Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts

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Fig 1.
Inclusion flow chart. PH indicates parenchymal hemorrhage.
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Fig 2.
Large MCA infarct on follow-up, with and without prominent space-occupying edema. Patient A (87-year-old man, follow-up day 5) has a large MCA infarct and generalized atrophy but does not show a midline shift. Patient B (58-year-old man, follow-up day 3) has a large MCA infarct with a midline shift of ≥5 mm, representing prominent space-occupying edema.

Table 1:

Clinical and imaging characteristics^{^a}

Characteristics	All Patients (N = 137)	Prominent Space-Occupying Edema (n = 51)	No Prominent Space-Occupying Edema (n = 86)	P Value
Clinical parameters
Age (yr) (median) (IQR)	66 (53–73)	63 (52–72)	67 (54–73)	.31
Female sex (No.) (%)	48 (35)	19 (37)	29 (34)	.68
Prior stroke (No.) (%)	20 (15)	10 (20)	10 (12)	.18
Atrial fibrillation (No.) (%)	16 (12)	8 (16)	8 (9)	.27
NIHSS (median) (IQR)	15 (12–19)	18 (13–21)	14 (11–18)	.01^{^b}
IV-rtPA (No.) (%)	94 (69)	32 (63)	62 (72)	.25
Intra-arterial treatment (No.) (%)	29 (21)	11 (22)	18 (21)	.93
Imaging parameters
Time to admission scan (min) (median) (IQR)	100 (64–152)	106 (70–240)	91 (63–135)	.11
NCCT
Early CT signs of infarction, ASPECTS, (median) (IQR)	8 (6–10)	7 (4–9)	9 (7–10)	.0001^{^b}
CTP
CBV deficit, ASPECTS (mean) (SD)	4.30 (2.57)	3.31 (2.32)	4.89 (2.54)	.001^{^b}
MTT deficit, ASPECTS (median) (IQR)	1 (0–3)	1 (0–3)	2 (0–3)	.11
CBV deficit in lentiform nucleus (No.) (%)	72 (53)	32 (63)	40 (47)	.15
CBV deficit in caudate nucleus or ACA territory (No.) (%)	54 (39)	28 (55)	26 (30)	.004^{^b}
Permeability ratio (median) (IQR)^{^c}	1.36 (1.13–1.88)	1.66 (1.24–2.60)	1.30 (1.09–1.54)	.002^{^b}
CTA
Clot burden score ≤6 (No.) (%)	99 (73)	44 (86)	55 (65)	.006^{^b}
Thrombus location ICA/M1 proximal (No.) (%)	63 (48)	33 (67)	30 (36)	.001^{^b}
Poor collateral score (No.) (%)	62 (46)	34 (68)	28 (33)	.0001^{^b}
Follow-up CTP and CTA
No recanalization^{^c}	26 (33)	6 (32)	20 (33)	.89
No reperfusion^{^c}	45 (62)	16 (76)	29 (56)	.10

Note:—IQR indicates interquartile range.
↵a χ² was used to compare categoric variables, and a t test or Mann-Whitney U test, continuous variables.
↵b All P < .05.
↵c The analysis of permeability ratio, recanalization, and reperfusion is a subanalysis on 101, 79, and 73 cases, respectively.

Table 2:

Univariate and multivariate regression

	OR (95% CI)	aOR (95% CI)
Clinical parameters
Age (per yr)	0.99 (0.96–1.01)	NA
Female sex	1.17 (0.57–2.40)	0.88 (0.41–1.90)
Prior stroke	1.90 (0.73–4.95)	2.08 (0.74–5.91)
Atrial fibrillation	1.79 (0.63–5.11)	2.74 (0.86–8.70)
NIHSS (per point)	1.12 (1.04–1.21)^{^a}	NA
IV-rtPA	0.65 (0.31–1.36)	0.56 (0.25–1.22)
Intra-arterial treatment	1.04 (0.45–2.42)	1.03 (0.42–2.49)
Imaging parameters
Time to admission scan (per min)	1.002 (0.997–1.007)	1.003 (0.999–1.006)
NCCT
Early CT signs of infarction, ASPECTS (0–10)	1.32 (1.14–1.53)^{^a}	1.32 (1.13–1.55)^{^a}
CTP
CBV deficit, ASPECTS (0–10)	1.30 (1.12–1.52)^{^a}	1.26 (1.07–1.49)^{^a}
MTT deficit, ASPECTS (0–10)	1.20 (0.98–1.46)	1.14 (0.93–1.41)
CBV deficit in lentiform nucleus	1.90 (0.93–3.85)	1.53 (0.72–3.22)
CBV deficit in caudate nucleus or ACA territory	2.81 (1.37–5.76)^{^a}	2.01 (0.93–4.32)
Permeability ratio^{^b}	2.08 (1.21–3.60)^{^a}	2.35 (1.30–4.24)^{^a}
CTA
Clot burden score ≤6	3.43 (1.38–8.55)^{^a}	2.88 (1.11–7.45)^{^a}
Thrombus location	3.64 (1.73–7.69)^{^a}	3.40 (1.57–7.37)^{^a}
ICA/M1 proximal versus M1 distal, M2, or >M2	3.64 (1.73–7.69)^{^a}	3.40 (1.57–7.37)^{^a}
Poor collateral score	4.33 (2.05–9.13)^{^a}	3.93 (1.78–8.69)^{^a}
Follow-up CTP and CTA
No recanalization^{^b}	0.92 (0.31–2.79)	0.92 (0.30–2.81)
No reperfusion^{^b}	2.54 (0.81–7.96)	2.18 (0.67–7.07)

Note:—aOR indicates adjusted odds ratio (for age and NIHSS); NA, not applicable.
↵a All P < .05.
↵b The analysis of permeability ratio, recanalization, and reperfusion is a subanalysis on 101, 79, and 73 cases respectively.