Absent Contrast Filling of Ipsilateral Superficial Middle Cerebral Vein Predicts Midline Shift in Acute Middle Cerebral Artery Occlusion.
AuthorZhang, S; Lin, L; Zhang, R; Wang, M; Yu, Y; Shi, Z; Parsons, M; Geng, Y
Source TitleFrontiers in Neurology
PublisherFrontiers Media SA
University of Melbourne Author/sParsons, Mark
AffiliationMedicine and Radiology
Document TypeJournal Article
CitationsZhang, S., Lin, L., Zhang, R., Wang, M., Yu, Y., Shi, Z., Parsons, M. & Geng, Y. (2020). Absent Contrast Filling of Ipsilateral Superficial Middle Cerebral Vein Predicts Midline Shift in Acute Middle Cerebral Artery Occlusion.. Front Neurol, 11, pp.570844-. https://doi.org/10.3389/fneur.2020.570844.
Access StatusOpen Access
Open Access at PMChttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674643
Background and purpose: Midline shift is a life-threatening complication of acute large artery occlusion (LAO). The value of superficial middle cerebral vein (SMCV) for predicting midline shift is currently unclear for patients with acute LAO. Methods: Consecutive acute LAO (middle cerebral artery M1 ± intracranial internal carotid artery) patients between March 2018 and May 2019 were included. Absent filling of ipsilateral cortical vein (marked as SMCV-) was defined as no contrast filling into the vein across the whole venous phase of four-dimensional computed tomography (CT) angiography derived from CT perfusion in the ischemic hemisphere. Results: In the total of 81 patients, 31 (38.4%) were identified as SMCV-. SMCV- independently predicted midline shift, with sensitivity of 87.5% and specificity of 82.5%. Receiver operating characteristic analysis showed that including SMCV- as a predictor in addition to baseline ischemic core volume significantly increased the area under the curve in predicting midline shift (SMCV- with baseline ischemic core volume vs. baseline ischemic core volume: AUC = 0.903 vs. 0.841, Z = 2.451, P = 0.014). Conclusion: In acute LAO patients, the presence of SMCV- was a sensitive and specific imaging marker for midline shift. SMCV- had supplementary value to baseline ischemic core volume in predicting midline shift.
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