The rCBV Ratio Is a Predictive Factor for Developing Malignant Middle Cerebral Artery Infarction within 6 Hours of Symptom Onset

Bae, Hyo Jin; Jeong, Eun Hwan; Kim, Dae Hyun; Cha, Jae Kwan

Abstract

BACKGROUND
Malignant middle cerebral artery (MCA) infarction is one of the leading cause of death for patients with acute MCA infarction. We investigated the predicting factors for developing malignant MCA infarction (MMI) using multi-parametric magnetic resonance imaging (MRI).
METHODS
We included 159 MCA infarction patients who visited Dong-A University Stroke Center from January 2007 to December 2010 and were diagnosed MCA occlusion within 6 hours after symptom onset. All patients underwent brain MRI including diffusion and perfusion-weighted image. The definition of the malignant MCA infarction is as follows: 1) deterioration of neurological symptoms and consciousness with clinical signs of uncal herniation, and 2) at least two-thirds of the MCA territory with compression of ventricles or midline shifting. The neurological deterioration was observed for 7 days. The severity of neurological symptom and clinical outcome were assessed by using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).
RESULTS
Among 159 patients, 49 patients (30.8%) developed MMI. In a multivariate analysis, a larger diffusion volume on diffusion-weighted image, a lower regional cerebral blood volume (rCBV) ratio on perfusion-weighted image, and a higher NIHSS score on admission were identified as the predictive factors of MMI. The cut-off values of diffusion volume, NIHSS on admission and rCBV ratio were 69 mL, 15 points and 0.78.
CONCLUSION
A large diffusion volume, a high NIHSS score and particularly a low rCBV ratio can predict a malignant course in MCA infarction within 6 hours of symptom onset in MCA occlusion.