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Brain Infarct Segmentation and Registration on MRI or CT for Lesion-symptom Mapping
Published on: September 25, 2019
Prediction of poor outcome in cerebellar infarction by diffusion MRI
Zahari Tchopev1, Marc Hiller, Jiachen Zhuo
1University of Maryland College Park, College Park, MD, USA.
Objective:
Identification of patients with posterior fossa infarction at risk for neurological deterioration remains a challenge. MRI-based assessments of MCA infarction can predict poor outcome. Similar quantitative imaging measures after cerebellar stroke have not been studied. We tested the hypothesis that MRI-based volumetric assessment of cerebellar infarcts can provide reliable information for the prediction of poor outcome.
Design:
We retrospectively identified 44 consecutive subjects (age 55.2 ± 13) with cerebellar stroke who underwent MRI with diffusion-weighted imaging (DWI) (median 63.7 h). Subjects were divided into poor (n = 13) and good outcomes (n = 31). Poor outcome was defined as having at least one of the following criteria: (1) mortality, (2) decompressive craniectomy, (3) ventriculostomy, and (4) decrease level of consciousness. DWI and cerebellar volume were defined on apparent diffusion coefficient maps. The ratio of the lesion volume to the whole cerebellum volume was calculated (rVolume).
Measurements And Main Results:
Logistic regression revealed that lesion volume and rVolume were associated with increased risk of poor outcome, even after adjusting for age and NIHSS (χ(2) = 8.2230, p < 0.0042; χ(2) = 8.3992, p < 0.0038, respectively). The receiver operating characteristic curve with age, NIHSS, and volume or rVolume achieved an AUC of 0.816 (95 % CI 0.678-0.955) and 0.831 (95 % CI 0.6989-0.9636), respectively.
Conclusions:
Quantitative volumetric measurement predicts poor outcome of cerebellar stroke patients, even when controlling for age and NIHSS. Quantitative analysis of diffusion MRI may assist in identification of patients with cerebellar stroke at highest risk of neurological deterioration. Prospective validation is warranted.
Insights
Quantitative MRI volumetry of cerebellar infarcts predicts poor patient outcomes. This imaging technique aids in identifying stroke patients at high risk for neurological deterioration.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Identifying patients with posterior fossa infarction at risk for neurological deterioration is challenging.
- While MRI-based assessments of middle cerebral artery infarction can predict poor outcomes, similar quantitative imaging measures for cerebellar stroke have not been studied.
- Cerebellar strokes can lead to significant neurological deficits and require accurate prognostication.
Purpose of the Study:
- To test the hypothesis that MRI-based volumetric assessment of cerebellar infarcts can reliably predict poor outcomes.
- To evaluate the utility of quantitative imaging measures in predicting neurological deterioration after cerebellar stroke.
- To establish a method for identifying high-risk cerebellar stroke patients.
Main Methods:
- Retrospective analysis of 44 consecutive patients with cerebellar stroke who underwent diffusion-weighted imaging (DWI) MRI.
- Calculation of lesion volume and the ratio of lesion volume to whole cerebellum volume (rVolume) using apparent diffusion coefficient maps.
- Classification of outcomes into poor (mortality, decompressive craniectomy, ventriculostomy, decreased consciousness) and good groups.
Main Results:
- Lesion volume and rVolume were significantly associated with an increased risk of poor outcome, even after adjusting for age and NIHSS.
- Logistic regression and receiver operating characteristic (ROC) curve analysis demonstrated the predictive value of volumetric measures.
- The area under the curve (AUC) for predicting poor outcome using age, NIHSS, and volume/rVolume ranged from 0.816 to 0.831.
Conclusions:
- Quantitative volumetric measurement of cerebellar infarcts is a reliable predictor of poor outcome.
- Diffusion MRI quantitative analysis can aid in identifying cerebellar stroke patients at the highest risk of neurological deterioration.
- Prospective validation of these quantitative imaging measures is warranted to confirm their clinical utility.
