Evidence map›Paper›PMID 39448427›Full record

Observational studyNeurocritical care2025

Iodine-Based Dual-Energy Computed Tomography After Mechanical Thrombectomy Predicts Secondary Neurologic Decline from Cerebral Edema After Severe Stroke.

William Zimmerman, Melissa Pergakis, Ghasan Ahmad, Nicholas A Morris, Jamie Podell, Wan-Tsu Chang, Melissa Motta, Hegang Chen, Gaurav Jindal, Uttam Bodanapally and 3 more

Registry-linked trialAbstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04189471 (Recovery After Cerebral Hemorrhage--Improving Outcomes for Patients With Life-Threatening Neurologic Illness), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04189471 recruitingnot on this map

Recovery After Cerebral Hemorrhage--Improving Outcomes for Patients With Life-Threatening Neurologic Illness

Typeobservational_patient_registrySponsorUniversity of Maryland, BaltimoreRan2014 to 2034Enrolled5,000ConditionsIntracerebral Hemorrhage, Subarachnoid Hemorrhage, Intraventricular Hemorrhage, Nontraumatic Haemorrhage
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

William ZimmermanDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Melissa PergakisDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Ghasan AhmadDepartment of Interventional Radiology, Jersey Shore University Medical Center, Neptune, NJ, USA.
Nicholas A MorrisDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Jamie PodellDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Wan-Tsu ChangDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Melissa MottaDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Hegang ChenDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA.
Gaurav JindalDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Uttam BodanapallyProgram in Trauma, R Adams Cowley Shock Trauma Hospital, Baltimore, MD, USA.
J Marc SimardDepartment of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA.
Neeraj BadjatiaDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA.
Gunjan Y ParikhDepartment of Neurology, University of Maryland School of Medicine, 22 S. Greene St., G7K18, Baltimore, MD, 21201, USA. gparikh@som.umaryland.edu.ORCID 0000-0002-8447-1349

Funding

QAQC Johns Hopkins Institute for Clinical and Translational ResearchUL1TR003098 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2019 to 2023
$57.7M
NCATS NIH HHS 1UL1TR003098
6 · The paper itself

Abstract

backgroundPatients with severe stroke are at high risk of secondary neurologic decline (ND) from the development of malignant cerebral edema (MCE). However, early infarcts are hard to diagnose on conventional head computed tomography (CT). We hypothesize that high-energy (190 keV) virtual monochromatic imaging (VMI) from dual-energy CT (DECT) imaging enables earlier detection of ND from MCE.

methodsConsecutive patients with severe stroke with National Institute of Health Stroke Scale (NIHSS) scores > 15 and DECT within 10 h of mechanical thrombectomy from May 2020 to March 2022 were included. We excluded patients with parenchymal hematoma type 2 transformation. Retrospective analysis of clinical and novel variables included the VMI Alberta Stroke Program Early CT Score (ASPECTS), total iodine content, and VMI infarct volume. The primary outcome was secondary ND, defined using a composite outcome variable of clinical worsening (increase in NIHSS score ≥ 4 or decrease in Glasgow Coma Scale score > 2) or malignant radiographical edema (midline shift ≥ 5 mm at the level of the septum pellucidum). Fisher's exact test and Wilcoxon's test were used for univariate analysis. Logistic regression was used to develop prediction models for categorical outcomes.

resultsEighty-four patients with severe stroke with a median age of 67.5 (interquartile range [IQR] 57-78) years and an NIHSS score of 22 (IQR 18-25) were included. Twenty-nine patients had ND. The VMI ASPECTS, total iodine content, and VMI infarct volume were associated with ND. The VMI ASPECTS, VMI infarct volume, and total iodine content were predictors of ND after adjusting for age, sex, initial NIHSS score, and tissue plasminogen activator administration, with areas under the receiver operating characteristic curve (AUROC) of 0.691 (95% confidence interval [CI] 0.572-0.810), 0.877 (95% CI 0.800-0.954), and 0.845 (95% CI 0.750-0.940). By including all three predictors, the model achieved an AUROC of 0.903 (95% CI 0.84-0.97) and was cross-validated by the leave one out method, with an AUROC of 0.827.

conclusionsThe VMI ASPECTS and VMI infarct volume from DECT are superior to the conventional CT ASPECTS and are novel predictors for secondary ND due to MCE after severe stroke. Clinical trial registration ClinicalTrials.gov identifier: NCT04189471.

Indexed as

Brain EdemaIodineIschemic StrokeStrokeThrombectomyTomography, X-Ray ComputedAgedFemaleHumansMaleMiddle AgedRetrospective StudiesSeverity of Illness IndexIodineDual-energy computed tomographyMalignant cerebral edemaMechanical thrombectomySecondary neurologic declineSevere stroke

Identifiers

PMID39448427

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.