Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Neuroradiology, Westpfalz-Klinikum, Kaiserslautern, Germany.
Neurosurgery. 2021 Feb 16;88(3):531-537. doi: 10.1093/neuros/nyaa438.
Malignant cerebellar edema (MCE) is a life-threatening complication of ischemic posterior circulation stroke that requires timely diagnosis and management. Yet, there is no established imaging biomarker that may serve as predictor of MCE. Early edematous water uptake can be determined using quantitative lesion water uptake, but this biomarker has only been applied in anterior circulation strokes.
To test the hypothesis that lesion water uptake in early posterior circulation stroke predicts MCE.
A total 179 patients with posterior circulation stroke and multimodal admission CT were included. A total of 35 (19.5%) patients developed MCE defined by using an established 10-point scale in follow-up CT, of which ≥4 points are considered malignant. Posterior circulation net water uptake (pcNWU) was quantified in admission CT based on CT densitometry and compared with posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) as predictor of MCE using receiver operating curve (ROC) analysis and logistic regression analysis.
Acute pcNWU within the early ischemic lesion was 24.6% (±8.4) for malignant and 7.2% (±7.4) for nonmalignant infarctions, respectively (P < .0001). Based on ROC analysis, pcNWU above 14.9% identified MCE with high discriminative power (area under the curve: 0.94; 95% CI: 0.89-0.97). Early pcNWU (odds ratio [OR]: 1.28; 95% CI: 1.15-1.42, P < .0001) and pc-ASPECTS (OR: 0.71, 95% CI: 0.53-0.95, P = .02) were associated with MCE, adjusted for age and recanalization status.
Quantitative pcNWU in early posterior circulation stroke is an important marker for MCE. Besides pc-ASPECTS, lesion water uptake measurements may further support identifying patients at risk for MCE at an early stage indicating stricter monitoring and consideration for further therapeutic measures.
恶性小脑水肿（MCE）是缺血性后循环卒中的一种危及生命的并发症，需要及时诊断和治疗。然而，目前尚无确定的影像学生物标志物可作为 MCE 的预测指标。早期水肿性水摄取可通过定量病变水摄取来确定，但该生物标志物仅在前循环卒中中有应用。
检验病变水摄取在早期后循环卒中预测 MCE 的假说。
共纳入 179 例后循环卒中且在入院时行多模态 CT 检查的患者。根据随访 CT 采用 10 分制建立的标准，共有 35 例（19.5%）患者发生 MCE，其中≥4 分被认为是恶性的。根据 CT 密度测量法，在后循环卒中的入院 CT 上量化后循环净水摄取（pcNWU），并将其与后循环急性卒中预后早期 CT 评分（pc-ASPECTS）进行比较，使用接受者操作特征曲线（ROC）分析和逻辑回归分析来预测 MCE。
恶性梗死的早期缺血性病变内急性 pcNWU 为 24.6%（±8.4），而非恶性梗死的为 7.2%（±7.4）（P<0.0001）。基于 ROC 分析，pcNWU 高于 14.9%可识别出具有高判别力的 MCE（曲线下面积：0.94；95%置信区间：0.89-0.97）。早期 pcNWU（比值比[OR]：1.28；95%置信区间：1.15-1.42，P<0.0001）和 pc-ASPECTS（OR：0.71，95%置信区间：0.53-0.95，P=0.02）与 MCE 相关，调整年龄和再通状态后仍具有相关性。
早期后循环卒中的定量 pcNWU 是 MCE 的重要标志物。除了 pc-ASPECTS 之外，病变水摄取测量可能进一步支持在早期识别出 MCE 风险患者，从而更严密地监测并考虑进一步的治疗措施。
