The effect of midline shift on survival time in dogs with structural brain disease diagnosed on MRI

The effect of midline shift identified on brain MRI on survival time in dogs with structural brain disease is relatively unknown. This retrospective single-centered cohort study reviewed medical and imaging data of 77 dogs with structural brain lesions evident on MRI. Images were reviewed for the presence of midline shift, brain edema, foramen magnum herniation, and ventriculomegaly. Kaplan-Meier method and Cox regression analysis were undertaken to compare survival between dogs with and without midline shift. Midline shift was present in 40 of 77 (52%) dogs and absent in 37 of 77 (48%). Univariate analysis revealed that dogs with midline shift had a median survival time of 34.5 days (95% CI, 4-108 days) compared with 241 days (95% CI, 133,- days) in dogs without midline shift (hazard ratio = 2.67, 95% CI, 1.5-4.49). Multivariate Cox regression analysis revealed a hazard ratio of 3.6 (95% CI, 1.7-7.6; P-value < .001) for dogs with midline shift. Shorter median survival times remained significant in all groups after segregation based on etiological diagnosis. The significantly shorter survival times observed herein for dogs with midline shifts, regardless of etiologic cause, provide further evidence that midline shift holds value as a negative prognostic factor in diagnostic imaging.