Prediction of Malignant Middle Cerebral Artery Infarction in Elderly Patients
Yuko Goto1, Eiji Kumura2, Tadashi Watabe3
1Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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 cm(3) (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.
Insights
Malignant middle cerebral artery (MCA) infarction (MMI) can be predicted in elderly patients using diffusion-weighted high-intensity volume (DHV) and brain volume (BV) ratios. These metrics reliably identify MMI, aiding in early diagnosis and management.
Area of Science:
- Neurology
- Radiology
- Geriatrics
Background:
- Malignant middle cerebral artery (MCA) infarction (MMI) poses significant risks, particularly in elderly patients.
- Accurate prediction of MMI is crucial for timely clinical intervention and improved patient outcomes.
Purpose of the Study:
- To evaluate the clinical outcomes associated with MMI in elderly patients.
- To establish a threshold value for infarcted brain volume (BV) to accurately predict MMI.
Main Methods:
- Analysis of 69 elderly patients with internal carotid artery or MCA infarction within 48 hours of onset.
- Measurement of diffusion-weighted high-intensity volume (DHV) and total brain volume (BV).
- Calculation of the DHV/BV ratio and comparison of clinical data (GCS, mRS) between MMI and non-MMI groups, stratified by age.
Main Results:
- The MMI group exhibited significantly larger DHV values and DHV/BV ratios compared to the non-MMI group.
- A DHV threshold of 102 cm³ (85% sensitivity, 91% specificity) and a DHV/BV ratio of 7.8% (86% sensitivity, 87% specificity) accurately predicted MMI.
- Clinical outcomes (mRS scores) were similarly poor in both younger and older MMI patient groups.
Conclusions:
- Diffusion-weighted high-intensity volume (DHV) and the DHV/BV ratio are reliable indicators for predicting malignant middle cerebral artery infarction (MMI) in elderly individuals.
- These imaging metrics can aid in the early identification of MMI, facilitating prompt clinical management.
- The predictive value of DHV and DHV/BV ratio holds true across different age strata within the elderly population.
