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Should we care about intracranial midline shift?
VRU 2024
Bethany Guy, Paul Freeman, Sam Khan, Marie-Aude Genain
Background
Midline shift, a lateral displacement of brain structures due to intracranial space-occupying lesions, is a significant prognostic factor in human neurology, but its impact on survival in dogs with structural brain disease remains unclear. This study aimed to evaluate whether midline shift observed on MRI influences survival time in dogs, considering various structural brain conditions.
Methods
A retrospective cohort study was conducted on 77 dogs diagnosed with structural brain diseases via MRI at the Queen’s Veterinary School Hospital. Diagnoses included neoplasia, inflammatory, and other structural disorders. MRI scans were reviewed for midline shift, brain edema, ventriculomegaly, and foramen magnum herniation. Survival times were compared using Kaplan-Meier and Cox regression analyses, accounting for multiple variables.
Results
Midline shift was observed in 52% of dogs. Median survival time was significantly shorter in dogs with midline shift (34.5 days) compared to those without (241 days). Multivariate analysis confirmed midline shift as a strong negative prognostic factor (HR = 3.6, P < .001). This trend was consistent across diagnostic categories, including both neoplastic (HR = 2.15) and nonneoplastic conditions (HR = 3.01). Other imaging variables did not significantly affect survival.
Limitations
The study's retrospective nature led to variability in imaging protocols and clinical follow-up. The predominance of neoplasia cases may limit generalizability to other conditions. A substantial number of diagnoses were presumptive, which may affect classification accuracy.
Conclusions
Midline shift on MRI is a significant negative prognostic indicator for survival in dogs with structural brain disease, regardless of the underlying diagnosis. These findings can guide clinical decision-making and provide owners with more accurate prognostic information. Further prospective studies are needed to validate these results.
(A) Kaplan–Meier curve demonstrating the overall survival probability for the neoplasia group. No, indicates the number of dogs without midline shift, n = 18. Yes, indicates the number of dogs with midline shift n = 30. (B) Kaplan–Meier curve demonstrating the overall survival probability for the nonneoplastic group. No, indicates the number of dogs without midline shift, n = 19. Yes, indicates the number of dogs with midline shift n = 10. The overall survival probability is a fraction of the total number of dogs still alive within each of the two groups. The numbers below denote the number of dogs at risk of dying at each time point “at risk” and the number of deaths that have occurred “events”. The shaded area represents the 95% confidence interval.
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