Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion

Abstract

BACKGROUND AND PURPOSE: Net water uptake is qualified as an imaging marker of brain edema. We aimed to investigate the ability of net water uptake to predict 90-day functional outcome in patients with acute ischemic stroke and large-vessel occlusion. MATERIALS AND METHODS:A total of 295 consecutive patients were retrospectively enrolled. Automated ASPECTS-net water uptake was calculated on the admission CT. The relationship between ASPECTS-net water uptake and 90-day neurologic outcome was assessed. The independent predictors of favorable outcome (mRS score #2) were assessed using multivariate logistic regression analysis and receiver operating characteristic curves and stratified by the ASPECTS.RESULTS: Favorable 90-day outcomes were observed in 156 (52.9%) patients. ASPECTS-net water uptake (OR, 0.79; 95% CI, 0.70-0.90), NIHSS scores (OR, 0.91; 95% CI, 0.87-0.96), age (OR, 0.96; 95% CI, 0.94-0.99), and vessel recanalization (OR, 7.78; 95% CI, 3.96-15.29) were independently associated with favorable outcomes at 90 days (all, P , .01). A lower ASPECTS-net water uptake independently predicted a good prognosis, even in the subgroup of patients with low ASPECTS (#5) (P , .05). An outcome-prediction model based on these variables yielded an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.814-0.899; sensitivity, 76.3%; specificity, 81.3%).CONCLUSIONS: ASPECTS-net water uptake could independently predict 90-day neurologic outcomes in patients with acute ischemic stroke and large-vessel occlusion. Integrating ASPECTS-net water uptake with clinical models could improve the efficiency of outcome stratification.ABBREVIATIONS: AIS ¼ acute ischemic stroke; AUC ¼ area under the curve; IQR ¼ interquartile range; LVO ¼ large-vessel occlusion; MT ¼ mechanical thrombectomy; mTICI ¼ modified TICI; NWU ¼ net water uptake; ROC ¼ receiver operating characteristic

Novel advanced imaging techniques for cerebral oedema

“…In a separate study, this group also found that NWU also predicted malignant oedema in the posterior circulation (41). The strength of NWU as a biomarker of cerebral oedema on pretreatment imaging is likewise shown when using ASPECTS-derived NWU, with ASPECTS-NWU being an independent predictor of neurologic outcome at 90 days, even in subgroup analysis of patients with ASPECTS less than 5 (42)(43)(44). This presents the notion that patients with low ASPECTS, traditionally thought to have a poor outcome, may still benefit from endovascular thrombectomy if NWU remains relatively normal or is only mildly deranged (45,46).…”