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McDonough RV, Rex NB, Ospel JM, Kashani N, Rinkel LA, Sehgal A, Fladt JC, McTaggart RA, Nogueira R, Menon B, Demchuk AM, Poppe A, Hill MD, Goyal M. Association between CT Perfusion Parameters and Hemorrhagic Transformation after Endovascular Treatment in Acute Ischemic Stroke: Results from the ESCAPE-NA1 Trial. AJNR Am J Neuroradiol 2024; 45:887-892. [PMID: 38697793 DOI: 10.3174/ajnr.a8227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation can occur as a complication of endovascular treatment for acute ischemic stroke. This study aimed to determine whether ischemia depth as measured by admission CTP metrics can predict the development of hemorrhagic transformation at 24 hours. MATERIALS AND METHODS Patients with baseline CTP and 24-hour follow-up imaging from the ESCAPE-NA1 trial were included. RAPID software was used to generate CTP volume maps for relative CBF, CBV, and time-to-maximum at different thresholds. Hemorrhage on 24-hour imaging was classified according to the Heidelberg system, and volumes were calculated. Univariable and multivariable regression analyses assessed the association between CTP lesion volumes and hemorrhage/hemorrhage subtypes. RESULTS Among 408 patients with baseline CTP, 142 (35%) had hemorrhagic transformation at 24-hour follow-up, with 89 (63%) classified as hemorrhagic infarction (HI1/HI2), and 53 (37%), as parenchymal hematoma (PH1/PH2). Patients with HI or PH had larger volumes of low relative CBF and CBV at each threshold compared with those without hemorrhage. After we adjustied for baseline and treatment variables, only increased relative CBF <30% lesion volume was associated with any hemorrhage (adjusted OR, 1.14; 95% CI, 1.02-1.27 per 10 mL), as well as parenchymal hematoma (adjusted OR, 1.23; 95% CI, 1.06-1.43 per 10 mL). No significant associations were observed for hemorrhagic infarction. CONCLUSIONS Larger "core" volumes of relative CBF <30% were associated with an increased risk of PH following endovascular treatment. This particular metric, in conjunction with other clinical and imaging variables, may, therefore, help estimate the risk of post-endovascular treatment hemorrhagic complications.
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Affiliation(s)
- Rosalie V McDonough
- From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Nathaniel B Rex
- From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Diagnostic Imaging (N.B.R.), Brown University, Providence, Rhode Island
| | - Johanna M Ospel
- From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Nima Kashani
- Department of Neurosurgery (N.K.), University of Saskatchewan, Saskatchewan, Canada
| | - Leon A Rinkel
- From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Neurology (L.A.R.), Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Arshia Sehgal
- From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Joachim C Fladt
- Department of Neurology and Stroke Center (J.C.F.), University Hospital Basel, Basel, Switzerland
| | - Ryan A McTaggart
- Department of Imaging (R.A.M.), Brown University, Providence, Rhode Island
| | - Raul Nogueira
- Department of Neurology and Neurosurgery (R.N.), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Bijoy Menon
- Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Andrew M Demchuk
- Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Alexandre Poppe
- Department of Neurosciences (A.P.), Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- From the Department of Radiology (R.V.M., N.B.R., J.M.O., L.A.R., A.S., M.G.), University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences (B.M., A.M.D., M.D.H., M.G.), University of Calgary, Calgary, Alberta, Canada
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Feng L, Yu M, Zheng M, Huang W, Yao F, Qiu C, Lin R, Zhou Y, Wu H, Cao G, Kong D, Yang Y, Xu H. Low blood flow ratio is associated with hemorrhagic transformation secondary to mechanical thrombectomy in patients with acute ischemic stroke. J Neuroradiol 2024; 51:101192. [PMID: 38580049 DOI: 10.1016/j.neurad.