Anatomical predictors of need for decompressive craniectomy after stroke using voxel-based lesion symptom mapping.

Autor: McCullough-Hicks M; Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA., Topiwala K; Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA., Christensen S; Department of Neurology, Stanford University, Palo Alto, California, USA., Ruiz-Betancourt D; School of Medicine, Stanford University, Palo Alto, California, USA., Mlynash M; Department of Neurology, Stanford University, Palo Alto, California, USA., Albers GW; Department of Neurology, Stanford University, Palo Alto, California, USA.
Jazyk: angličtina
Zdroj: Journal of neuroimaging : official journal of the American Society of Neuroimaging [J Neuroimaging] 2023 Sep-Oct; Vol. 33 (5), pp. 737-741. Date of Electronic Publication: 2023 Jul 03.
DOI: 10.1111/jon.13144
Abstrakt: Background and Purpose: Malignant cerebral edema (MCE) secondary to ischemic stroke is a highly morbid condition. Decompressive craniectomy (DC) is the only treatment for MCE that has been shown to reduce mortality. We examined whether early infarction and/or hypoperfusion in specific topographic regions was predictive of the need for later DC.
Methods: A retrospective database of patients evaluated for large vessel occlusion (LVO) stroke at Stanford between 2010 and 2019 was used. Thirty patients with LVO and baseline perfusion MRI who underwent DC were evaluated. Propensity matching based on age, lesion size, and recanalization status was performed on the remaining cohort. Baseline masks of apparent diffusion coefficient (ADC) + T max  >6 seconds lesions were generated using automated perfusion software. Voxel-based lesion symptom maping was used to perform logistic regression at each voxel to generate statistical maps of lesion location associated with DC. Hemispheres were combined to increase statistical power.
Results: Sixty patients were analyzed. After adjusting for age, lesion size, and recanalization status as covariates, scattered cortical regions, predominately within the temporal and frontal lobe, were mildly to moderately predictive of the need for DC (z-scores: 2.4-6.74, p < .01).
Conclusions: Scattered temporal and frontal lobe regions on baseline diffusion and perfusion MRI were found to be mildly to moderately predictive of the need for subsequent DC in patients with LVO stroke.
(© 2023 American Society of Neuroimaging.)
Databáze: MEDLINE
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