Early computed tomography features in extensive middle cerebral artery territory infarct: prediction of survival.
BACKGROUND
To assess the predictive value of prognosis of different computed tomography (CT) features and National Institutes of Health Stroke Scale score (NIHSS) in acute extensive middle cerebral artery (MCA) infarct.


METHODS
Fifty five patients with acute extensive MCA infarct had the CT performed within 24 hours of the onset of symptoms. A total of 11 CT features were analysed. The age distribution, presence of risk factors, presence of individual CT feature, the total CT score, and the NIHSS were correlated with the 30 day mortality.


RESULTS
Single explanatory variable analysis showed NIHSS, presence of midline shift, midline shift of more than 1 cm, extent of infarct, presence of hydrocephalus, effacement of subarachnoid space/cella media, attenuation of corticomedullary differentiation, and total CT score were associated with the 30 day mortality. Both extent of infarct >67% and attenuation of corticomedullary differentiation gave a sensitivity and specificity of 93% and 95%, respectively, for the prediction of survival. Logistic regression analysis showed that the extent of infarct and NIHSS were the only independent predictors.


CONCLUSIONS
CT features and admission NIHSS are important parameters for prediction of survival in extensive MCA infarct.
Lam
W W M
WW
Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, c/o Rm 27029, X-ray Department, Prince of Wales Hospital, Ngan Shing Street, Shatin, N.T., Hong Kong. wynnie@cuhk.edu.hk
Leung
T W H
TW
Chu
W C W
WC
Yeung
D T K
DT
Wong
L K S
LK
Poon
W S
WS
D000368:Aged; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
Radiology. 1988 Aug;168(2):463-7
3393665
Stroke. 1970 May-Jun;1(3):158-63
5522913
AJR Am J Roentgenol. 1982 Feb;138(2):307-11
6976735
AJNR Am J Neuroradiol. 1994 Jan;15(1):9-15; discussion 16-8
8141071
AJNR Am J Neuroradiol. 2003 May;24(5):878-85
12748088
Neurology. 1957 Apr;7(4):223-37
13418959
Arch Neurol. 1959 Aug;1:161-77
14445627
Arch Neurol. 1996 Apr;53(4):309-15
8929152
JAMA. 1995 Oct 4;274(13):1017-25
7563451
J Neurol. 2002 Sep;249(9):1183-90
12242536
Intensive Care Med. 1998 Jun;24(6):620-3
9681786
Stroke. 1999 May;30(5):1076-82
10229747
Radiology. 1990 Sep;176(3):801-6
2389039
Cerebrovasc Dis. 2003;16(3):230-5
12865610
Neurology. 1997 Oct;49(4):1090-5
9339695
J Neurol Neurosurg Psychiatry. 1987 Nov;50(11):1550-2
3694213