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND PURPOSE A significant decrease of cerebral blood flow (CBF) is a risk factor for hemorrhagic transformation (HT) in acute ischemic stroke (AIS). This study aimed to ascertain whether the ratio of different CBF thresholds derived from computed tomography perfusion (CTP) is an independent risk factor for HT after mechanical thrombectomy (MT). METHODS A retrospective single center cohort study was conducted on patients with AIS undergoing MT at the First Affiliated Hospital of Wenzhou Medical University from August 2018 to December 2023. The perfusion parameters before thrombectomy were obtained according to CTP automatic processing software. The low blood flow ratio (LFR) was defined as the ratio of brain volume with relative CBF <20 % over volume with relative CBF <30 %. HT was evaluated on the follow-up CT images. Binary logistic regression was used to analyze the correlation between parameters that differ between the two groups with regards to HT occurrence. The predictive efficacy was assessed utilizing the receiver operating characteristic curve. RESULTS In total, 243 patients met the inclusion criteria. During the follow-up, 46.5 % of the patients (113/243) developed HT. Compared with the Non-HT group, the HT group had a higher LFR (0.47 (0.34-0.65) vs. 0.32 (0.07-0.56); P < 0.001). According to the binary logistic regression analysis, the LFR (aOR: 6.737; 95 % CI: 1.994-22.758; P = 0.002), Hypertension history (aOR: 2.231; 95 % CI: 1.201-4.142; P = 0.011), plasma FIB levels before MT (aOR: 0.641; 95 % CI: 0.456-0.902; P = 0.011), and the mismatch ratio (aOR: 0.990; 95 % CI: 0.980-0.999; P = 0.030) were independently associated with HT secondary to MT. The area under the curve of the regression model for predicting HT was 0.741. CONCLUSION LFR, a ratio quantified via CTP, demonstrates potential as an independent risk factor of HT secondary to MT.
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Affiliation(s)
- Lufei Feng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Department of Radiology, Zhuji Central Hospital, Shaoxing, Zhejiang, China
| | - Mengying Yu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mo Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wangle Huang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fei Yao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chaomin Qiu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ru Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ying Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haoyu Wu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guoquan Cao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Haoli Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China; Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.
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Ciacciarelli A, Tessitore A, Fiume G, Currò CT, Coglitore A, Gardin A, Giammello F, Grillo F, Longo M, Mormina E, Vecchio CF, Vicari D, Musolino RF, Toscano A, Vinci SL, La Spina P. Factors associated with hemorrhagic transformation after endovascular treatment despite early recanalization. J Neurol Sci 2023; 453:120778. [PMID: 37669577 DOI: 10.1016/j.jns.2023.120778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/24/2023] [Accepted: 08/27/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE To identify new factors associated with hemorrhagic transformation (HT) despite early recanalization in patients with acute ischemic stroke treated with mechanical thrombectomy. METHODS We retrospectively included patients with known onset of large vessel occlusion treated with mechanical thrombectomy +/- intravenous thrombolysis. Non-contrast CT was performed at 24 +/- 12 h from endovascular procedure. We collected data on patient characteristics, risk factors, radiological and treatment features, stroke severity on admission and discharge, carotid intima-media thickness (CIMT), Neutrophils-to-Lymphocytes ratio (NLR), white matter hyperintensities measured according to the Fazekas score on FLAIR MRI data. The main outcome measures were the incidence of HT and factors associated with it. Secondary outcome measures were symptomatic intracerebral hemorrhage and parenchymal hematoma. RESULTS Of 874 patients, 472 met the inclusion criteria, 211 (44.7%) had HT. Factors significantly associated with increased risk of HT included onset-to-recanalization time, CIMT (normal/mild), ASPECT-MRI < 6, and a higher NLR. We found that beyond 7.67 h from onset-to-recanalization, the risk of HT increases and exceeds 50%. ASPECT-MRI, NLR, and CIMT independently predict HT despite early recanalization. CONCLUSIONS We identified novel factors associated with HT in patients with acute ischemic stroke of known onset treated with mechanical thrombectomy. We found that at 7.67 h from onset to recanalization, the risk of HT is >50%, and we identified factors responsible for HT despite early recanalization.
