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Purpose <p>Iodine extravasation signifies blood–brain barrier disruption and predicts hemorrhagic transformation (HT) after thrombectomy for acute ischemic stroke (AIS). We aimed to evaluate the role of net water uptake (NWU) in patients with acute anterior circulation ischemic stroke who developed high-density lesions on computed tomography (CT) after endovascular treatment (EVT).</p> Methods <p>This retrospective study included patients who underwent dual-energy CT immediately after EVT for acute anterior circulation occlusion between January 2022 and December 2023. Alberta Stroke Program Early CT Score (ASPECTS)-based NWU was calculated using baseline non-contrast CT. The clinical endpoint was presence of high-density lesions after EVT. A final clinical imaging model incorporating NWU was constructed.</p> Results <p>In total, 109 patients (mean age, 68.2 ± 12.8 years; 42 male participants) were evaluated, with 67 (61.5%) patients showing high-density lesions after EVT. Multivariable logistic regression analysis identified the National Institutes of Health Stroke Scale (NIHSS) score (odds ratio = 1.049; 95% confidence interval [CI]: 1.004–1.096; <i>p</i> = 0.033) and NWU (odds ratio = 1.396; 95% CI: 1.170–1.666; <i>p</i> &lt; 0.001) as predictors of high-density appearance post-EVT. The receiver operating characteristic curve showed an area under the curve of 0.663 (95% CI: 0.557–0.768) for the NIHSS-based model and 0.778 (95% CI: 0.690–0.867) when NWU was included.</p> Conclusion <p>ASPECTS-based quantitative NWU independently predicted high-density lesions post-EVT, implying that it can assist in early patient risk stratification. Baseline NWU, indicating brain tissue edema, could forecast blood–brain barrier disruption following EVT.</p>

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Net water uptake as a predictor of the development of high-density lesions after endovascular treatment

  • 期刊论文

  • 发表日期：

    2025年12月15日

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  • Cong Ning,
  • Shanshan Huang,
  • Bofeng Bai,
  • Yannan Wang,
  • Ying Yan,
  • Kong Fang,
  • Yongbin Li

摘要

Purpose

Iodine extravasation signifies blood–brain barrier disruption and predicts hemorrhagic transformation (HT) after thrombectomy for acute ischemic stroke (AIS). We aimed to evaluate the role of net water uptake (NWU) in patients with acute anterior circulation ischemic stroke who developed high-density lesions on computed tomography (CT) after endovascular treatment (EVT).

Methods

This retrospective study included patients who underwent dual-energy CT immediately after EVT for acute anterior circulation occlusion between January 2022 and December 2023. Alberta Stroke Program Early CT Score (ASPECTS)-based NWU was calculated using baseline non-contrast CT. The clinical endpoint was presence of high-density lesions after EVT. A final clinical imaging model incorporating NWU was constructed.

Results

In total, 109 patients (mean age, 68.2 ± 12.8 years; 42 male participants) were evaluated, with 67 (61.5%) patients showing high-density lesions after EVT. Multivariable logistic regression analysis identified the National Institutes of Health Stroke Scale (NIHSS) score (odds ratio = 1.049; 95% confidence interval [CI]: 1.004–1.096; p = 0.033) and NWU (odds ratio = 1.396; 95% CI: 1.170–1.666; p < 0.001) as predictors of high-density appearance post-EVT. The receiver operating characteristic curve showed an area under the curve of 0.663 (95% CI: 0.557–0.768) for the NIHSS-based model and 0.778 (95% CI: 0.690–0.867) when NWU was included.

Conclusion

ASPECTS-based quantitative NWU independently predicted high-density lesions post-EVT, implying that it can assist in early patient risk stratification. Baseline NWU, indicating brain tissue edema, could forecast blood–brain barrier disruption following EVT.