@article {Lu, author = {S.S. Lu and R.R. Wu and Y.Z. Cao and X.Q. Xu and Z.Y. Jia and H.B. Shi and S. Liu and F.Y. Wu}, title = {Automated Estimation of Quantitative Lesion Water Uptake as a Prognostic Biomarker for Patients with Ischemic Stroke and Large-Vessel Occlusion}, year = {2022}, doi = {10.3174/ajnr.A7741}, publisher = {American Journal of Neuroradiology}, abstract = {BACKGROUND AND PURPOSE: Net water uptake is qualified as an imaging marker of brain edema. We aimed to investigate the ability of net water uptake to predict 90-day functional outcome in patients with acute ischemic stroke and large-vessel occlusion.MATERIALS AND METHODS: A total of 295 consecutive patients were retrospectively enrolled. Automated ASPECTS{\textendash}net water uptake was calculated on the admission CT. The relationship between ASPECTS{\textendash}net water uptake and 90-day neurologic outcome was assessed. The independent predictors of favorable outcome (mRS score <=2) were assessed using multivariate logistic regression analysis and receiver operating characteristic curves and stratified by the ASPECTS.RESULTS: Favorable 90-day outcomes were observed in 156 (52.9\%) patients. ASPECTS{\textendash}net water uptake (OR, 0.79; 95\% CI, 0.70{\textendash}0.90), NIHSS scores (OR, 0.91; 95\% CI, 0.87{\textendash}0.96), age (OR, 0.96; 95\% CI, 0.94{\textendash}0.99), and vessel recanalization (OR, 7.78; 95\% CI, 3.96{\textendash}15.29) were independently associated with favorable outcomes at 90 days (all, P \< .01). A lower ASPECTS{\textendash}net water uptake independently predicted a good prognosis, even in the subgroup of patients with low ASPECTS (<=5) (P \< .05). An outcome-prediction model based on these variables yielded an area under the receiver operating characteristic curve of 0.856 (95\% CI, 0.814{\textendash}0.899; sensitivity, 76.3\%; specificity, 81.3\%).CONCLUSIONS: ASPECTS{\textendash}net water uptake could independently predict 90-day neurologic outcomes in patients with acute ischemic stroke and large-vessel occlusion. Integrating ASPECTS{\textendash}net water uptake with clinical models could improve the efficiency of outcome stratification.AISacute ischemic strokeAUCarea under the curveIQRinterquartile rangeLVOlarge-vessel occlusionMTmechanical thrombectomymTICImodified TICINWUnet water uptakeROCreceiver operating characteristic}, issn = {0195-6108}, URL = {https://www.ajnr.org/content/early/2022/12/21/ajnr.A7741}, eprint = {https://www.ajnr.org/content/early/2022/12/21/ajnr.A7741.full.pdf}, journal = {American Journal of Neuroradiology} }