1. Intracranial Cerebrospinal Fluid Volume as a Predictor of Malignant Middle Cerebral Artery Infarction
- Author
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Kauw, Frans, Bennink, Edwin, de Jong, Hugo W. A. M., Kappelle, L. Jaap, Horsch, Alexander D., Velthuis, Birgitta K., Dankbaar, Jan W., Majoie, C. B., Roos, Y. B., Duijm, L. E., Keizer, K., van der Lugt, A., Dippel, D. W., Droogh-de Greve, K. E., Bienfait, H. P., van Walderveen, M. A., Wermer, M. J., Nijeholt, Lycklama A. G. J., Boiten, J., Duyndam, D., Kwa, V., I, Meijer, F. J., van Dijk, E. J., Kesselring, F. O., Hofmeijer, J., Vos, J. A., Schonewille, W. J., van Rooij, W. J., de Kort, P. L., Pleiter, C. C., Bakker, S. L., Bot, J., Visser, M. C., Velthuis, B. K., van der Schaaf, I. C., Dankbaar, J. W., Mali, W. P., van Seeters, T., Horsch, A. D., Niesten, J. M., Biessels, G. J., Kappelle, L. J., Luitse, M. J., van der Graaf, Y., Radiology & Nuclear Medicine, Neurology, Physics and medical technology, Radiology and nuclear medicine, VU University medical center, Dermatology, Surgery, Public and occupational health, Human genetics, Radiation Oncology, Amsterdam Neuroscience - Neurovascular Disorders, and ACS - Atherosclerosis & ischemic syndromes
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medicine.medical_specialty ,Original Contributions ,infarction ,Clinical Sciences ,Clinical Neurology ,Infarction ,Perfusion scanning ,All institutes and research themes of the Radboud University Medical Center ,Midline shift ,Internal medicine ,medicine.artery ,Journal Article ,Medicine ,odds ratio ,cardiovascular diseases ,Advanced and Specialised Nursing ,humans ,Stroke ,Advanced and Specialized Nursing ,brain edema ,middle cerebral artery ,infarction, middle cerebral artery ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Odds ratio ,medicine.disease ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,Angiography ,Middle cerebral artery ,Cardiology ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Neurology (clinical) ,prognosis ,business ,Cardiology and Cardiovascular Medicine ,Rare cancers Radboud Institute for Health Sciences [Radboudumc 9] - Abstract
Supplemental Digital Content is available in the text., Background and Purpose— Predicting malignant middle cerebral artery (MCA) infarction can help to identify patients who may benefit from preventive decompressive surgery. We aimed to investigate the association between the ratio of intracranial cerebrospinal fluid (CSF) volume to intracranial volume (ICV) and malignant MCA infarction. Methods— Patients with an occlusion proximal to the M3 segment of the MCA were selected from the DUST (Dutch Acute Stroke Study). Admission imaging included noncontrast computed tomography (CT), CT perfusion, and CT angiography. Patient characteristics and CT findings were collected. The ratio of intracranial CSF volume to ICV (CSF/ICV) was quantified on admission thin-slice noncontrast CT. Malignant MCA infarction was defined as a midline shift of >5 mm on follow-up noncontrast CT, which was performed 3 days after the stroke or in case of clinical deterioration. To test the association between CSF/ICV and malignant MCA infarction, odds ratios and 95% CIs were calculated for 3 multivariable models by using binary logistic regression. Model performances were compared by using the likelihood ratio test. Results— Of the 286 included patients, 35 (12%) developed malignant MCA infarction. CSF/ICV was independently associated with malignant MCA infarction in 3 multivariable models: (1) with age and admission National Institutes of Health Stroke Scale (odds ratio, 3.3; 95% CI, 1.1–11.1), (2) with admission National Institutes of Health Stroke Scale and poor collateral score (odds ratio, 7.0; 95% CI, 2.6–21.3), and (3) with terminal internal carotid artery or proximal M1 occlusion and poor collateral score (odds ratio, 7.7; 95% CI, 2.8–23.9). The performance of model 1 (areas under the receiver operating characteristic curves, 0.795 versus 0.824; P=0.033), model 2 (areas under the receiver operating characteristic curves, 0.813 versus 0.850; P
- Published
- 2019
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