Background
We evaluated the clinical outcomes of malignant middle cerebral artery (MCA) infarction
(MMI) and determined an infarcted brain volume (BV) threshold value for accurate MMI
prediction in elderly patients.
Methods
We analyzed 69 consecutive patients (mean, 75.6 ± 11.7) with internal carotid artery
or MCA infarction within 48 hours from onset. Diffusion-weighted high-intensity volume
(DHV) and BV were measured in all patients. The percentage of DHV within BV (DHV/BV
ratio) was calculated to standardize the DHV difference for each individual BV. Patients
were stratified based upon their MMI status and age, compared with the following:
(1) MMI versus non-MMI groups and (2) age ≥75 years group versus age <75 years group,
based on DHV values, DHV/BV ratio, Glasgow Coma Scale (GCS) scores on admission, and
modified Rankin Scale (mRS) scores at 3 months after onset.
Results
The MMI group (n = 14) showed significantly larger DHV values (P < .001), larger DHV/BV ratios (P < .001), lower GCS scores on admission (P < .01), and higher mRS scores at 3 months (P < .001) than the non-MMI group. The DHV threshold value predicting MMI was 102 cm3 (sensitivity 85%, specificity 91%, P < .01) and DHV/BV threshold ratio was 7.8% (sensitivity 86%, specificity 87%, P < .01). Both the age ≥75 years group and the age <75 years group with MMI showed
equally poor outcomes (mRS 5.7 ± .7 versus 5.3 ± 1.3).
Conclusions
DHV and DHV/BV can provide reliable information for MMI prediction in elderly patients.
Key Words
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Article info
Publication history
Published online: March 19, 2016
Accepted:
December 27,
2015
Received in revised form:
December 17,
2015
Received:
November 13,
2015
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.034
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
