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Abstract TP37: Prediction of Outcome in Cerebellar Infarction by Diffusion MRI


 Background and Purpose —
 Early identification of patients at risk for neurological deterioration due to edema after stroke remains a challenge. MRI based volumetric assessments of infarct have been shown to predict poor outcome amongst patients with large middle cerebral artery infarcts. However, no such quantitative imaging measure exists to predict outcome following cerebellar stroke. In this study, we tested the hypothesis that volumetric assessment of cerebellar infarcts can provide reliable information for the prediction of neurological deterioration.
 
 
 Methods —
 We retrospectively identified forty-four consecutive subjects (age 55.2±13) with cerebellar stroke who underwent MRI with DWI (mean 63.7 hours). Subjects were divided into poor (n=13) and good outcomes (n=31). Subjects were classified in the poor outcome group according to at least one of the following criteria: (1) mortality (2) decompressive craniectomy (3) ventriculostomy (4) decrease of consciousness according to item 1a of the NIH stroke scale score (NIHSS). These poor outcomes represent mass effect of the cerebellar infarct. Lesion and cerebellar volume were defined on ADC maps. The ratio of the lesion volume to the whole cerebellum volume was calculated (rVolume). The predictive value of volume and rVolume was determined using ROC analysis.
 
 
 Results —
 Logistic regression revealed that rVolume was associated with increased risk of poor outcome, even after adjusting for age and NIHSS (χ2 =9.4449, p < 0.0022). The logistic regression model with age, rVolume, and NIHSS achieved an AUC of 0.816 (95% CI: 0.678-0.955), while a regression model with age and NIHSS alone achieved an AUC of 0.711 (95% CI: 0.537-0.885). The difference in AUC between these models was not statistically significant (Z = 0.3816, p = NS).
 
 
 Conclusions —
 Quantitative measurement of rVolume predicts poor outcome of cerebellar stroke patients, even when controlling for age and NIHSS. Quantitative analysis of diffusion MRI may assist in identification of patients with cerebellar stroke at highest risk of life-threatening edema. Prospective validation is warranted.
