Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany.
Stroke. 2011 Dec;42(12):3403-9. doi: 10.1161/STROKEAHA.111.619734. Epub 2011 Sep 8.
Early decompressive surgery in patients with malignant middle cerebral artery (MCA) infarction improves outcome. Elevation of intracranial pressure depends on both the space occupying brain edema and the intracranial volume reserve (cerebrospinal fluid [CSF]). However, CSF volume was not investigated as a predictor of malignant infarction so far. We hypothesize that assessment of CSF volume in addition to admission infarct size improves early prediction of malignant MCA infarction.
Stroke patients with carotid-T or MCA main stem occlusion and ischemic lesion (reduced cerebral blood volume [CBV]) on perfusion CT were considered for the analysis. The end point malignant MCA infarction was defined by clinical signs of herniation. Volumes of CSF and CBV lesion were determined on admission. Receiver-operator characteristics analysis was used to calculate predictive values for radiological and clinical measurements.
Of 52 patients included, 26 (50%) developed malignant MCA infarction. Age, a decreased level of consciousness on admission, CBV lesion volume, CSF volume, and the ratio of CBV lesion volume to CSF volume were significantly different between malignant and nonmalignant groups. The best predictor of a malignant course was the ratio of CBV lesion volume to CSF volume with a cut-off value of 0.92 (96.2% sensitivity, 96.2% specificity, 96.2% positive predictive value, and 96.2% negative predictive value).
Based on admission native CT and perfusion CT measurements, the ratio of ischemic lesion volume to CSF volume predicts the development of malignant MCA infarction with higher accuracy than other known predictors, including ischemic lesion volume or clinical characteristics.
早期减压手术可改善恶性大脑中动脉（MCA）梗死患者的预后。颅内压升高既取决于占位性脑水肿，也取决于颅内容积储备（脑脊液 [CSF]）。然而，迄今为止，CSF 体积尚未被视为恶性梗死的预测指标。我们假设，除了入院时的梗死灶大小外，CSF 体积的评估可以改善对恶性 MCA 梗死的早期预测。
对接受颈动脉-T 或 MCA 主干闭塞且灌注 CT 显示缺血性病变（脑血容量 [CBV] 减少）的卒中患者进行分析。根据脑疝的临床征象来定义恶性 MCA 梗死的终点。入院时确定 CSF 和 CBV 病变的体积。使用受试者工作特征曲线分析来计算影像学和临床测量的预测值。
在纳入的 52 例患者中，26 例（50%）发生了恶性 MCA 梗死。恶性组与非恶性组在年龄、入院时意识水平降低、CBV 病变体积、CSF 体积以及 CBV 病变体积与 CSF 体积之比等方面存在显著差异。CBV 病变体积与 CSF 体积之比是恶性病程的最佳预测指标，其截断值为 0.92（灵敏度 96.2%、特异性 96.2%、阳性预测值 96.2%和阴性预测值 96.2%）。
基于入院时的平扫 CT 和灌注 CT 测量值，缺血性病变体积与 CSF 体积之比预测恶性 MCA 梗死的发生具有比其他已知预测指标（包括缺血性病变体积或临床特征）更高的准确性。
