Lesion Water Content on CT Predicts 12-Month Outcome and Modifies Thrombectomy Effect in Large-Core Stroke-A Secondary Analysis of the TENSION Trial
In brief
Each percentage-point rise in CT lesion water content linked to 10% higher odds of worse stroke
In a secondary analysis of 198 patients with large-core stroke, higher lesion water content on admission CT was associated with worse 12-month function and modified the observed effect of thrombectomy. Water content on a 24-hour scan was the strongest imaging predictor, with 56% of patients dead by 12 months; whether this measure can guide treatment needs further study.
- Journal
- Translational stroke research (Q1)
- Published
- 23 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Gabriel Broocks, Martin Bendszus, Sophia Hohenstatt, Claus Z Simonsen, Götz Thomalla, Elke R Gizewski, et al.
- PMID
- 42909781
- DOI
- 10.1007/s12975-026-01501-1
Why clinicians should know about it
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 25 October 2026): CT-derived lesion water predicts outcome and modifies thrombectomy effect
Abstract
In large-core ischemic stroke, outcomes after thrombectomy remain heterogeneous, and imaging markers that capture treatment-modifiable injury beyond lesion extent are needed. We investigated whether lesion water content on noncontrast CT, quantified as net water uptake (NWU), predicts 12-month functional outcome and modifies the effect of endovascular thrombectomy (EVT). This secondary analysis of the randomized TENSION trial included 198 patients with admission CT suitable for NWU quantification and available 12-month modified Rankin Scale (mRS) scores; 168 had paired 24-h CT for follow-up NWU (NWUFU) assessment. The primary outcome was ordinal 12-month mRS. Multivariable ordinal and logistic regression tested associations and the NWU × EVT interaction, with discrimination assessed by area under the receiver operating characteristic curve (AUC). Median baseline NWU was 16.4% and NWUFU 28.9%. At 12 months, 45 patients (23%) had mRS 0-3 and 111 (56%) had died. Higher baseline NWU independently predicted worse 12-month mRS (adjusted common odds ratio [acOR], 1.10 per percentage-point; 95% CI, 1.05-1.16; P < 0.001) and modified the EVT effect (interaction acOR, 1.17; 95% CI, 1.06-1.30; P = 0.002), with greater discrimination than ASPECTS. NWUFU was the strongest single imaging predictor (acOR, 1.10; 95% CI, 1.06-1.14; P < 0.001; AUC, 0.78 for mRS 0-3) and superseded baseline NWU when co-modeled. Among 97 90-day survivors, higher NWUFU independently predicted late mortality (adjusted odds ratio, 1.09; 95% CI, 1.02-1.18; P = 0.019). Lesion water content may therefore provide a clinically accessible CT biomarker linking treatment-modifiable injury at baseline with realized post-treatment injury and long-term outcome.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.