Computed tomography perfusion as an early predictor of malignant cerebral infarction
Introduction: Malignant middle cerebral artery infarction (MCI) needs rapid intervention. This study aimed to enhance the prediction of MCI using computed tomography perfusion (CTP) with varied quantitative benchmarks. Materials and methods: We retrospectively analyzed 253 patients from a single-cen...
| Autores: | , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión aceptada para publicación |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/219888 |
| Acceso en línea: | https://hdl.handle.net/2445/219888 |
| Access Level: | acceso abierto |
| Palabra clave: | Vasos sanguinis Oclusions arterials Infart cerebral Tomografia computada per emissió de fotó simple Artèries caròtides Blood vessels Arterial occlusions Cerebral infarctio Single-photon emission computed tomography Carotid artery |
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Computed tomography perfusion as an early predictor of malignant cerebral infarctionRodríguez Vázquez, AlejandroLaredo Gregorio, CarlosReyes, LuisDolz Alvarez de la Ballina, GuillemDoncel Moriano, AntonioLlansó, LauraRudilosso, SalvatoreLlull Estrany, LauraRenú, ArturoAmaro Delgado, Sergio Torné, RamónUrra, XabierChamorro Sánchez, ÁngelVasos sanguinisOclusions arterialsInfart cerebralTomografia computada per emissió de fotó simpleArtèries caròtidesBlood vesselsArterial occlusionsCerebral infarctioSingle-photon emission computed tomographyCarotid arteryIntroduction: Malignant middle cerebral artery infarction (MCI) needs rapid intervention. This study aimed to enhance the prediction of MCI using computed tomography perfusion (CTP) with varied quantitative benchmarks. Materials and methods: We retrospectively analyzed 253 patients from a single-center registry presenting with acute, severe, proximal large vessel occlusion studied with whole-brain CTP imaging at hospital arrival within the first 24 h of symptoms-onset. MCI was defined by clinical and imaging criteria, including decreased level of consciousness, anisocoria, death due to cerebral edema, or need for decompressive craniectomy, together with midline shift ⩾6 mm, or infarction of more than 50% of the MCA territory. The predictive accuracy of baseline ASPECTS and CTP quantifications for MCI was assessed by receiver operating characteristic (ROC) area under the curve (AUC) while F-score was calculated as an indicator of precision and sensitivity. Results: Sixty-three out of 253 patients (25%) fulfilled MCI criteria and had worse clinical and imaging results than the non-MCI group. The capacity to predict MCI was lower for baseline ASPECTS (AUC 0.83, F-score 0.52, Youden's index 6), than with perfusion-based measures: relative cerebral blood volume threshold <40% (AUC 0.87, F-score 0.71, Youden's index 34 mL) or relative cerebral blood flow threshold <35% (AUC 0.87, F-score 0.62, Youden's index 67 mL). CTP based on rCBV measurements identified twice as many MCI as baseline CT ASPECTS. Discussion and conclusion: CTP-based quantifications may offer enhanced predictive capabilities for MCI compared to non-contrast baseline CT ASPECTS, potentially improving the monitoring of severe ischemic stroke patients at risk of life-threatening edema and its treatment.SAGE Publications2024info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfhttps://hdl.handle.net/2445/219888Articles publicats en revistes (Medicina)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésVersió postprint del document publicat a: https://doi.org/10.1177/23969873241260965European Stroke Journal, 2024, vol. 10, num.1https://doi.org/10.1177/23969873241260965cc-by-nc-nd (c) European Stroke Journal, 2024http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/2198882026-05-27T06:46:51Z |
| dc.title.none.fl_str_mv |
Computed tomography perfusion as an early predictor of malignant cerebral infarction |
| title |
Computed tomography perfusion as an early predictor of malignant cerebral infarction |
| spellingShingle |
Computed tomography perfusion as an early predictor of malignant cerebral infarction Rodríguez Vázquez, Alejandro Vasos sanguinis Oclusions arterials Infart cerebral Tomografia computada per emissió de fotó simple Artèries caròtides Blood vessels Arterial occlusions Cerebral infarctio Single-photon emission computed tomography Carotid artery |
| title_short |
Computed tomography perfusion as an early predictor of malignant cerebral infarction |
| title_full |
Computed tomography perfusion as an early predictor of malignant cerebral infarction |
| title_fullStr |
Computed tomography perfusion as an early predictor of malignant cerebral infarction |
| title_full_unstemmed |
Computed tomography perfusion as an early predictor of malignant cerebral infarction |
| title_sort |
