Accelerating Prediction of Malignant Cerebral Edema After Ischemic Stroke with Automated Image Analysis and Explainable Neural Networks

Imaging biomarkers of cerebral edema automatically extracted from routine CT scans of large vessel occlusion strokes

“…These volumetric biomarkers are more widely measurable at early time points (ie, do not require a visible infarct or concurrent estimation of infarct from CT perfusion) and are strongly linked to clinically significant outcomes. Further studies should assess how incorporating these biomarkers, measured at 24 hours or even earlier after stroke, can enable more accurate and earlier prediction of those who may require surgery for malignant edema than conventional measures such as NIHSS and midline shift 4 …”

“…[10][11][12] Both these densitometric and volumetric CT-based approaches have been proposed as means of better quantifying edema in order to predict midline shift and subsequent clinical deterioration (including the need for decompressive surgery) and as a therapeutic biomarker to assess response to emerging antiedema interventions. 4,9,19 Such tools could facilitate both clinical and research endeavors to mitigate the consequences of cerebral edema after stroke. However, it remains unclear how these two classes of biomarkers are related and whether one or the other better captures brain swelling and risk of deterioration, as no side-by-side studies have been performed.…”

“…While this may begin to be visible by 24 hours, it is primarily a manifestation of decompensated late‐stage edema, peaking 2‐4 days poststroke. Detection of edema before midline shift and clinical deterioration occurs has been the subject of increasing interest 4 . This would allow selection of patients for targeted interventions to reduce the impact of edema after stroke 5 …”

“…Both these densitometric and volumetric CT‐based approaches have been proposed as means of better quantifying edema in order to predict midline shift and subsequent clinical deterioration (including the need for decompressive surgery) and as a therapeutic biomarker to assess response to emerging antiedema interventions 4,9,19 . Such tools could facilitate both clinical and research endeavors to mitigate the consequences of cerebral edema after stroke.…”

“…Detection of edema before midline shift and clinical deterioration occurs has been the subject of increasing interest. 4 This would allow selection of patients for targeted interventions to reduce the impact of edema after stroke. 5 Furthermore, quantification of edema across its full spectrum would facilitate a broader understanding of its biologic basis and contribution to stroke outcomes.…”