Journal Article

Automated quantitative lesion water uptake in acute stroke is a predictor of malignant cerebral edema

Zhu, Wusheng, Cheng, XiaoQing, Dong, Zheng, Liu, QuanHui, Liang, XianXian, Su, XiaoQin, Liu, Jia, Wu, Hang, Zhou, ChangSheng, Lu, MengJie, Lu, GuangMing, Shi, JiaQian

2022

Overview

Objectives Net water uptake (NWU) has been shown to have a linear relationship with brain edema. Based on an automated-Alberta Stroke Program Early Computed Tomography Score (ASPECTS) technique, we automatically derived NWU from baseline multimodal computed tomography (CT), namely ASPECTS-NWU. We aimed to determine if ASPECTS-NWU can predict the development of malignant cerebral edema (MCE). Methods One hundred and forty-six patients with large-vessel occlusion were retrospectively enrolled. Quantitative NWU based on automated-ASPECTS was measured both on nonenhanced CT (NECT) and CT angiography (CTA), namely NECT-ASPECT-NWU and CTA-ASPECTS-NWU. The correlation between ASPECTS-NWU and cerebral edema (CED) grades was calculated using Spearman rank correlation. Univariate logistic regression was used to assess the effect of radiological and clinical features on MCE, and a multivariable model with significant factors from the univariate regression analysis was built. Receiver operating characteristic (ROC) was obtained and area under curve (AUC) was compared. Results CTA-ASPECTS-NWU had a moderate positive correlation with CED grades ( r  = 0.62; 95% confidence interval [CI], 0.51–0.71; p  < 0.001). The CTA-ASPECTS-NWU performed better than the NECT-ASPECTS-NWU with AUC: 0.88 vs. 0.71 ( p  < 0.001). Multivariable logistic regression model integrating CTA-ASPECTS-NWU, collateral score, and age showed the CTA-ASPECTS-NWU was an independent predictor of MCE with an AUC of 0.94 (95% CI: 0.90–0.98; p  < 0.001). Conclusions This study demonstrates that ASPECTS-NWU is a quantitative predictor of MCE after large-vessel occlusion of the middle cerebral artery territory. The multivariable logistic regression model may enhance the identification of patients with MCE needing anti-edematous treatment. Key Points • The automated-ASPECTS technique can automatically detect the affected regions with early ischemic changes and NWU could be manually calculated. • The CTA-ASPECTS-NWU performs better than the NECT-ASPECTS-NWU on predicting the development of MCE. • The multivariable logistic regression model may enhance the identification of patients with MCE needing anti-edematous treatment.

• Publisher: Springer Berlin Heidelberg,Springer Nature B.V
• Subject: Angiography / Automation / Brain Edema - diagnostic imaging / Brain Ischemia / Cerebral Angiography / Cerebral blood flow / Computed tomography / Computed Tomography Angiography / Confidence intervals / Correlation / Diagnostic Radiology / Edema / Humans / Imaging / Internal Medicine / Interventional Radiology / Ischemia / Lesions / Medical diagnosis / Medicine / Medicine & Public Health / Neuro / Neuroradiology / Occlusion / Patients / Radiology / Regression analysis / Regression models / Retrospective Studies / Statistical analysis / Stroke - diagnostic imaging / Tomography / Tomography, X-Ray Computed - methods / Ultrasound / Water / Water uptake