Hyperacute extensive middle cerebral artery territory infarcts. Role of computed tomography in predicting outcome.
OBJECTIVE
To assess the prognostic value of computed tomography (CT) in hyperacute middle cerebral artery (MCA) infarcts.


METHODS
The CT features, total CT score, and National Institutes of Health Stroke Scale (NIHSS) score were correlated with the 30-day mortality in 16 patients with a hyperacute MCA infarct.


RESULTS
Admission NIHSS scores were significantly lower in the survival group (P = 0.016). The extent of infarct, attenuation of corticomedullary differentiation, and total CT score were associated with 30-day mortality (P < 0.05). In prediction of mortality, extent of an infarct > 67% gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 100%, 100%, and 90%, respectively. Attenuation of corticomedullary differentiation gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 89%, 86%, and 89%, respectively. An NIHSS score > 28 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 67%, 67%, and 86%, respectively. A CT score > 4 gave sensitivity, specificity, positive predictive value, and negative predictive value rates of 86%, 78%, 75%, and 88%, respectively.


CONCLUSIONS
Computed tomography features and the admission NIHSS score are important predictors of survival in hyperacute extensive MCA infarcts.
Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, c/o Room 27029, Prince of Wales Hospital, Ngan Shing Street, Shatin, NT Hong Kong. wynnie@cuhk.edu.hk
Wynnie Wai-Man
WW
Lam
Thomas Wai-Hong
TW
Leung
Winnie Chiu-Wing
WC
Chu
Deacons Tai-Kong
DT
Yeung
Lawrence Ka-Sing
LK
Wong
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed