title: Prediction of Malignant Middle Cerebral Artery Infarction in Elderly Patients.
abstract: BACKGROUND
  We evaluated the clinical outcomes of malignant middle cerebral artery (MCA) infarction (MMI) and determined an infarcted brain volume (BV) threshold value for accurate MMI prediction in elderly patients.
  
  
  METHODS
  We analyzed 69 consecutive patients (mean, 75.6 ± 11.7) with internal carotid artery or MCA infarction within 48 hours from onset. Diffusion-weighted high-intensity volume (DHV) and BV were measured in all patients. The percentage of DHV within BV (DHV/BV ratio) was calculated to standardize the DHV difference for each individual BV. Patients were stratified based upon their MMI status and age, compared with the following: (1) MMI versus non-MMI groups and (2) age ≥75 years group versus age <75 years group, based on DHV values, DHV/BV ratio, Glasgow Coma Scale (GCS) scores on admission, and modified Rankin Scale (mRS) scores at 3 months after onset.
  
  
  RESULTS
  The MMI group (n = 14) showed significantly larger DHV values (P < .001), larger DHV/BV ratios (P < .001), lower GCS scores on admission (P < .01), and higher mRS scores at 3 months (P < .001) than the non-MMI group. The DHV threshold value predicting MMI was 102 cm(3) (sensitivity 85%, specificity 91%, P < .01) and DHV/BV threshold ratio was 7.8% (sensitivity 86%, specificity 87%, P < .01). Both the age ≥75 years group and the age <75 years group with MMI showed equally poor outcomes (mRS 5.7 ± .7 versus 5.3 ± 1.3).
  
  
  CONCLUSIONS
  DHV and DHV/BV can provide reliable information for MMI prediction in elderly patients.
authors.affiliation: Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Neurosurgery, Osaka Neurological Institute, Osaka, Japan. Electronic address: ekumura@nyc.odn.ne.jp.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kumura
authors.affiliation: Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Watabe
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Department of Neurosurgery, Hanwa Memorial Hospital, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Nishino
authors.affiliation: Department of Neurosurgery, Hanwa Memorial Hospital, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Neurosurgery, Hanwa Memorial Hospital, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniwaki
authors.affiliation: Yuguchi Neurosurgical and Spine Clinic, Japan.
authors.forename: Takamichi
authors.initials: T
authors.lastname: Yuguchi
authors.affiliation: Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging*; D038524:Diffusion Magnetic Resonance Imaging; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
keywords: Middle cerebral artery occlusion; diffusion-weighted imaging; elderly; volumetry