Early Imaging Prediction of Malignant Cerebellar Edema Development in Acute Ischemic Stroke

BACKGROUND AND PURPOSE—Malignant cerebellar edema (MCE) is a life-threatening complication of acute ischemic stroke that requires timely diagnosis and management. Aim of this study was to identify imaging predictors in initial multiparametric computed tomography (CT), including whole-brain CT perfusion (WB-CTP). METHODS—We consecutively selected all subjects with cerebellar ischemic WB-CTP deficits and follow-up–confirmed cerebellar infarction from an initial cohort of 2635 patients who had undergone multiparametric CT because of suspected stroke. Follow-up imaging was assessed for the presence of MCE, measured using an established 10-point scale, of which scores ≥4 are considered malignant. Posterior circulation–Acute Stroke Prognosis Early CT Score (pc-ASPECTS) was determined to assess ischemic changes on noncontrast CT, CT angiography (CTA), and parametric WB-CTP maps (cerebellar blood flow [CBF]; cerebellar blood volume; mean transit time; time to drain). Fisher’s exact tests, Mann–Whitney U tests, and receiver operating characteristics analyses were performed for statistical analyses. RESULTS—Out of a total of 51 patients who matched the inclusion criteria, 42 patients (82.4%) were categorized as MCE− and 9 (17.6%) as MCE+. MCE+ patients had larger CBF, cerebellar blood volume, mean transit time, and time to drain deficit volumes (all with P