer R, Aschoff A, et al.
Author(s): Sarov M, Guichard JP, Chibarro S, Guettard E, Godin O, et al.
Author(s): Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, et al.
Author(s): Uhl E, Kreth FW, Elias B, Goldammer A, Hempelmann RG, et al.
Author(s): Huttner HB, Schwab S