Enhanced Prediction of Malignant Cerebral Edema in Large Vessel Occlusion with Successful Recanalization Through Automated Weighted Net Water Uptake

• Published in: World neurosurgery 2024-08, Vol.188, p.e312-e319
• Main Authors: Xu, Haoli, Zheng, Mo, Liu, Wenhui, Peng, Weili, Qiu, Jiamei, Huang, Wangle, Zhang, Jiaqi, Xin, Enhui, Xia, Nengzhi, Lin, Ru, Qiu, Chaomin, Cao, Guoquan, Chen, Weijian, Yang, Yunjun, Qian, Yinfeng, Chen, Jun
• Format: Article
• Language: English
• Subjects: Brain edema; Computed tomography; Ischemic stroke; Thrombectomy
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.05.101

Malignant cerebral edema (MCE) is associated with both net water uptake (NWU) and infarct volume. We hypothesized that NWU weighted by the affected Alberta Stroke Program Early Computed Tomography Score (ASPECTS) regions could serve as a quantitative imaging biomarker of aggravated edema development in acute ischemic stroke with large vessel occlusion (LVO). The aim of this study was to evaluate the performance of weighted NWU (wNWU) to predict MCE in patients with mechanical thrombectomy (MT). We retrospectively analyzed consecutive patients who underwent MT due to LVO. NWU was computed from nonenhanced computed tomography scans upon admission using automated ASPECTS software. wNWU was derived by multiplying NWU with the number of affected ASPECTS regions in the ischemic hemisphere. Predictors of MCE were assessed through multivariate logistic regression analysis and receiver operating characteristic curves. NWU and wNWU were significantly higher in MCE patients than in non-MCE patients. Vessel recanalization status influenced the performance of wNWU in predicting MCE. In patients with successful recanalization, wNWU was an independent predictor of MCE (adjusted odds ratio 1.61; 95% confidence interval [CI] 1.24–2.09; P