Absent Cortical Venous Filling Is Associated with Aggravated Brain Edema in Acute Ischemic Stroke

Xia, Haiqin; Sun, Haizhou; He, Song; Zhao, Minglei; Huang, Wei; Zhang, Z.; Xue, Yi; Fu, Paul; Chen, W.

doi:10.3174/ajnr.a7039

Cited by 20 publications

(15 citation statements)

References 34 publications

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“…Notably, all have focused on estimation of NWU from baseline CTs only and most require manual region selection or other input/review. One approach applied an automated core region (similar to our CTP-based method) but derived from commercial software ( 38 ); it was unclear how this region was transferred to the NCCT as alignment of CTP source images with NCCT is not trivial, but likely involved manual inspection and alignment. Another study manually placed a standard large ROI within the MCA territory (on a single slice) to estimate where ischemia might be seen and avoid the need to use CTP to locate the exact core region ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Automated Measurement of Net Water Uptake From Baseline and Follow-Up CTs in Patients With Large Vessel Occlusion Stroke

et al. 2022

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Quantifying the extent and evolution of cerebral edema developing after stroke is an important but challenging goal. Lesional net water uptake (NWU) is a promising CT-based biomarker of edema, but its measurement requires manually delineating infarcted tissue and mirrored regions in the contralateral hemisphere. We implement an imaging pipeline capable of automatically segmenting the infarct region and calculating NWU from both baseline and follow-up CTs of large-vessel occlusion (LVO) patients. Infarct core is extracted from CT perfusion images using a deconvolution algorithm while infarcts on follow-up CTs were segmented from non-contrast CT (NCCT) using a deep-learning algorithm. These infarct masks were flipped along the brain midline to generate mirrored regions in the contralateral hemisphere of NCCT; NWU was calculated as one minus the ratio of densities between regions, removing voxels segmented as CSF and with HU outside thresholds of 20–80 (normal hemisphere and baseline CT) and 0–40 (infarct region on follow-up). Automated results were compared with those obtained using manually-drawn infarcts and an ASPECTS region-of-interest based method that samples densities within the infarct and normal hemisphere, using intraclass correlation coefficient (ρ). This was tested on serial CTs from 55 patients with anterior circulation LVO (including 66 follow-up CTs). Baseline NWU using automated core was 4.3% (IQR 2.6–7.3) and correlated with manual measurement (ρ = 0.80, p < 0.0001) and ASPECTS (r = −0.60, p = 0.0001). Automatically segmented infarct volumes (median 110-ml) correlated to manually-drawn volumes (ρ = 0.96, p < 0.0001) with median Dice similarity coefficient of 0.83 (IQR 0.72–0.90). Automated NWU was 24.6% (IQR 20–27) and highly correlated to NWU from manually-drawn infarcts (ρ = 0.98) and the sampling-based method (ρ = 0.68, both p < 0.0001). We conclude that this automated imaging pipeline is able to accurately quantify region of infarction and NWU from serial CTs and could be leveraged to study the evolution and impact of edema in large cohorts of stroke patients.

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Section: Discussionmentioning

confidence: 99%

Automated Measurement of Net Water Uptake From Baseline and Follow-Up CTs in Patients With Large Vessel Occlusion Stroke

et al. 2022

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“…Jo et al reported that a collateral status score of <2 strongly predicts malignant cerebral edema [odds ratio (OR): 0.165, 95% confidence interval (CI): 0.064–0.426] ( 92 ). Poor collateral status is known to augment the progression of the infarct core and induce more proximal vascular occlusion, which are both associated with brain edema ( 93 , 94 ).…”

Section: Neuroimaging Predictors Of Edemamentioning

confidence: 99%

“…Venous changes in the affected hemisphere after acute ischemic stroke may play a crucial role in determining clinical outcomes ( 94 , 96 ), given that the venous system is responsible for ~70–80% of the cerebral blood volume. Zhang et al suggested that a lack of superficial middle cerebral vein filling contributes to poor outcomes following thrombolysis and that this indicator predicts edema progression within 24 h in non-reperfusion patients ( 97 , 98 ).…”

