To compare edema volume (EV) and midline shift (MLS) as imaging biomarkers of ischemic edema and predictors of malignant infarction (MI) and very poor functional outcomes (VPCO), defined as modified Rankin Scale (mRS) 5–6 at discharge, in patients with large hemispheric infarcts.
Key Findings:
EV is a reliable imaging biomarker for edema quantification, even in infarcts without apparent MLS, which is crucial for timely intervention.
MLS only detects edema in large infarcts, missing smaller territorial infarcts that also correlate with poor outcomes, highlighting the need for comprehensive assessment.
Both EV and MLS can predict malignant infarction and very poor functional outcomes, but EV offers a broader applicability.
Interpretation:
EV provides a more comprehensive assessment of ischemic edema compared to MLS, particularly in smaller infarcts where MLS may not be applicable, suggesting a shift in imaging practices.
Limitations:
Retrospective design may introduce selection bias, potentially affecting the reliability of the findings.
Single-center study limits generalizability, necessitating further multicenter studies.
Potential confounding factors not fully controlled may influence the outcomes.
Conclusion:
EV should be considered a valuable imaging biomarker for assessing ischemic edema and predicting outcomes in extensive ischemic stroke.
by Vincent Geest, Paul Steffen, Laurens Winkelmeier, Tobias D. Faizy, Christian Heitkamp, Helge Kniep, Lukas Meyer, Kamil Zelenak, Thomalla Götz, Jens Fiehler, Gabriel Broocks