Computed tomography perfusion as an early predictor of malignant cerebral infarction |
| dc.creator.none.fl_str_mv |
Rodríguez Vázquez, Alejandro Laredo Gregorio, Carlos Reyes, Luis Dolz Alvarez de la Ballina, Guillem Doncel Moriano, Antonio Llansó, Laura Rudilosso, Salvatore Llull Estrany, Laura Renú, Arturo Amaro Delgado, Sergio Torné, Ramón Urra, Xabier Chamorro Sánchez, Ángel |
| author |
Rodríguez Vázquez, Alejandro |
| author_facet |
Rodríguez Vázquez, Alejandro Laredo Gregorio, Carlos Reyes, Luis Dolz Alvarez de la Ballina, Guillem Doncel Moriano, Antonio Llansó, Laura Rudilosso, Salvatore Llull Estrany, Laura Renú, Arturo Amaro Delgado, Sergio Torné, Ramón Urra, Xabier Chamorro Sánchez, Ángel |
| author_role |
author |
| author2 |
Laredo Gregorio, Carlos Reyes, Luis Dolz Alvarez de la Ballina, Guillem Doncel Moriano, Antonio Llansó, Laura Rudilosso, Salvatore Llull Estrany, Laura Renú, Arturo Amaro Delgado, Sergio Torné, Ramón Urra, Xabier Chamorro Sánchez, Ángel |
| author2_role |
author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
Vasos sanguinis Oclusions arterials Infart cerebral Tomografia computada per emissió de fotó simple Artèries caròtides Blood vessels Arterial occlusions Cerebral infarctio Single-photon emission computed tomography Carotid artery |
| topic |
Vasos sanguinis Oclusions arterials Infart cerebral Tomografia computada per emissió de fotó simple Artèries caròtides Blood vessels Arterial occlusions Cerebral infarctio Single-photon emission computed tomography Carotid artery |
| description |
Introduction: Malignant middle cerebral artery infarction (MCI) needs rapid intervention. This study aimed to enhance the prediction of MCI using computed tomography perfusion (CTP) with varied quantitative benchmarks. Materials and methods: We retrospectively analyzed 253 patients from a single-center registry presenting with acute, severe, proximal large vessel occlusion studied with whole-brain CTP imaging at hospital arrival within the first 24 h of symptoms-onset. MCI was defined by clinical and imaging criteria, including decreased level of consciousness, anisocoria, death due to cerebral edema, or need for decompressive craniectomy, together with midline shift ⩾6 mm, or infarction of more than 50% of the MCA territory. The predictive accuracy of baseline ASPECTS and CTP quantifications for MCI was assessed by receiver operating characteristic (ROC) area under the curve (AUC) while F-score was calculated as an indicator of precision and sensitivity. Results: Sixty-three out of 253 patients (25%) fulfilled MCI criteria and had worse clinical and imaging results than the non-MCI group. The capacity to predict MCI was lower for baseline ASPECTS (AUC 0.83, F-score 0.52, Youden's index 6), than with perfusion-based measures: relative cerebral blood volume threshold <40% (AUC 0.87, F-score 0.71, Youden's index 34 mL) or relative cerebral blood flow threshold <35% (AUC 0.87, F-score 0.62, Youden's index 67 mL). CTP based on rCBV measurements identified twice as many MCI as baseline CT ASPECTS. Discussion and conclusion: CTP-based quantifications may offer enhanced predictive capabilities for MCI compared to non-contrast baseline CT ASPECTS, potentially improving the monitoring of severe ischemic stroke patients at risk of life-threatening edema and its treatment. |
| publishDate |
2024 |
| dc.date.none.fl_str_mv |
2024 |
| dc.type.none.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion |
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article |
| status_str |
acceptedVersion |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2445/219888 |
| url |
https://hdl.handle.net/2445/219888 |
| dc.language.none.fl_str_mv |
Inglés |
| language_invalid_str_mv |
Inglés |
| dc.relation.none.fl_str_mv |
Versió postprint del document publicat a: https://doi.org/10.1177/23969873241260965 European Stroke Journal, 2024, vol. 10, num.1 https://doi.org/10.1177/23969873241260965 |
| dc.rights.none.fl_str_mv |
cc-by-nc-nd (c) European Stroke Journal, 2024 http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
| rights_invalid_str_mv |
cc-by-nc-nd (c) European Stroke Journal, 2024 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| eu_rights_str_mv |
openAccess |
| dc.format.none.fl_str_mv |
application/pdf |
| dc.publisher.none.fl_str_mv |
SAGE Publications |
| publisher.none.fl_str_mv |
SAGE Publications |
| dc.source.none.fl_str_mv |
Articles publicats en revistes (Medicina) reponame:Dipòsit Digital de la UB instname:Universidad de Barcelona |
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Universidad de Barcelona |
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Dipòsit Digital de la UB |
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Dipòsit Digital de la UB |
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