已经提出使用容积和密度生物标记来更好地量化脑水肿，但它们的相对表现尚未得到严格评估。我们对来自三个机构的大血管闭塞性卒中患者进行了分析，自动化流程从序列化CT中提取了脑、脑脊液（CSF）和梗死的容积。测量了几个生物标记：与基线相比全局CSF容量变化（ΔCSF）；半球之间的CSF容量比（CSF比）以及梗死区相对于镜像对侧区域的相对密度（净水摄取[net water uptake，NWU]）。这些指标与放射学标准，中线移位和相对半球容积（RHV）以及恶性水肿进行了比较，定义为加重导致需要渗透性治疗、减压手术或死亡。共分析了255名患者，包括210个基线CT、255个24小时CT和81个72小时CT。其中35名（14％）患者发展成恶性水肿，63名（27％）患者出现中线移位。其中310例（92％）患者的CSF指标可以计算，而NWU只能从193例（57％）患者中得到。高峰中线移位与基线CSF比率（ρ = -.22）和24小时（ρ = -.55 / .63）和72小时（ρ = -.66 / .69）的CSF比率和ΔCSF呈负相关，但与NWU无关（ρ = .15 / .25）。类似地，CSF比率与RHV呈负相关（ρ = -.69 / -.78），而NWU则无关。在年龄、国立卫生研究院卒中量表、组织型纤溶酶原激活剂治疗以及阿尔伯塔卒中计划早期CT评分的调整下，24小时的ΔCSF（每10％，OR：1.87，95％CI：1.47-2.49）和CSF比率（每0.1，OR：1.95，95％CI：1.52-2.59）与恶性水肿有关。CSF容积生物标记可以从几乎所有常规CT中自动测量，并与标准水肿终点相关得更好。©2023美国神经成像学会。

Volumetric and densitometric biomarkers have been proposed to better quantify cerebral edema after stroke, but their relative performance has not been rigorously evaluated.Patients with large vessel occlusion stroke from three institutions were analyzed. An automated pipeline extracted brain, cerebrospinal fluid (CSF), and infarct volumes from serial CTs. Several biomarkers were measured: change in global CSF volume from baseline (ΔCSF); ratio of CSF volumes between hemispheres (CSF ratio); and relative density of infarct region compared with mirrored contralateral region (net water uptake [NWU]). These were compared to radiographic standards, midline shift and relative hemispheric volume (RHV) and malignant edema, defined as deterioration resulting in need for osmotic therapy, decompressive surgery, or death.We analyzed 255 patients with 210 baseline CTs, 255 24-hour CTs, and 81 72-hour CTs. Of these, 35 (14%) developed malignant edema and 63 (27%) midline shift. CSF metrics could be calculated for 310 (92%), while NWU could only be obtained from 193 (57%). Peak midline shift was correlated with baseline CSF ratio (ρ = -.22) and with CSF ratio and ΔCSF at 24 hours (ρ = -.55/.63) and 72 hours (ρ = -.66/.69), but not with NWU (ρ = .15/.25). Similarly, CSF ratio was correlated with RHV (ρ = -.69/-.78), while NWU was not. Adjusting for age, National Institutes of Health Stroke Scale, tissue plasminogen activator treatment, and Alberta Stroke Program Early CT Score, CSF ratio (odds ratio [OR]: 1.95 per 0.1, 95% confidence interval [CI]: 1.52-2.59) and ΔCSF at 24 hours (OR: 1.87 per 10%, 95% CI: 1.47-2.49) were associated with malignant edema.CSF volumetric biomarkers can be automatically measured from almost all routine CTs and correlate better with standard edema endpoints than net water uptake.© 2023 American Society of Neuroimaging.