Computed Tomography Based Score of Early Ischemic Changes Predicts Malignant Infarction

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Early identification of ischemic stroke patients at high risk for malignant infarction is crucial for timely intervention.
• Malignant middle cerebral artery infarctions (MMI) pose a significant threat, necessitating accurate early prediction methods.

Purpose of the Study:

• To evaluate the predictive capability of a novel Non-Enhanced Malignant Middle Cerebral Artery Infarction (NEMMI) score for identifying MMI.
• To compare the diagnostic power of the NEMMI score against established clinical and imaging parameters.

Main Methods:

• A cohort of 109 patients with acute proximal MCA occlusion was analyzed.
• The NEMMI score was calculated based on visual grading of hypoattenuation and lesion dimensions on non-enhanced CT.
• Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were employed.

Main Results:

• The NEMMI score was significantly higher in patients who developed MMI compared to those who did not (median 13.6 vs. 7.7, p < 0.0001).
• A NEMMI score >10.5 demonstrated strong discriminative power for MMI (AUC: 0.84), outperforming age, NIHSS, and ischemic core volume.
• The NEMMI score was independently associated with MMI (OR: 1.33, p < 0.001), even after adjusting for recanalization status.

Conclusions:

• The NEMMI score is a simple, rapid tool for assessing early ischemic changes on CT.
• This score serves as a valuable surrogate marker for predicting malignant edema in stroke patients.
• The diagnostic accuracy of the NEMMI score is comparable to CT Perfusion (CTP) and clinical parameters.