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@ARTICLE{Dohmen:19328,
      author       = {Dohmen, C. and Galldiks, N. and Bosche, B. and Kracht, L.
                      and Graf, R.},
      title        = {{T}he {S}everity of {I}schemia {D}etermines and {P}redicts
                      {M}alignant {B}rain {E}dema in {P}atients with {L}arge
                      {M}iddle {C}erebral {A}rtery {I}nfarction},
      journal      = {Cerebrovascular diseases},
      volume       = {33},
      issn         = {1015-9770},
      address      = {Basel},
      publisher    = {Karger},
      reportid     = {PreJuSER-19328},
      pages        = {1 - 7},
      year         = {2012},
      note         = {This study was supported by the Federal Ministry of
                      Education and Research (BMBF), Competence Network Stroke.},
      abstract     = {In order to determine the impact of the severity of
                      ischemia on malignant edema formation, we investigated
                      various degrees of perfusional deficit by (11)C-flumazenil
                      PET in patients with large middle cerebral artery (MCA)
                      infarction.17 patients with large MCA stroke were included.
                      Cerebral blood flow (CBF) was measured 15.9 ± 6.4 h after
                      the ictus. Patients were divided into a malignant (n = 9)
                      and a benign group (n = 8) as a function of their clinical
                      courses and edema. Edema was measured as maximal midline
                      shift on follow-up CTs. Total hypoperfusion volume was
                      divided into different subvolumes according to the degree of
                      CBF reduction.Subvolumes of severe ischemia relative to
                      total ischemic area were significantly larger in the
                      malignant group than in the benign group and were
                      significantly correlated with edema formation. The highest
                      correlation and best predictive values for edema formation
                      with a sensitivity, specificity, and a positive and negative
                      predictive value of $100\%$ were found for subvolumes with
                      severe ischemia. Correlation coefficients and prediction
                      decreased for subvolumes with less severe perfusional
                      deficit, pointing to the risk of misclassifying patients
                      when relying on the volume of total perfusional deficit
                      alone.Malignant MCA infarction seems to be determined more
                      by the volume of severe perfusional deficit than that of
                      total perfusional deficit. Assessment of severely ischemic
                      areas allows prediction of malignant edema formation and
                      might help to select candidates for hemicraniectomy.},
      keywords     = {Aged / Brain Edema: etiology / Brain Edema: physiopathology
                      / Brain Edema: radiography / Brain Edema: surgery /
                      Cerebrovascular Circulation / Chi-Square Distribution /
                      Decompressive Craniectomy / Female / Flumazenil: diagnostic
                      use / Germany / Humans / Infarction, Middle Cerebral Artery:
                      complications / Infarction, Middle Cerebral Artery:
                      physiopathology / Infarction, Middle Cerebral Artery:
                      radionuclide imaging / Infarction, Middle Cerebral Artery:
                      surgery / Male / Middle Aged / Patient Selection / Perfusion
                      Imaging: methods / Positron-Emission Tomography / Predictive
                      Value of Tests / Prognosis / Radiopharmaceuticals:
                      diagnostic use / Risk Assessment / Risk Factors /
                      Sensitivity and Specificity / Severity of Illness Index /
                      Time Factors / Tomography, X-Ray Computed /
                      Radiopharmaceuticals (NLM Chemicals) / Flumazenil (NLM
                      Chemicals) / J (WoSType)},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {Funktion und Dysfunktion des Nervensystems (FUEK409) /
                      89572 - (Dys-)function and Plasticity (POF2-89572)},
      pid          = {G:(DE-Juel1)FUEK409 / G:(DE-HGF)POF2-89572},
      shelfmark    = {Clinical Neurology / Peripheral Vascular Disease},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:22143164},
      UT           = {WOS:000302135900002},
      doi          = {10.1159/000330648},
      url          = {https://juser.fz-juelich.de/record/19328},
}