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Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake

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Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake. / Broocks, Gabriel; Elsayed, Sarah; Kniep, Helge; Kemmling, Andre; Flottmann, Fabian; Bechstein, Matthias; Faizy, Tobias D; Meyer, Lukas; Lindner, Thomas; Sporns, Peter; Rusche, Thilo; Schön, Gerhard; Mader, Marius M; Nawabi, Jawed; Fiehler, Jens; Hanning, Uta.

In: NEUROSURGERY, Vol. 88, No. 3, 16.02.2021, p. 531-537.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Broocks, G, Elsayed, S, Kniep, H, Kemmling, A, Flottmann, F, Bechstein, M, Faizy, TD, Meyer, L, Lindner, T, Sporns, P, Rusche, T, Schön, G, Mader, MM, Nawabi, J, Fiehler, J & Hanning, U 2021, 'Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake', NEUROSURGERY, vol. 88, no. 3, pp. 531-537. https://doi.org/10.1093/neuros/nyaa438

APA

Broocks, G., Elsayed, S., Kniep, H., Kemmling, A., Flottmann, F., Bechstein, M., Faizy, T. D., Meyer, L., Lindner, T., Sporns, P., Rusche, T., Schön, G., Mader, M. M., Nawabi, J., Fiehler, J., & Hanning, U. (2021). Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake. NEUROSURGERY, 88(3), 531-537. https://doi.org/10.1093/neuros/nyaa438

Vancouver

Broocks G, Elsayed S, Kniep H, Kemmling A, Flottmann F, Bechstein M et al. Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake. NEUROSURGERY. 2021 Feb 16;88(3):531-537. https://doi.org/10.1093/neuros/nyaa438

Bibtex

@article{650a951cc73d47f18477028b009e6029,
title = "Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake",
abstract = "BACKGROUND: 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.OBJECTIVE: To test the hypothesis that lesion water uptake in early posterior circulation stroke predicts MCE.METHODS: 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.RESULTS: 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.CONCLUSION: 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.",
author = "Gabriel Broocks and Sarah Elsayed and Helge Kniep and Andre Kemmling and Fabian Flottmann and Matthias Bechstein and Faizy, {Tobias D} and Lukas Meyer and Thomas Lindner and Peter Sporns and Thilo Rusche and Gerhard Sch{\"o}n and Mader, {Marius M} and Jawed Nawabi and Jens Fiehler and Uta Hanning",
note = "Copyright {\textcopyright} 2020 by the Congress of Neurological Surgeons.",
year = "2021",
month = feb,
day = "16",
doi = "10.1093/neuros/nyaa438",
language = "English",
volume = "88",
pages = "531--537",
journal = "NEUROSURGERY",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

RIS

TY - JOUR

T1 - Early Prediction of Malignant Cerebellar Edema in Posterior Circulation Stroke Using Quantitative Lesion Water Uptake

AU - Broocks, Gabriel

AU - Elsayed, Sarah

AU - Kniep, Helge

AU - Kemmling, Andre

AU - Flottmann, Fabian

AU - Bechstein, Matthias

AU - Faizy, Tobias D

AU - Meyer, Lukas

AU - Lindner, Thomas

AU - Sporns, Peter

AU - Rusche, Thilo

AU - Schön, Gerhard

AU - Mader, Marius M

AU - Nawabi, Jawed

AU - Fiehler, Jens

AU - Hanning, Uta

N1 - Copyright © 2020 by the Congress of Neurological Surgeons.

PY - 2021/2/16

Y1 - 2021/2/16

N2 - BACKGROUND: 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.OBJECTIVE: To test the hypothesis that lesion water uptake in early posterior circulation stroke predicts MCE.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

AB - BACKGROUND: 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.OBJECTIVE: To test the hypothesis that lesion water uptake in early posterior circulation stroke predicts MCE.METHODS: 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.RESULTS: 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.CONCLUSION: 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.

U2 - 10.1093/neuros/nyaa438

DO - 10.1093/neuros/nyaa438

M3 - SCORING: Journal article

C2 - 33040147

VL - 88

SP - 531

EP - 537

JO - NEUROSURGERY

JF - NEUROSURGERY

SN - 0148-396X

IS - 3

ER -