Related Experiment Video
Updated: Jul 6, 2026
Automated Midline Shift and Intracranial Pressure Estimation based on Brain CT Images
Published on: April 13, 2013
Development and validation of a prognostic computed tomography scoring model for functional outcomes in patients with
Yutong Zhao1, Yuguang Tang1, Zongyi Xie1
1Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Insights
A new imaging score predicts poor outcomes in large hemispheric infarction (LHI) patients after decompressive craniectomy (DC). This tool aids in assessing prognosis and guiding clinical decisions for stroke patients.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- No established prognostic scoring system exists for large hemispheric infarction (LHI) patients undergoing decompressive craniectomy (DC) based on imaging.
- Existing prognostic tools lack specificity for LHI patients treated with DC.
Purpose of the Study:
- To develop and validate a novel computed tomography (CT) scoring model.
- To assess the 6-month risk of poor functional outcomes (modified-Rankin Scale [mRS] score of 4-6) in LHI patients receiving DC.
Main Methods:
- Retrospective cohort study at two tertiary stroke centers.
- Multivariable logistic regression used to develop a prediction model incorporating ASPECTS, longitudinal fissure cistern, Sylvian fissure cistern, and vascular territory.
- Validation through 1,000 bootstrap resamples and temporal validation.
Main Results:
- The scoring model demonstrated excellent discrimination (C-index=0.87 development, C-index=0.83 validation) and calibration.
- The model showed improved AUC compared to ASPECTS alone.
- Each score point increased the adjusted risk of poor outcomes by 47.8% (OR=1.48, p<0.001).
- Scores were inversely correlated with mean arterial pressure (MAP) and cerebral perfusion pressure (CPP).
Conclusions:
- The developed score system is an excellent predictor of poor functional outcomes in LHI patients post-DC.
- The score is associated with CPP and MAP, suggesting potential clinical utility.
- Further external validation is recommended before widespread clinical adoption.
Background:
There is no established prognostic scoring system developed for patients with large hemispheric infarction (LHI) following decompressive craniectomy (DC) based on imaging characteristics. The present study aimed to develop and validate a new computed tomography scoring model to assess the 6-month risk of poor functional outcomes (modified-Rankin scale [mRS] score of 4-6) in patients with LHI receiving DC.
Methods:
This retrospective cohort study included patients at two tertiary stroke centers. A prediction model was developed based on a multivariable logistic regression. The final risk factors included the ASPECTS (Alberta Stroke Program Early Computed Tomography Score), longitudinal fissure cistern, Sylvian fissure cistern, and additional vascular territory involvement. 1,000 bootstrap resamples and temporal validation were implemented as validations for the scoring system.
Results:
Of the 100 individuals included in the development cohort, 71 had poor functional outcomes. The scoring model presented excellent discrimination and calibration with C-index = 0.87 for the development cohort, and C-index = 0.83 for the temporal validation cohort with non-significant Hosmer-Lemeshow goodness-of-fit test. The scoring model also showed an improved AUC compared to the ASPECTS. For each point in the score model, the adjusted risk of poor functional outcomes increase by 47.8% (OR = 1.48, p < 0.001). The scores were inversely correlated with MAP (mean arterial pressure, paired t-test, p = 0.0015) and CPP (cerebral perfusion pressure, rho = -0.17, p = 0.04).
Conclusion:
In patients with LHI following DC, the score system is an excellent predictor of poor functional outcomes and is associated with CPP and MAP, which might be worth considering in clinical settings after further external validation.