Section: Neuroimaging Predictors Of Edemamentioning

confidence: 99%

“…Zhang et al suggested that a lack of superficial middle cerebral vein filling contributes to poor outcomes following thrombolysis and that this indicator predicts edema progression within 24 h in non-reperfusion patients ( 97 , 98 ). Xia et al assessed cortical veins (Labbe, sphenoparietal sinus, and the superficial middle cerebral vein) and found that the absence of cortical venous filling is associated with increased brain edema and a higher risk of malignant cerebral edema (OR, 14.68; 95% CI, 4.03–53.45) ( 94 ) regardless of whether patients received reperfusion therapy. The likely pathophysiologic mechanism of these signs is the elevation of venous pressure caused by micro-thrombotic occlusion in venules or endothelium swelling after ischemia ( 99 , 100 ), which may increase fluid leakage into the perivascular space, resulting in brain edema ( 101 ).…”

Section: Neuroimaging Predictors Of Edemamentioning

confidence: 99%

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Evaluation and Prediction of Post-stroke Cerebral Edema Based on Neuroimaging

Huang

Zhang

2022

Front. Neurol.

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Cerebral edema is a common complication of acute ischemic stroke that leads to poorer functional outcomes and substantially increases the mortality rate. Given that its negative effects can be reduced by more intensive monitoring and evidence-based interventions, the early identification of patients with a high risk of severe edema is crucial. Neuroimaging is essential for the assessment and prediction of edema. Simple markers, such as midline shift and hypodensity volume on computed tomography, have been used to evaluate edema in clinical trials; however, advanced techniques can be applied to examine the underlying mechanisms. In this study, we aimed to review current imaging tools in the assessment and prediction of cerebral edema to provide guidance for using these methods in clinical practice.

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“…2) Patients with large infarcts and high cranial pressure have a deflated venous lumen, collapsed venous structures and reduced PVS-SWI visualization. 44,45 These two mechanisms may have narrowed the difference in poor prognosis between the two groups of people with and without PVS-SWI.…”

Section: Modality Of Treatment and Functional Prognosismentioning

confidence: 99%

The Prognostic Impact of Susceptibility-Weighted Imaging Prominent Veins in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

Lü¹,

Cui²,

Wang³

2021

NDT

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Purpose:We aimed to determine the prognostic impact of prominent veins (PVS) after an acute ischemic stroke identified on susceptibility-weighted imaging (PVS-SWI). Methods: We searched for studies published in PubMed, Embase, Cochrane Library and Chinese Biomedical Literature Database. Poor functional prognosis, early neurological deterioration, and hemorrhagic transformation were evaluated. Risk ratios (RR) were pooled implementing a random effect model. We performed a subgroup analysis by treatment, location (cortical/medullary) and a sensitivity analysis by follow-up time. Results: Sixteen studies were included (a total of 1605 patients) in the quantitative metaanalysis. PVS-SWI were related with a poor functional outcome (RR 1.62, 95% CI 1.25 to 2.10), especially in the patients receiving thrombolysis (RR 2.19, 95% CI 1.53 to 3.15) and an augmented risk of early neurological damage (RR 2.85, 95% CI 2.31 to 3.51). Both cortical and medullary prominent veins were accompanied by a poor functional outcome (RR 1.82, 95% CI 1.30 to 2.56/RR 2.59, 95% CI 1.98 to 3.38). PVS-SWI were not associated with poor functional outcomes when patients were treated conservatively (RR 1.35, 95% CI 0.82 to 2.22), or with an increased risk of hemorrhagic transformation (RR 0.97, 95% CI 0.64 to 1.47). Conclusion: PVS-SWI were related to a poor functional prognosis and an increased risk of early neurological damage. In patients treated conservatively, PVS-SWI were not accompanied by a poor prognosis. PVS-SWI were not associated with an augmented risk of hemorrhagic transformation.

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Absent Cortical Venous Filling Is Associated with Aggravated Brain Edema in Acute Ischemic Stroke

Cited by 20 publications

References 34 publications

Automated Measurement of Net Water Uptake From Baseline and Follow-Up CTs in Patients With Large Vessel Occlusion Stroke

Automated Measurement of Net Water Uptake From Baseline and Follow-Up CTs in Patients With Large Vessel Occlusion Stroke

Evaluation and Prediction of Post-stroke Cerebral Edema Based on Neuroimaging

The Prognostic Impact of Susceptibility-Weighted Imaging Prominent Veins in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

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