title: Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts.
abstract: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatment strategies. This study aimed to identify variables associated with the development of prominent edema in patients with large MCA infarcts.
  
  
  
  From the Dutch Acute Stroke Study (DUST), 137 patients were selected with large MCA infarcts on follow-up NCCT (3 ± 2 days after stroke onset), defined as ASPECTS ≤4. Prominent edema was defined as a midline shift of ≥5 mm on follow-up. Admission patient and treatment characteristics were collected. Admission CT parameters used were ASPECTS on NCCT and CBV and MTT maps, and occlusion site, clot burden, and collaterals on CTA. Permeability on admission CTP, and day 3 recanalization and reperfusion statuses were obtained if available. Unadjusted and adjusted (age and NIHSS) odds ratios were calculated for all variables in relation to prominent edema.
  
  
  
  Prominent edema developed in 51 patients (37%). Adjusted odds ratios for prominent edema were higher with lower ASPECTS on NCCT (adjusted odds ratio, 1.32; 95% CI, 1.13-1.55) and CBV (adjusted odds ratio, 1.26; 95% CI, 1.07-1.49), higher permeability (adjusted odds ratio, 2.35; 95% CI, 1.30-4.24), more proximal thrombus location (adjusted odds ratio, 3.40; 95% CI, 1.57-7.37), higher clot burden (adjusted odds ratio, 2.88; 95% CI, 1.11-7.45), and poor collaterals (adjusted odds ratio, 3.93; 95% CI, 1.78-8.69).
  
  
  
  Extensive proximal occlusion, poor collaterals, and larger ischemic deficits with higher permeability play a role in the development of prominent edema in large MCA infarcts.
authors.affiliation: From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.) alexanderhorsch@gmail.com.
authors.forename: A D
authors.identifier: 0000-0001-8213-2784
authors.initials: AD
authors.lastname: Horsch
authors.affiliation: From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.).
authors.forename: J W
authors.identifier: 0000-0003-4646-9587
authors.initials: JW
authors.lastname: Dankbaar
authors.affiliation: From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.).
authors.forename: T A
authors.identifier: 0000-0003-0988-0756
authors.initials: TA
authors.lastname: Stemerdink
authors.affiliation: From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.).
authors.forename: E
authors.identifier: 0000-0002-3689-8532
authors.initials: E
authors.lastname: Bennink
authors.affiliation: From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.).
authors.forename: T
authors.identifier: 0000-0001-8839-964X
authors.initials: T
authors.lastname: van Seeters
authors.affiliation: Neurology (L.J.K.), Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: L J
authors.identifier: 0000-0001-8665-6630
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: Department of Neurology (J.H.), Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: J
authors.identifier: 0000-0002-7593-5674
authors.initials: J
authors.lastname: Hofmeijer
authors.affiliation: From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.).
authors.forename: H W
authors.identifier: 0000-0002-3000-8316
authors.initials: HW
authors.lastname: de Jong
authors.affiliation: Julius Center for Health Sciences and Primary Care (Y.v.d.G.), Utrecht, the Netherlands.
authors.forename: Y
authors.identifier: 0000-0003-3590-3130
authors.initials: Y
authors.lastname: van der Graaf
authors.affiliation: From the Departments of Radiology (A.D.H., J.W.D., T.A.S., E.B., T.v.S., H.W.d.J., B.K.V.).
authors.forename: B K
authors.identifier: 0000-0002-2542-9474
authors.initials: BK
authors.lastname: Velthuis
mesh_terms: D004487:Edema / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D016017:Odds Ratio