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Affiliation(s)
- Antonio Ciacciarelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy; U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giulia Fiume
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Alessandra Coglitore
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Anna Gardin
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Grillo
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mirta Longo
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Enrico Mormina
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Concetto Fabio Vecchio
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Davide Vicari
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Antonio Toscano
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Paolino La Spina
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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Mubarak F, Fatima H, Mustafa MS, Shafique MA, Abbas SR, Rangwala HS. Assessment Precision of CT Perfusion Imaging in the Detection of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e44396. [PMID: 37791142 PMCID: PMC10542215 DOI: 10.7759/cureus.44396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Stroke, a prevalent medical emergency, comprises ischemic and hemorrhagic subtypes, with acute ischemic stroke (AIS) being a predominant type. The application of computed tomography perfusion (CTP) imaging has gained prominence due to its rapidity and accessibility in stroke evaluation. This study systematically reviews and conducts a meta-analysis of existing literature to assess the diagnostic accuracy of CTP in detecting AIS and predicting hemorrhagic transformation (HT). Employing Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an extensive search was conducted across electronic databases and relevant radiology journals. Studies conducted between 2007 and 2023 that fulfilled predetermined inclusion criteria underwent quality assessment using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) tool. Cochrane diagnostic accuracy tools were used for data extraction. Thirteen studies involving a total of 1014 patients were included in the analysis. The diagnostic performance of CTP in predicting HT demonstrated high sensitivity (86.7%) and moderate specificity (77.8%), resulting in an overall accuracy of 79.1%. The negative predictive value (NPV) was notably high (92.9%), signifying its efficacy in excluding patients at risk of HT. The positive predictive value (PPV) was comparatively lower (60.3%), highlighting the need for clinical context when making thrombolysis decisions. The false positive rate was 16.2%, while the false negative rate was minimal (9.8%). Subgroup analysis underscored consistent sensitivity and specificity across diverse imaging metrics. The findings of this study emphasize the promising diagnostic accuracy of CTP imaging in predicting HT subsequent to AIS. This non-invasive technique can aid treatment decisions and patient management strategies. By effectively assessing perfusion status and offering predictive insights, CTP imaging improves stroke intervention choices, especially in identifying patients with a lower risk of HT.
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Affiliation(s)
- Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Karachi, PAK
| | - Hareer Fatima
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | | | | | - Syed Raza Abbas
- Department of Medicine, Dow University of Health Sciences, Karachi, PAK
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Elsaid N, Bigliardi G, Dell'Acqua ML, Vandelli L, Ciolli L, Picchetto L, Borzì G, Ricceri R, Pentore R, Vallone S, Meletti S, Saied A. Proposal of multimodal computed tomography-based scoring system in prediction of hemorrhagic transformation in acute ischemic stroke. Acta Neurol Belg 2023:10.1007/s13760-023-02239-5. [PMID: 37029844 DOI: 10.1007/s13760-023-02239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/10/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION The routinely used computed tomography (CT)-based workup in the setting of acute ischemic stroke (AIS) includes non-contrast brain CT, CT angiography (CTA), and CT perfusion. Several CT, CTA, CTP-based radiological biomarkers of hemorrhagic transformation (HT) were reported. AIM OF THE STUDY To assess the predictive value of the combined multimodal CT parameters for HT after AIS and proposal of predictive scoring scale. METHODS The source images of the NCCT, CTA and CTP of 282 AIS patients involving the anterior circulation (HT = 91, non-HT = 191) were retrospectively reviewed and the following biomarkers were recorded and analyzed: Early subtle ischemic signs, hyperdense middle cerebral artery sign (HMCAS) and Alberta Stroke Program Early CT Score (ASPECTS) < 7 in NCCT, large-vessel occlusion (LVO), clot burden score (CBS) < 6, large-vessel occlusion, poor collateral score (CS) and Tmax > 6 s ≥ 56.5 ml. A scoring system to predict HT based on these biomarkers was developed. Each biomarker counts for a single point with the total score ranging from 0 to 7. RESULTS All the aforementioned multimodal CT biomarkers and the selected cut offs were significantly associated with higher HT risk. The calculated scores were statistically significant different between the HT and the non-HT groups with AUC 0.761 (95% CI 0.703-0.819, P < 0.0000001). Rates of HT were approximately five times higher in patients with score ≥ 3. CONCLUSION Multimodal CT-based scoring system may provide highly reliable predictive model of hemorrhagic transformation in acute ischemic stroke.
