Prediction of Malignant Acute Middle Cerebral Artery Infarction via Computed Tomography Radiomics

Background: Cerebral collateral circulation is necessary to maintain cerebral blood flow and penumbra when arterial insufficiency occurred. Only a few studies about collateral status on development of malignant middle cerebral artery infarction (mMCAi) have been documented. Objective: To determine whether collateral status evaluated by single phase computed tomographic angiography (CTA) help prediction of mMCAi in patients with large arterial occlusion whom not received endovascular treatment. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke in anterior circulation in our institute during January 2015 to December 2015. We analyzed clinical data, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS) on baseline nonenhanced computed tomography of the brain (NECT brain), and CTA collateral status. Malignant MCA infarction was defined according to clinical criteria. Results: Thirty-five patients were included. Mean age was 68.8±15.56 years. Mean baseline NIHSS and baseline ASPECTS were 17(±5) and 6(±3), respectively. All patients received intravenous thrombolysis. CTA collateral status and baseline NECT ASPECTS significantly correlated with development of mMCAi (P-value = 0.007 and 0.001). Only baseline NECT ASPECTS was an independent predictive factor for mMCAi (OR 0.63, 95%CI 0.46-0.86, P-value =0.004). Patients with baseline NECT ASPECTS ≤ 7 were more likely develop mMCAi (OR 14.29 95%CI 1.57-129.94, P-value 0.018). Conclusion: In acute stroke patients with proximal MCA or ICA occlusion received intravenous thrombolysis alone, baseline NECT ASPECTS and CTA collateral status were significantly correlate with development of mMCAi. However, only baseline ASPECTS ≤ 7 was an independent predictor for mMCAi.

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Association Between Preoperative Midline Shift Growing Rate and Outcomes of Decompressive Craniectomy in Patients with Malignant Middle Cerebral Artery Infarction

Current Neurovascular Research ◽

10.2174/1567202617666200207125552 ◽

2020 ◽

Vol 17 (2) ◽

pp. 131-139

Author(s):

Ruozhen Yuan ◽

Simiao Wu ◽

Yajun Cheng ◽

Kaili Ye ◽

Zilong Hao ◽

...

Keyword(s):

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Decompressive Craniectomy ◽

Mass Effect ◽

Midline Shift ◽

Middle Cerebral Artery Infarction ◽

West China Hospital ◽

Computed Tomography Scans ◽

Adequate Decompression

Background: Whether preoperative midline shift and its growing rate are associated with outcomes of decompressive craniectomy in patients with malignant middle cerebral artery infarction is unknown. Methods: We retrospectively included patients: 1) who underwent decompressive craniectomy for malignant middle cerebral artery infarction in West China Hospital from August 2010 to December 2, 2018) who had at least two brain computed tomography scans before decompressive craniectomy. Midline shift was measured on the first and last preoperative computed tomography scans. Midline shift growing rate was calculated by dividing Δmidline shift value using Δ time. The primary outcome was inadequate decompression of the mass effect. Secondary outcomes were 3 month death and unfavorable outcomes. Results: Sixty-one patients (mean age 53.7 years, 57.4% (35/61) male) were included. Median time from onset to decompressive craniectomy was 51.8 h (interquartile range: 39.7-77.8). Rates of inadequate decompression, 3 month death, 3 month modified Rankin Scale 5-6 and 4-6 were 50.8% (31/61), 50.9% (29/57), 64.9% (37/57) and 84.2% (48/57), respectively. The inadequate decompression group had a higher midline shift growing rate than the adequate decompression group (median: 2.7 mm/8 h vs. 1.4 mm/8 h, P=0.041). No intergroup difference of 3 month outcomes was found in terms of preoperative midline shift growing rate. Conclusion: Higher preoperative midline shift growing rate was associated with inadequate decompression of decompressive craniectomy in patients with malignant middle cerebral artery infarction.

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Attenuated Corticomedullary Contrast: An Early Cerebral Computed Tomography Sign Indicating Malignant Middle Cerebral Artery Infarction

Stroke ◽

10.1161/01.str.30.5.1076 ◽

1999 ◽

Vol 30 (5) ◽

pp. 1076-1082 ◽

Cited By ~ 36

Author(s):

Hans-Peter Haring ◽

Erika Dilitz ◽

Anton Pallua ◽

Gerald Hessenberger ◽

Andreas Kampfl ◽

...

Keyword(s):

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Middle Cerebral Artery Infarction ◽

Cerebral Computed Tomography

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Spot Sign on Initial Brain Computed Tomography Angiography Source Image to Predict Large Hemorrhagic Transformation after Middle Cerebral Artery Infarction

Journal of the Korean Neurological Association ◽

10.17340/jkna.2015.1.4 ◽

2015 ◽

Vol 33 (1) ◽

pp. 18-20

Author(s):

Su Jin Chung ◽

Younggwang Kim ◽

Jun Hong Lee ◽

Sun-Ah Choi ◽

Jeong Hee Cho ◽

...

