Neuroimaging markers associated with early neurological deterioration in acute isolated pontine infarction: a systematic review and meta-analysis
- 1Neurology Department, The First People's Hospital of Guangyuan
Abstract
Background: We evaluated imaging features associated with early neurological deterioration (END) after acute isolated pontine infarction (AIPI).
Methods: PubMed, Embase, and Web of Science were searched from their inception to 3 August 2026. We included observational studies of adults with imaging-confirmed AIPI that assessed imaging findings before the onset of neurological deterioration. Unadjusted and adjusted odds ratios (ORs) were pooled separately using restricted maximum-likelihood random-effects models with Hartung–Knapp adjustment; infarct size was summarized using standardized mean differences (SMDs). Heterogeneity, influence, prediction intervals, and small-study effects were assessed when feasible.
Results: A total of 29 studies were included, of which 14 contributed to at least one meta-analysis. Ventral surface extension/branch atheromatous disease (BAD) morphology was associated with END in the unadjusted analysis (9 studies; OR 3.96, 95% CI 2.33–6.74; I ² = 52.8%) and in the adjusted analysis (7 studies; OR 3.15, 95% CI 1.37–7.26; I ² = 43.4%). Lower pontine location (2 studies; adjusted OR 2.48, 95% CI 1.27–4.84) and basilar artery (BA) stenosis (3 studies; adjusted OR 2.13, 95% CI 1.27–3.57) were also associated with END, although these estimates were based on a small number of studies. Infarct size was not significantly associated with END (3 studies; SMD 1.10, 95% CI − 0.43 to 2.64; I ² = 90.7%). Egger’s test indicated evidence of small-study effects in the only analysis, including at least 10 studies ( p = 0.010).
Conclusion: Ventral surface extension/BAD morphology was most consistently associated with END. Evidence for lower pontine location and basilar artery stenosis was limited. Standardized prospective validation is needed.
Systematic review registration: [ https://www.crd.york.ac.uk/prospero/ ], identifier [CRD420261475990].
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BibTeX
@article{guo2026neuroimaging,
title = {{Neuroimaging markers associated with early neurological deterioration in acute isolated pontine infarction: a systematic review and meta-analysis}},
author = {Feng Guo and Xiaorong Liu and Jia Chen and Chenkai Yangyang},
journal = {Frontiers in Neurology},
year = {2026},
month = nov,
doi = {10.3389/fneur.2026.1966356},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1966356/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Neuroimaging markers associated with early neurological deterioration in acute isolated pontine infarction: a systematic review and meta-analysis
AU - Feng Guo
AU - Xiaorong Liu
AU - Jia Chen
AU - Chenkai Yangyang
PY - 2026
DA - 2026/11/02
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1966356
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1966356/full
AB - Background: We evaluated imaging features associated with early neurological deterioration (END) after acute isolated pontine infarction (AIPI). Methods: PubMed, Embase, and Web of Science were searched from their inception to 3 August 2026. We included observational studies of adults with imaging-confirmed AIPI that assessed imaging findings before the onset of neurological deterioration. Unadjusted and adjusted odds ratios (ORs) were pooled separately using restricted maximum-likelihood random-effects models with Hartung–Knapp adjustment; infarct size was summarized using standardized mean differences (SMDs). Heterogeneity, influence, prediction intervals, and small-study effects were assessed when feasible. Results: A total of 29 studies were included, of which 14 contributed to at least one meta-analysis. Ventral surface extension/branch atheromatous disease (BAD) morphology was associated with END in the unadjusted analysis (9 studies; OR 3.96, 95% CI 2.33–6.74; I ² = 52.8%) and in the adjusted analysis (7 studies; OR 3.15, 95% CI 1.37–7.26; I ² = 43.4%). Lower pontine location (2 studies; adjusted OR 2.48, 95% CI 1.27–4.84) and basilar artery (BA) stenosis (3 studies; adjusted OR 2.13, 95% CI 1.27–3.57) were also associated with END, although these estimates were based on a small number of studies. Infarct size was not significantly associated with END (3 studies; SMD 1.10, 95% CI − 0.43 to 2.64; I ² = 90.7%). Egger’s test indicated evidence of small-study effects in the only analysis, including at least 10 studies ( p = 0.010). Conclusion: Ventral surface extension/BAD morphology was most consistently associated with END. Evidence for lower pontine location and basilar artery stenosis was limited. Standardized prospective validation is needed. Systematic review registration: [ https://www.crd.york.ac.uk/prospero/ ], identifier [CRD420261475990].
SN - 1664-2295
ER -