| Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: A prospective multicenter observational study. | |
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MedLine Citation:
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PMID: 20865766 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 [CI] 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% CI 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. |
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Authors:
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Götz Thomalla; Frank Hartmann; Eric Juettler; Oliver C Singer; Fritz-Georg Lehnhardt; Martin Köhrmann; Jan F Kersten; Anna Krützelmann; Marek C Humpich; Jan Sobesky; Christian Gerloff; Arno Villringer; Jens Fiehler; Tobias Neumann-Haefelin; Peter D Schellinger; Joachim Röther; |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of neurology Volume: 68 ISSN: 1531-8249 ISO Abbreviation: Ann. Neurol. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-26 Completed Date: 2010-11-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7707449 Medline TA: Ann Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 435-45 Citation Subset: IM |
Affiliation:
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Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. thomalla@uke.uni-hamburg.de |
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Area Under Curve Carotid Artery Diseases / diagnosis Diffusion Magnetic Resonance Imaging* / methods Female Humans Infarction, Middle Cerebral Artery / diagnosis*, drug therapy, physiopathology* Magnetic Resonance Angiography* / methods Male Middle Aged Observation Perfusion Imaging Predictive Value of Tests Prospective Studies Regression Analysis Retrospective Studies Sensitivity and Specificity Severity of Illness Index Thrombolytic Therapy |
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