title: Radiological imaging features of the basal ganglia that may predict progression to hemicraniectomy in large territory middle cerebral artery infarct.
abstract: OBJECTIVE
  Predicting which patients are at risk for hemicraniectomy can be helpful for triage and can help preserve neurologic function if detected early. We evaluated basal ganglia imaging predictors for early hemicraniectomy in patients with large territory anterior circulation infarct.
  
  
  METHODS
  This retrospective study evaluated patients with ischemic infarct admitted from January 2005 to July 2011. Patients with malignant cerebral edema refractory to medical therapy or with herniating signs such as depressed level of consciousness, anisocoria, and contralateral leg weakness were triaged to hemicraniectomy. Admission images were reviewed for presence of caudate, lentiform nucleus (putamen and globus pallidus), or basal ganglia (caudate + lentiform nucleus) infarction.
  
  
  RESULTS
  Thirty-one patients with large territory MCA infarct, 10 (32%), underwent hemicraniectomy. Infarction of the caudate nucleus (9/10 vs 6/21, p = 0.002) or basal ganglia (5/10 vs 2/21, p = 0.02) predicted progression to hemicraniectomy. Infarction of the lentiform nucleus only did not predict progression to hemicraniectomy. Sensitivity for patients who did and did not have hemicraniectomy were 50% (5/10) and 90.5% (19/21). For caudate nucleus and caudate plus lentiform nucleus infarcts, the crude- and age-adjusted odds of progression to hemicraniectomy were 9.5 (1.4-64.3) and 6.6 (0.78-55.4), respectively.
  
  
  CONCLUSIONS
  Infarction of the caudate nucleus or basal ganglia correlated with patients progressing to hemicraniectomy. Infarction of the lentiform nucleus alone did not.
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3, Boston, MA 02118, USA. asim.mian@bmc.org.
authors.forename: Asim Z
authors.initials: AZ
authors.lastname: Mian
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3, Boston, MA 02118, USA.
authors.forename: David
authors.initials: D
authors.lastname: Edasery
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3, Boston, MA 02118, USA.
authors.forename: Osamu
authors.initials: O
authors.lastname: Sakai
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3, Boston, MA 02118, USA.
authors.forename: M
authors.initials: M
authors.lastname: Mustafa Qureshi
authors.affiliation: Department of Neurosurgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Holsapple
authors.affiliation: Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Thanh
authors.initials: T
authors.lastname: Nguyen
mesh_terms: D001479:Basal Ganglia / Q000000981:diagnostic imaging* / Q000473:pathology*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000473:pathology; D003399:Craniotomy; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D012189:Retrospective Studies
keywords: Basal ganglia; CT; Hemicraniectomy; MRI; Stroke