Background and Purpose:Infarct volumes predict malignant infarcts in patients undergoing decompressive hemicraniectomy (DH) for large middle cerebral artery territory infarcts. The aim of the study was to determine the optimal magnetic resonance imaging infarct volume threshold that predicts a catastrophic outcome at 1 year (modified Rankin Scale score of 5 or death).Methods:We included consecutive patients who underwent DH for large middle cerebral artery infarcts. We analyzed infarct volumes before DH with semi-automated methods on b1000 diffusion-weighted imaging sequences and apparent diffusion coefficient maps. We studied infarct volume thresholds for prediction of catastrophic outcomes, and analyzed sensitivity, specificity, and the area under the curve, a value ≥0.70 indicating an acceptable prediction.Results:Of 173 patients (109 men, 63%; median age 53 years), 42 (24.3%) had catastrophic outcomes. Magnetic resonance imaging b1000 diffusion-weighted imaging and apparent diffusion coefficient infarct volumes were associated to the occurrence of 1-year catastrophic outcome (adjusted odds ratio, 9.17 [95% CI, 2.00–42.04] and odds ratio, 4.18 [95% CI, 1.33–13.19], respectively, per 1 log increase). The optimal volume cutoff of were 211 mL on b1000 diffusion-weighted imaging and 181 mL on apparent diffusion coefficient maps. The 2 methods showed similar sensitivities and specificities and overlapping area under the curve of 0.64 (95% CI, 0.54–0.74).Conclusions:In patients with large middle cerebral artery infarcts, optimal magnetic resonance imaging infarct volume thresholds showed poor accuracy and low specificity to predict 1-year catastrophic outcome, with different b1000 diffusion-weighted imaging and apparent diffusion coefficient thresholds. In the setting of DH, optimal infarct volumes alone should not be used to deny DH, irrespectively of the method used.

中文翻译：

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大面积中脑动脉的半颅脑切除术之前的梗死体积不良地预测了灾难性结果。

背景与目的：梗塞量可预测接受减压半脑切除术（DH）的大脑中动脉大面积梗死患者的恶性梗塞。这项研究的目的是确定可以预测1年大灾难性结果的最佳磁共振成像梗死体积阈值（改良的Rankin Scale评分为5或死亡）。方法：我们纳入了连续接受DH的中脑大动脉梗死患者。我们在b1000扩散加权成像序列和表观扩散系数图上使用半自动方法分析了DH之前的梗死体积。我们研究了梗死体积阈值，以预测灾难性后果，并分析了敏感性，特异性和曲线下面积，该值≥0.70表明可以接受。结果：173例患者中，109例男性，63％；中位年龄为53岁），其中42人（占24.3％）具有灾难性后果。磁共振成像b1000扩散加权成像和表观扩散系数梗死体积与1年灾难性结局的发生相关（调整后的优势比为9.17 [95％CI，2.00-42.04]，优势比为4.18 [95％CI， 1.33–13.19]，每增加1 log分别）。在b1000扩散加权成像中，最佳体积截止值为211 mL，在表观扩散系数图上为181 mL。两种方法在0.64（95％CI，0.54-0.74）曲线下均显示出相似的敏感性和特异性和重叠面积。预测一年的灾难性后果，具有不同的b1000扩散加权成像和视扩散系数阈值。在DH的情况下，无论采用哪种方法，都不应单独使用最佳的梗死体积来拒绝DH。