Abstract
Background: There is no validated neuroimaging marker for quantifying brain edema. We sought to test whether magnetic resonance imaging (MRI)-based metrics would reliably change during the early subacute period in a manner consistent with edema and whether they would correlate with relevant clinical endpoints. Methods: Serial MRI studies from patients in the Echoplanar Imaging Thrombolytic Evaluation Trial with initial diffusion-weighted imaging (DWI) lesion volume >82 cm3 were analyzed. Two independent readers outlined the hemisphere and lateral ventricle on the involved side and calculated respective volumes at baseline and days 3 to 5. We assessed interrater agreement, volume change between scans, and the association of volume change with early neurologic deterioration (National Institutes of Health Stroke Scale score worsening of ≥4 points), a 90-day modified Rankin scale (mRS) score of 0 to 4, and mortality. Results: Of 12 patients who met study criteria, average baseline and follow-up DWI lesion size was 138 cm3 and 234 cm3, respectively. The mean time to follow-up MRI was 62 hours. Concordance correlation coefficients between readers were >0.90 for both hemisphere and ventricle volume assessment. Mean percent hemisphere volume increase was 16.2 ± 8.3% (P <.0001), and the mean percent ventricle volume decrease was 45.6 ± 16.9% (P <.001). Percent hemisphere growth predicted early neurologic deterioration (area under the curve [AUC] 0.92; P =.0005) and 90-day mRS 0 to 4 (AUC 0.80; P =.02). Conclusions: In this exploratory analysis of severe ischemic stroke patients, statistically significant changes in hemisphere and ventricular volumes within the first week are consistent with expected changes of cerebral edema. MRI-based analysis of hemisphere growth appears to be a suitable biomarker for edema formation.
Original language | English (US) |
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Pages (from-to) | 742-749 |
Number of pages | 8 |
Journal | Journal of Stroke and Cerebrovascular Diseases |
Volume | 22 |
Issue number | 6 |
DOIs | |
State | Published - Aug 2013 |
Externally published | Yes |
Keywords
- Acute ischemic stroke
- biomarker subject codes 44 and 45
- cerebral edema
- magnetic resonance imaging
- malignant stroke
ASJC Scopus subject areas
- Surgery
- Rehabilitation
- Clinical Neurology
- Cardiology and Cardiovascular Medicine