ArticleJournal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism2021
Hemispheric CSF volume ratio quantifies progression and severity of cerebral edema after acute hemispheric stroke.
Article in Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 22 citations in OpenAlex.
- A Platform for Automatic Extraction of Imaging Biomarkers in CT Scans from Ischemic and Hemorrhagic Stroke Patients.Journal of imaging informatics in medicine · 2026Article
- Automatic measurement and reference values setting of intracranial cerebrospinal fluid volume: a large-scale analysis of computed tomography images.Quantitative imaging in medicine and surgery · 2025Article
- Iodine-Based Dual-Energy Computed Tomography After Mechanical Thrombectomy Predicts Secondary Neurologic Decline from Cerebral Edema After Severe Stroke.Neurocritical care · 2025Observational
- Novel advanced imaging techniques for cerebral oedema.Frontiers in neurology · 2024Review
- Automated volumetric evaluation of intracranial compartments and cerebrospinal fluid distribution on emergency trauma head CT scans to quantify mass effect.Frontiers in neuroscience · 2024Article
- Iodine-based dual-energy CT predicts early neurological decline from cerebral edema after large hemispheric infarction.Research square · 2023Article
- Intracranial pressure elevation post-stroke: Mechanisms and consequences.Frontiers in stroke · 2023Review
- Net water uptake within the ischemic penumbra predicts the presence of the midline shift in patients with acute ischemic stroke.Frontiers in neurology · 2023Article
- Accelerating Prediction of Malignant Cerebral Edema After Ischemic Stroke with Automated Image Analysis and Explainable Neural Networks.Neurocritical care · 2022Article
- Commentary on "Midline Shift Greater than 3 mm Independently Predicts Outcome After Ischemic Stroke".Neurocritical care · 2022Article
- Automated Measurement of Net Water Uptake From Baseline and Follow-Up CTs in Patients With Large Vessel Occlusion Stroke.Frontiers in neurology · 2022Article
- Imaging biomarkers of cerebral edema automatically extracted from routine CT scans of large vessel occlusion strokes.Journal of neuroimaging : official journal of the American Society of NeuroimagingArticle
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 3 countries.
Funding
Abstract
As swelling occurs, CSF is preferentially displaced from the ischemic hemisphere. The ratio of CSF volume in the stroke-affected hemisphere to that in the contralateral hemisphere may quantify the progression of cerebral edema. We automatically segmented CSF from 1,875 routine CTs performed within 96 hours of stroke onset in 924 participants of a stroke cohort study. In 737 subjects with follow-up imaging beyond 24-hours, edema severity was classified as affecting less than one-third of the hemisphere (CED-1), large hemispheric infarction (LHI, over one-third the hemisphere), without midline shift (CED-2) or with midline shift (CED-3). Malignant edema was LHI resulting in deterioration, requiring osmotic therapy, surgery, or resulting in death. Hemispheric CSF ratio was lower on baseline CT in those with LHI (0.91 vs. 0.97, p < 0.0001) and decreased more rapidly in those with LHI who developed midline shift (0.01 per hour for CED-3 vs. 0.004/hour CED-2). The ratio at 24-hours was lower in those with midline shift (0.41, IQR 0.30-0.57 vs. 0.66, 0.56-0.81 for CED-2). A ratio below 0.50 provided 90% sensitivity, 82% specificity for predicting malignant edema among those with LHI (AUC 0.91, 0.85-0.96). This suggests that the hemispheric CSF ratio may provide an accessible early biomarker of edema severity.
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