Universität zu Köln

Thomalla, Goetz, Hartmann, Frank, Juettler, Eric, Singer, Oliver C., Lehnhardt, Fritz-Georg, Koehrmann, Martin, Kersten, Jan F., Kruetzelmann, Anna, Humpich, Marek C., Sobesky, Jan, Gerloff, Christian ORCID: 0000-0002-6484-8882, Villringer, Arno, Fiehler, Jens, Neumann-Haefelin, Tobias, Schellinger, Peter D. and Roether, Joachim (2010). Prediction of Malignant Middle Cerebral Artery Infarction by Magnetic Resonance Imaging Within 6 Hours of Symptom Onset: A Prospective Multicenter Observational Study. Ann. Neurol., 68 (4). S. 435 - 446. HOBOKEN: WILEY-LISS. ISSN 0364-5134

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Abstract

Objective: Early identification of patients at risk of space-occupying malignant middle cerebral artery (MCA) infarction (MMI) is needed to enable timely decision for potentially life-saving treatment such as decompressive hemicraniectomy. We tested the hypothesis that acute stroke magnetic resonance imaging (MRI) predicts MMI within 6 hours of stroke onset. Methods: In a prospective, multicenter, observational cohort study patients with acute ischemic stroke and MCA main stem occlusion were studied by MRI including diffusion-weighted imaging (DWI), perfusion imaging (PI), and MR-angiography within 6 hours of symptom onset. Multivariate regression analysis was used to identify clinical and imaging predictors of MMI. Results: Of 140 patients included, 27 (19.3%) developed MMI. The following parameters were identified as independent predictors of MMI: larger acute DWI lesion volume (per 1 ml odds ratio [OR] 1.04, 95% confidence interval [Cl] 1.02-1.06; p < 0.001), combined MCA + internal carotid artery occlusion (5.38, 1.55-18.68; p = 0.008), and severity of neurological deficit on admission assessed by the National Institutes of Health Stroke Scale score (per 1 point 1.16, 1.00-1.35; p = 0.053). The prespecified threshold of a DWI lesion volume >82 ml predicted MMI with high specificity (0.98, 95% Cl 0.94-1.00), negative predictive value (0.90, 0.83-0.94), and positive predictive value (0.88, 0.62-0.98), but sensitivity was low (0.52, 0.32-0.71). Interpretation: Stroke MRI on admission predicts malignant course in severe MCA stroke with high positive and negative predictive value and may help in guiding treatment decisions, such as decompressive surgery. In a subset of patients with small initial DWI lesion volumes, repeated diagnostic tests are required. ANN NEUROL 2010;68:435-445

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Thomalla, Goetz UNSPECIFIED UNSPECIFIED UNSPECIFIED Hartmann, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Juettler, Eric UNSPECIFIED UNSPECIFIED UNSPECIFIED Singer, Oliver C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Lehnhardt, Fritz-Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Koehrmann, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kersten, Jan F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kruetzelmann, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED Humpich, Marek C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sobesky, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Gerloff, Christian UNSPECIFIED orcid.org/0000-0002-6484-8882 UNSPECIFIED Villringer, Arno UNSPECIFIED UNSPECIFIED UNSPECIFIED Fiehler, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Neumann-Haefelin, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Schellinger, Peter D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Roether, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-494551
DOI:	10.1002/ana.22125
Journal or Publication Title:	Ann. Neurol.
Volume:	68
Number:	4
Page Range:	S. 435 - 446
Date:	2010
Publisher:	WILEY-LISS
Place of Publication:	HOBOKEN
ISSN:	0364-5134
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE ISCHEMIC-STROKE; BRAIN EDEMA; DECOMPRESSIVE CRANIECTOMY; COMPUTED-TOMOGRAPHY; EARLY CT; RECLASSIFICATION; HEMICRANIECTOMY; TERRITORY; MORTALITY; OCCLUSION Multiple languages Clinical Neurology; Neurosciences Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/49455