title: Timely assessment of infarct volume and brain atrophy in acute hemispheric infarction for early surgical decompression: strict cutoff criteria with high specificity.
abstract: OBJECTIVE
  For a large hemispheric infarction, the clinical decision for decompressive surgery is commonly made on the basis of both radiological data showing brain swelling with herniation and concomitant neurological deterioration. However, for early decompressive surgery before clinical deterioration, strict cutoff criteria with a high specificity are required on the basis of timely assessment of the infarct volume.
  
  
  METHODS
  Sixty-one patients who presented with a hemispheric infarction were initially evaluated using diffusion-weighted images (DWIs) within 14 h and computed tomography (CT) scans 24 ± 4 h after stroke onset to assess the infarct volume and midline shift. In addition, brain atrophy was evaluated using the bicaudate ratio. Twenty-one patients developed a malignant course, while 40 patients experienced a non-malignant course.
  
  
  RESULTS
  According to a receiver-operating characteristic curve analysis for 50 patients with a bicaudate ratio <0.16, an initial infarct volume >160 ml in the DWI achieved a 97% specificity and 76% sensitivity, while an initial infarct volume >135 ml achieved an 86% specificity and 91% sensitivity. For the follow-up CT scans, an infarcted lesion volume >220 ml and midline shift >3.7 mm provided a 100% and 98% specificity, respectively.
  
  
  CONCLUSIONS
  For the patients who presented with an acute hemispheric infarction and had a bicaudate ratio <0.16, an initial infarct volume >160 ml in a DWI within 14 h after stroke onset is highly predictive of a malignant course. In addition, an infarct volume >220 ml or midline shift >3.7 mm in the follow-up CT approximately 24 h after stroke onset facilitates early surgical decompression before clinical deterioration.
authors: Department of Neurosurgery, Kyungpook National University, Jung-Gu, Daegu, Republic of Korea. jparkmd@hotmail.com
authors: Jaechan
authors: J
authors: Park
authors: Duck-Ho
authors: DH
authors: Goh
authors: Joo-Kyung
authors: JK
authors: Sung
authors: Yang-Ha
authors: YH
authors: Hwang
authors: Dong-Hun
authors: DH
authors: Kang
authors: Yongsun
authors: Y
authors: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D016022:Case-Control Studies; D019299:Decompression, Surgical / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors