Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion

BACKGROUND AND PURPOSE:

Net water uptake is qualified as an imaging marker of brain edema. We aimed to investigate the ability of net water uptake to predict 90-day functional outcome in patients with acute ischemic stroke and large-vessel occlusion.

MATERIALS AND METHODS:

A total of 295 consecutive patients were retrospectively enrolled. Automated ASPECTS–net water uptake was calculated on the admission CT. The relationship between ASPECTS–net water uptake and 90-day neurologic outcome was assessed. The independent predictors of favorable outcome (mRS score ≤2) were assessed using multivariate logistic regression analysis and receiver operating characteristic curves and stratified by the ASPECTS.

RESULTS:

Favorable 90-day outcomes were observed in 156 (52.9%) patients. ASPECTS–net water uptake (OR, 0.79; 95% CI, 0.70–0.90), NIHSS scores (OR, 0.91; 95% CI, 0.87–0.96), age (OR, 0.96; 95% CI, 0.94–0.99), and vessel recanalization (OR, 7.78; 95% CI, 3.96–15.29) were independently associated with favorable outcomes at 90 days (all, P < .01). A lower ASPECTS–net water uptake independently predicted a good prognosis, even in the subgroup of patients with low ASPECTS (≤5) (P < .05). An outcome-prediction model based on these variables yielded an area under the receiver operating characteristic curve of 0.856 (95% CI, 0.814–0.899; sensitivity, 76.3%; specificity, 81.3%).

CONCLUSIONS:

ASPECTS–net water uptake could independently predict 90-day neurologic outcomes in patients with acute ischemic stroke and large-vessel occlusion. Integrating ASPECTS–net water uptake with clinical models could improve the efficiency of outcome stratification.