Keyword(s):

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Computed Tomography Angiography ◽

Hemorrhagic Transformation ◽

Source Image ◽

Spot Sign ◽

Middle Cerebral Artery Infarction ◽

Brain Computed Tomography

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Value of computed tomography angiographic collateral status in prediction of malignant middle cerebral artery infarction

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v21i1.51 ◽

2020 ◽

Vol 21 (1) ◽

pp. 04-20

Author(s):

Sasitorn Petcharunpaisan ◽

Wannaporn Ngernbumrung ◽

Sukalaya Lerdlum

Keyword(s):

Computed Tomography ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

P Value ◽

Anterior Circulation ◽

Independent Predictive Factor ◽

Middle Cerebral Artery Infarction ◽

Clinical Criteria

Background: Cerebral collateral circulation is necessary to maintain cerebral blood flow and penumbra when arterial insufficiency occurred. Only a few studies about collateral status on development of malignant middle cerebral artery infarction (mMCAi) have been documented. Objective: To determine whether collateral status evaluated by single phase computed tomographic angiography (CTA) help prediction of mMCAi in patients with large arterial occlusion whom not received endovascular treatment. Material and Methods: We retrospectively reviewed patients with acute ischemic stroke in anterior circulation in our institute during January 2015 to December 2015. We analyzed clinical data, baseline National Institutes of Health Stroke Scale (NIHSS), Alberta Stroke Program Early CT Score (ASPECTS) on baseline nonenhanced computed tomography of the brain (NECT brain), and CTA collateral status. Malignant MCA infarction was defined according to clinical criteria. Results: Thirty-five patients were included. Mean age was 68.8±15.56 years. Mean baseline NIHSS and baseline ASPECTS were 17(±5) and 6(±3), respectively. All patients received intravenous thrombolysis. CTA collateral status and baseline NECT ASPECTS significantly correlated with development of mMCAi (P-value = 0.007 and 0.001). Only baseline NECT ASPECTS was an independent predictive factor for mMCAi (OR 0.63, 95%CI 0.46-0.86, P-value =0.004). Patients with baseline NECT ASPECTS ? 7 were more likely develop mMCAi (OR 14.29 95%CI 1.57-129.94, P-value 0.018). Conclusion: In acute stroke patients with proximal MCA or ICA occlusion received intravenous thrombolysis alone, baseline NECT ASPECTS and CTA collateral status were significantly correlate with development of mMCAi. However, only baseline ASPECTS ? 7 was an independent predictor for mMCAi.

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Aneurysm Arising at the Origin of a Duplicated Middle Cerebral Artery

Case Reports in Neurology ◽

10.1159/000517366 ◽

2021 ◽

pp. 446-450

Author(s):

Jean Roch Alliez ◽

Luis Manera

Keyword(s):

Computed Tomography ◽

Subarachnoid Haemorrhage ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

World Federation ◽

Treatment Procedure ◽

3D Computed Tomography ◽

Ruptured Aneurysms ◽

Tomography Reconstruction ◽

Computed Tomography Reconstruction

A duplicated middle cerebral artery (DMCA) is a common anomaly. However, aneurysms arising from the origin of a DMCA are extremely rare. A 22-year-old female was admitted to our hospital with a World Federation of Neurosurgical Societies grade 2 subarachnoid haemorrhage. Four-vessel angiography revealed a DMCA and an aneurysm arising from the origin of this artery. The aneurysm was successfully treated by embolization, and the patient was discharged 2 weeks later. Ruptured aneurysms arising from the origin of a DMCA can be successfully treated by embolization. These aneurysms are small and 3D-computed tomography reconstruction is mandatory to detect them. It is important to preserve the DMCA during the treatment procedure.

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Crossed cerebellar diaschisis in patients with acute middle cerebral artery infarction: Occurrence and perfusion characteristics

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x15617953 ◽

2015 ◽

Vol 36 (4) ◽

pp. 743-754 ◽

Cited By ~ 30

Author(s):

Wieland H Sommer ◽

Christine Bollwein ◽

Kolja M Thierfelder ◽

Alena Baumann ◽

Hendrik Janssen ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Symptom Onset ◽

Ct Perfusion ◽

Clinical Factors ◽

Middle Cerebral Artery Infarction ◽

Whole Brain ◽

Crossed Cerebellar Diaschisis ◽

Brain Ct ◽

Cerebellar Diaschisis

We aimed to investigate the overall prevalence and possible factors influencing the occurrence of crossed cerebellar diaschisis after acute middle cerebral artery infarction using whole-brain CT perfusion. A total of 156 patients with unilateral hypoperfusion of the middle cerebral artery territory formed the study cohort; 352 patients without hypoperfusion served as controls. We performed blinded reading of different perfusion maps for the presence of crossed cerebellar diaschisis and determined the relative supratentorial and cerebellar perfusion reduction. Moreover, imaging patterns (location and volume of hypoperfusion) and clinical factors (age, sex, time from symptom onset) resulting in crossed cerebellar diaschisis were analysed. Crossed cerebellar diaschisis was detected in 35.3% of the patients with middle cerebral artery infarction. Crossed cerebellar diaschisis was significantly associated with hypoperfusion involving the left hemisphere, the frontal lobe and the thalamus. The degree of the relative supratentorial perfusion reduction was significantly more pronounced in crossed cerebellar diaschisis-positive patients but did not correlate with the relative cerebellar perfusion reduction. Our data suggest that (i) crossed cerebellar diaschisis is a common feature after middle cerebral artery infarction which can robustly be detected using whole-brain CT perfusion, (ii) its occurrence is influenced by location and degree of the supratentorial perfusion reduction rather than infarct volume (iii) other clinical factors (age, sex and time from symptom onset) did not affect the occurrence of crossed cerebellar diaschisis.

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