From the Department of Radiology (H.X.), Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, Zhejiang, China.
Department of Radiology (H.S., S.H., M.Z., W.H., Z.Z., Y.X., P.F., W.C.), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
AJNR Am J Neuroradiol. 2021 Jun;42(6):1023-1029. doi: 10.3174/ajnr.A7039. Epub 2021 Mar 18.
Predicting malignant cerebral edema can help identify patients who may benefit from appropriate evidence-based interventions. We investigated whether absent cortical venous filling is associated with more pronounced early brain edema, which leads to malignant cerebral edema.
Patients with acute ischemic stroke caused by large-vessel occlusion in the MCA territory who presented between July 2017 and September 2019 to our hospital were included. Collateral filling was rated using the modified Tan scale on CTA, and good collaterals were defined as a score of 2-3. The Cortical Vein Opacification Score (COVES) was calculated, and absent cortical venous filling was defined as a score of 0. Early brain edema was determined using net water uptake on baseline CT images. Malignant cerebral edema was defined as a midline shift of ≥5 mm on follow-up imaging or a massive cerebral swelling leading to decompressive hemicraniectomy or death. Multivariate linear and logistic regression models were performed to analyze data.
A total of 163 patients were included. Net water uptake was significantly higher in patients with absent than in those with favorable cortical venous filling (8.1% versus 4.2%; < .001). In the multivariable regression analysis, absent cortical venous filling (β = 2.04; 95% CI, 0.75-3.32; = .002) was significantly and independently associated with higher net water uptake. Absent cortical venous filling (OR, 14.68; 95% CI, 4.03-53.45; < .001) and higher net water uptake (OR, 1.29; 95% CI, 1.05-1.58; = .016) were significantly associated with increased likelihood of malignant cerebral edema.
Patients with absent cortical venous filling were associated with an increased early brain edema and a higher risk of malignant cerebral edema. These patients may be targeted for optimized adjuvant antiedematous treatment.
预测恶性脑水肿有助于识别可能受益于适当循证干预的患者。我们研究了皮质静脉充盈缺失是否与更明显的早期脑水肿相关，进而导致恶性脑水肿。
本研究纳入了 2017 年 7 月至 2019 年 9 月期间因 MCA 区域大血管闭塞导致急性缺血性卒中的患者。采用 CTA 的改良 Tan 评分评估侧支循环填充情况，良好的侧支循环定义为评分 2-3 分。计算皮质静脉充盈评分（COVES），将皮质静脉充盈缺失定义为评分 0 分。采用基线 CT 图像上的净水分摄取来确定早期脑水肿。恶性脑水肿定义为随访影像学上的中线移位≥5mm或巨大脑肿胀导致减压性半脑切除术或死亡。采用多元线性和逻辑回归模型进行数据分析。
共纳入 163 例患者。无皮质静脉充盈患者的净水分摄取明显高于有皮质静脉充盈良好患者（8.1%比 4.2%； <.001）。在多变量回归分析中，皮质静脉充盈缺失（β=2.04；95%CI，0.75-3.32； =.002）与更高的净水分摄取显著且独立相关。皮质静脉充盈缺失（OR，14.68；95%CI，4.03-53.45； <.001）和更高的净水分摄取（OR，1.29；95%CI，1.05-1.58； =.016）与恶性脑水肿的发生风险增加显著相关。
皮质静脉充盈缺失的患者与早期脑水肿增加和恶性脑水肿风险增加相关。这些患者可能是优化辅助去水肿治疗的目标人群。
