Cheng XiaoQing, Tian Bing, Huang LiJun, Shen Xi, Liao AnYu, Zhou ChangSheng, Liu Quan Hui, Pang HuiMin, Tang JinJing, Luo BaiYan, Tian Xia, Hou YuXi, Chen LuGuang, Chen Qian, Zhu WuSheng, Shao ChengWei, Yin XinDao, Lu GuangMing
From the Department of Medical Imaging (X.C., C.Z., Q.H.L., H.P., J.T., B.L., G.L.), Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu, China.
Department of Radiology (B.T., X.T., Y.H., L.C., C.S.), Changhai Hospital of Shanghai, The First Affiliated Hospital of Navy Medical University, Shanghai, China.
AJNR Am J Neuroradiol. 2025 Jul 1;46(7):1329-1335. doi: 10.3174/ajnr.A8659.
Early identification of malignant cerebral edema (MCE) in patients with acute ischemic stroke is crucial for timely interventions. We aimed to identify regions critically associated with MCE using the ASPECTS to evaluate the association between location-specific net water uptake (NWU) and MCE.
This multicenter, retrospective cohort study included patients with acute ischemic stroke following large anterior circulation occlusion. The ASPECTS was determined by RAPID ASPECTS software. ASPECTS-NWU and Region-NWU were calculated automatically by comparing the Hounsfield unit values in the ischemic and contralateral regions. Critical ASPECTS MCE regions and Region-NWU were evaluated by multivariate logistic regression and the areas under the receiver operating characteristic curves (AUCs).
The study included 513 patients. Multivariate analysis showed that the ASPECTS insula (OR = 2.49; 95% CI, 1.44-4.31) and M5 (OR = 1.59; 95% CI, 1.11-3.41) regions were significantly associated with MCE. After adjustment, only the insula (OR = 2.34; 95% CI, 1.23-4.45) was independently associated with MCE. Univariable receiver operating characteristic curve analysis found AUCs for Insula-NWU (AUC, 0.70; 95% CI, 0.65-0.76) and ASPECTS-NWU (AUC, 0.64; 95% CI, 0.58-0.70). The Insula-NWU had better diagnostic power than ASPECTS-NWU (DeLong test; = .01). A multivariate regression model that combined the NIHSS, ASPECTS, insula involvement, and Insula-NWU had good discriminatory power (AUC = 0.80; 95% CI, 0.74-0.86) and better diagnostic power than Insula-NWU (DeLong test; < .01).
The insula region is critical for MCE, and Insula-NWU has better prediction efficacy than ASPECTS-NWU. This method does not rely on advanced imaging, facilitating rapid assessment in emergencies.
急性缺血性脑卒中患者恶性脑水肿（MCE）的早期识别对于及时干预至关重要。我们旨在利用脑缺血半暗带早期CT评分（ASPECTS）确定与MCE密切相关的区域，以评估特定部位的净吸水量（NWU）与MCE之间的关联。
这项多中心回顾性队列研究纳入了大脑前循环大血管闭塞后的急性缺血性脑卒中患者。ASPECTS由RAPID ASPECTS软件确定。通过比较缺血区域和对侧区域的亨氏单位值自动计算ASPECTS-NWU和区域-NWU。通过多因素逻辑回归和受试者工作特征曲线（ROC）下面积评估关键的ASPECTS MCE区域和区域-NWU。
该研究纳入了513例患者。多因素分析显示，ASPECTS脑岛（OR = 2.49；95%CI，1.44 - 4.31）和M5（OR = 1.59；95%CI，1.11 - 3.41）区域与MCE显著相关。调整后，仅脑岛（OR = 2.34；95%CI，1.23 - 4.45）与MCE独立相关。单因素ROC曲线分析发现脑岛-NWU的曲线下面积（AUC，0.70；95%CI，0.65 - 0.76）和ASPECTS-NWU的曲线下面积（AUC，0.64；95%CI，0.58 - 0.70）。脑岛-NWU的诊断效能优于ASPECTS-NWU（德龙检验；P = 0.01）。结合美国国立卫生研究院卒中量表（NIHSS）、ASPECTS、脑岛受累情况和脑岛-NWU的多因素回归模型具有良好的鉴别能力（AUC = 0.80；95%CI，0.74 - 0.86），且诊断效能优于脑岛-NWU（德龙检验；P < 0.01）。
脑岛区域对MCE至关重要，脑岛-NWU的预测效能优于ASPECTS-NWU。该方法不依赖于先进的影像学检查，便于在紧急情况下进行快速评估。
