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Review of net water uptake in the management of acute ischemic stroke

  • Computed Tomography
  • Published:
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Abstract

CT densitometry-based methods to directly quantify net water uptake in ischemic brain tissue have been increasingly applied recently. There is potential for net water uptake to be used as an imaging biomarker for the pathophysiology of infarcted lesions. This review is aimed at summarizing the potential and current status of the application of net water uptake as a biomarker in the management of ischemic stroke and future directions in this context. Specifically, we provide a brief overview of the principle and different methods of net water uptake measurement, followed by a discussion of the role of net water uptake in predicting malignant brain edema and hemorrhagic transformation, evaluating lesion age, and predicting the efficacy of reperfusion therapy and long-term clinical prognosis. Artificial intelligence will help address the lack of automation and standardization in the measurement of net water absorption. Further validation of net water uptake in a prospective multicenter setting is necessary.

Key Points

• NWU can be used as a quantitative imaging biomarker for developing malignant brain edema in anterior and posterior circulation strokes.

• The difference in NWU in edema arrest or reversibility suggests that rapid and successful revascularization can influence the progression of ischemic edema.

• NWU can be used to predict the age of a lesion, with predictive power comparable to that of DWI/FLAIR mismatch.

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Abbreviations

ASPECTS:

Alberta Stroke Program Early CT Score

AUC:

Area under the curve

CBV:

Cerebral blood volume

CTP:

CT perfusion

HU:

Hounsfield units

MCE:

Malignant cerebral edema

NWU:

Net water uptake

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Funding

This study has received funding from the Major Project of the National Natural Scientific Foundation of China (Grant Nos 81790653)and the Natural Science Foundation of Jiangsu Province (BK20201234).

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Author notes

  1. XiaoQing Cheng and JiaQian Shi contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China

    XiaoQing Cheng, JiaQian Shi & GuangMing Lu

  2. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China

    Hang Wu

  3. Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China

    WuSheng Zhu

Authors
  1. XiaoQing Cheng
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  2. JiaQian Shi
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  4. WuSheng Zhu
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  5. GuangMing Lu
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Corresponding authors

Correspondence to WuSheng Zhu or GuangMing Lu.

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The scientific guarantor of this publication is GuangMing Lu.

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The authors declare that they have no conflicts of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was not required for this study because it is a review article.

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Institutional Review Board approval was not required because it is a review article that does not involve research on human subjects.

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Cheng, X., Shi, J., Wu, H. et al. Review of net water uptake in the management of acute ischemic stroke. Eur Radiol 32, 5517–5524 (2022). https://doi.org/10.1007/s00330-022-08658-x

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  • DOI: https://doi.org/10.1007/s00330-022-08658-x

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