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Permeability surface area product analysis in malignant brain edema prediction - A pilot study
O Volny1, P Cimflova2, T-Y Lee3
1International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; First Department of Neurology, Medical Faculty of Masaryk University, St. Anne's University Hospital, Brno, Czech Republic.
Journal of the Neurological Sciences
|April 23, 2017
Summary
Cerebral blood volume (CBV) showed the highest accuracy in predicting malignant edema after ischemic stroke. Permeability surface area (PS) trends suggest potential for midline shift prediction.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Ischemic stroke can lead to malignant edema, a serious complication.
- Early prediction of malignant edema is crucial for patient outcomes.
Purpose of the Study:
- To investigate the association between CT perfusion (CTP) parameters and malignant edema.
- To determine the predictive value of CTP parameters for midline shift in ischemic stroke.
Main Methods:
- Prospective study (PROVE-IT) of patients with internal carotid artery or middle cerebral artery occlusion.
- CT angiography (CTA) assessed clot and leptomeningeal collaterals.
- CT perfusion (CTP) calculated permeability surface area (PS), cerebral blood flow (CBF), and cerebral blood volume (CBV).
- Midline shift and infarction volume evaluated on follow-up imaging.
Main Results:
- Five patients with significant midline shift were compared to five matched controls.
- No significant differences in mean PS, CBF, or CBV within the ischemic territory were found between groups.
- A cerebral blood volume (CBV) threshold of 1.7ml/100g demonstrated the highest accuracy (AUC=0.72) for predicting early midline shift.
Conclusions:
- Preliminary analysis did not reveal significant differences in permeability surface area (PS) for the entire ischemic region.
- Cerebral blood volume (CBV) exhibited the highest predictive accuracy for midline shift.
- A trend suggested potential utility of mean PS values in predicting midline shift.
