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Early computed tomography features in extensive middle cerebral artery territory infarct: prediction of survival

¹ Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, Hong Kong
² Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
³ Department of Surgery, The Chinese University of Hong Kong, Hong Kong

Correspondence to:
Correspondence to:
W W M Lam
Department of Diagnostic Radiology and Organ Imaging, The Chinese University of Hong Kong, c/o Rm 27029, X-ray Department, Prince of Wales Hospital, Ngan Shing Street, Shatin, N.T., Hong Kong; wynnie{at}cuhk.edu.hk

Background: To assess the predictive value of prognosis of different computed tomography (CT) features and National Institutes of Health Stroke Scale score (NIHSS) in acute extensive middle cerebral artery (MCA) infarct.

Methods: Fifty five patients with acute extensive MCA infarct had the CT performed within 24 hours of the onset of symptoms. A total of 11 CT features were analysed. The age distribution, presence of risk factors, presence of individual CT feature, the total CT score, and the NIHSS were correlated with the 30 day mortality.

Results: Single explanatory variable analysis showed NIHSS, presence of midline shift, midline shift of more than 1 cm, extent of infarct, presence of hydrocephalus, effacement of subarachnoid space/cella media, attenuation of corticomedullary differentiation, and total CT score were associated with the 30 day mortality. Both extent of infarct >67% and attenuation of corticomedullary differentiation gave a sensitivity and specificity of 93% and 95%, respectively, for the prediction of survival. Logistic regression analysis showed that the extent of infarct and NIHSS were the only independent predictors.

Conclusions: CT features and admission NIHSS are important parameters for prediction of survival in extensive MCA infarct.

Abbreviations: CT, computed tomography; MCA, middle cerebral artery; NIHSS, National Institutes of Health Stroke Scale score

Keywords: middle cerebral artery infarct; computed tomography; prognosis