Hemisphere Volume Is Associated with Neurological Deterioration and Outcome after Malignant Infarction (P07.034)

Abstract

Objective: We hypothesize that MRI based hemisphere volume increases in the first days after stroke is associated with neurological deterioration and functional outcome in patients with malignant edema. Background 70% of patients with malignant infarction die secondary to cerebral edema. A fundamental challenge in the development of treatment strategies is the lack of a validated imaging marker for brain edema. Design/Methods: We conducted a retrospective analysis of the EPITHET study MRI9s at stroke onset and at 3-5 days. We selected patients with an acute diffusion weighted imaging volume > 82cc, which is highly predictive for malignant edema. The involved hemisphere was manually outlined by two independent readers, and volumes were measured using Analyze software. We assessed inter-rater agreement, volume change between scans and the association of volume change with early neurological deterioration (END: NIHSS score worsening ≥4 points), 90-day modified Rankin Scale (mRS) score 0-4 and mortality. Results: Of 12 patients who met study criteria, average baseline and follow-up DWI lesion size was 138 cm 3 and 234 cm 3 , respectively. Mean time to follow-up MRI was 62 hours. Concordance correlation coefficients between readers were >0.90 for both hemisphere and ventricle volume assessment. Mean percent hemisphere volume increase was 16.2±8.3% (p Conclusions: In this exploratory analysis of severe ischemic stroke patients, statistically significant changes in hemisphere and ventricular volumes within the first week are consistent with expected changes of cerebral edema. MRI-based analysis of hemisphere growth appears to be a suitable biomarker for edema formation. Disclosure: Dr. Sheth has nothing to disclose. Dr. Yoo has nothing to disclose. Dr. Gonzalez has nothing to disclose. Dr. Kimberly has nothing to disclose. Dr. Chaudhry has nothing to disclose. Dr. Elm has nothing to disclose. Dr. Jacobson has received personal compensation for activities with Remedy Pharmaceuticals as the CEO.Dr. Jacobson has received compensation for serving as the CEO of Remedy Pharmaceuticals.Dr. Jacobson holds stock and/or stock options in Remedy Pharmaceuticals. Dr. Davis has received personal compensation for activities with Boehringer Ingelheim, Sanofi- Aventis, and Ever Pharma. Dr. Davis has received personal compensation in an editorial capacity for Associate Editor of Cerebrovascular Diseases. Dr. Donnan has nothing to disclose. Dr. Albers has received personal compensation for activities with Genentech and Lundbeck as a member of the Advisory Board. Dr. Albers has received research support from Genetech, Aventis, Sanofi, BI, Ono, and AstraZeneca. Dr. Stern has received personal compensation in an editorial capacity for the Neurologist. Dr. Stern has received research support from Remedy Pharmaceuticals, Inc.