Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea.
BMC Neurol. 2020 Sep 22;20(1):354. doi: 10.1186/s12883-020-01931-w.
In acute large anterior circulation infarct patients with large core volume, we evaluated the role of optic nerve sheath diameter (ONSD) change rates in prediction of malignant progression.
We performed a retrospective observational study including patients with anterior circulation acute ischemic stroke with large ischemic cores from January 2010 to October 2017. Primary outcome was defined as undergoing decompressive surgery or death due to severe cerebral edema, and termed malignant progression. Patients were divided into malignant progressors and nonprogressors. Malignant progression was divided into early progression that occurred before D1 CT, and late progression that occurred afterwards. Retrospective analysis of changes in mean ONSD/eyeball transverse diameter (ETD) ratio, and midline shifting (MLS) were evaluated on serial computed tomography (CT). Through analysis of CT at baseline, postprocedure, and at D1, the predictive ability of time based change in ONSD/ETD ratio in predicting malignant progression was evaluated.
A total of 58 patients were included. Nineteen (32.8%) were classified as malignant; 12 early, and 7 late progressions. In analysis of CT, A 1 mm/hr. rate of change in MLS during the CT-CT time phase lead to a 6.7 fold increased odds of early malignant progression (p < 0.05). For ONSD/ETD, 1%/hr. change lead to a 1.6 fold increased odds, but this association was trending (p = 0.249). In the CT, 1%/day change of ONSD/ETD in the CT-CT time phase lead to a 1.4 fold increased odds of late malignant progression (p = 0.021) while 1 mm/day rate of change in MLS lead to a 1.5 fold increased odds (p = 0.014).
The rate of ONSD/ETD changes compared to baseline at D1 CT can be a predictor of late malignant progression along with MLS. ONSD/ETD change rates evaluated at postprocedure did not predict early malignant progression.
在伴有大核心体积的急性大动脉前循环梗死患者中，我们评估了视神经鞘直径（ONSD）变化率在预测恶性进展中的作用。
我们进行了一项回顾性观察研究，纳入了 2010 年 1 月至 2017 年 10 月期间患有大动脉急性缺血性卒中且有大缺血核心的患者。主要结局定义为因严重脑水肿而行减压手术或死亡，称为恶性进展。患者分为恶性进展者和非进展者。恶性进展分为 D1 CT 前发生的早期进展和之后发生的晚期进展。通过对连续计算机断层扫描（CT）的 ONSD/眼球横径（ETD）比和中线移位（MLS）的变化进行回顾性分析来评估。通过分析基线、术后和 D1 的 CT，评估 ONSD/ETD 比随时间变化在预测恶性进展方面的预测能力。
共纳入 58 例患者，其中 19 例（32.8%）被归类为恶性；12 例为早期进展，7 例为晚期进展。在 CT 分析中，CT-CT 时间阶段 MLS 变化率为 1mm/hr，导致早期恶性进展的可能性增加 6.7 倍（p<0.05）。对于 ONSD/ETD，1%/hr 的变化导致可能性增加 1.6 倍，但这种关联呈趋势（p=0.249）。在 CT 中，CT-CT 时间阶段 ONSD/ETD 变化率为 1%/天，导致晚期恶性进展的可能性增加 1.4 倍（p=0.021），而 MLS 的变化率为 1mm/day 导致可能性增加 1.5 倍（p=0.014）。
与 D1 CT 相比，ONSD/ETD 的变化率可以预测晚期恶性进展以及 MLS。术后 ONSD/ETD 变化率不能预测早期恶性进展。