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Affiliation(s)
- Nada Elsaid
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy.
- Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Guido Bigliardi
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Maria Luisa Dell'Acqua
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Laura Vandelli
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Ludovico Ciolli
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Livio Picchetto
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Giuseppe Borzì
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Riccardo Ricceri
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Roberta Pentore
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Stefano Vallone
- Neuroradiology, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Stefano Meletti
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Ahmed Saied
- Stroke Unit-Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
- Department of Neurology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Elsaid N, Bigliardi G, Dell’Acqua ML, Vandelli L, Ciolli L, Picchetto L, Borzì G, Ricceri R, Pentore R, Vallone S, Meletti S, Saied A. The role of automated computed topography perfusion in prediction of hemorrhagic transformation after acute ischemic stroke. Neuroradiol J 2023; 36:182-188. [PMID: 35850570 PMCID: PMC10034700 DOI: 10.1177/19714009221111084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The role of computed tomography perfusion (CTP) in prediction of hemorrhagic transformation (HT) has been evolving. We aimed to study the role of automated perfusion post-processing software in prediction of HT using the commercially available RAPID software. METHODS Two hundred eighty-two patients with anterior circulation ischemic stroke, who underwent CTP with RAPID automated post-processing, were retrospectively enrolled and divided into HT (n = 91) and non-HT groups (n = 191). The automated RAPID-generated perfusion maps were reviewed. Mismatch volume and ratio, time to maximum (Tmax) > 4-10s volumes, hypoperfusion index, cerebral blood flow (CBF) < 20-38% volumes, cerebral blood volume (CBV) < 34%-42% volumes, and CBV index were recorded and analyzed. RESULTS The volumes of brain tissues suffering from reduction of cerebral blood flow (CBF < 20%-38%), reduction in cerebral blood volumes (CBV < 34-42%), and delayed contrast arrival times (Tmax > 4-10s) were significantly higher in the HT group. The mismatch volumes were also higher in the HT group (p = .001). Among these parameters, the Tmax > 6s volume was the most reliable and sensitive predictor of HT (p = .001, AUC = 0.667). However, the combination of the perfusion parameters can slightly improve the diagnostic efficiency (AUC = 0.703). There was no statistically significant difference between the non-HT group and either the parenchymal or the symptomatic subtypes. CONCLUSION The RAPID automated CTP parameters can provide a reliable predictor of HT overall but not the parenchymal or the symptomatic subtypes. The infarct area involving the penumbra and core represented by the Tmax > 6s threshold is the most sensitive predictor; however, the combination of the perfusion parameters can slightly improve the diagnostic efficiency.
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Affiliation(s)
- Nada Elsaid
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
- Department of Neurology, Mansoura University, Mansoura, Egypt
| | - Guido Bigliardi
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Maria Luisa Dell’Acqua
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Laura Vandelli
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Ludovico Ciolli
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Livio Picchetto
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Giuseppe Borzì
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Riccardo Ricceri
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Roberta Pentore
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Stefano Vallone
- Neuroradiology, Department of
Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Stefano Meletti
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
| | - Ahmed Saied
- Stroke Unit – Neurology Clinic,
Department of Neuroscience, Ospedale Civile di
Baggiovara, AOU di Modena, Modena, Italy
- Department of Neurology, Mansoura University, Mansoura, Egypt
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Predictive Value of CT Perfusion in Hemorrhagic Transformation after Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:brainsci13010156. [PMID: 36672136 PMCID: PMC9856940 DOI: 10.3390/brainsci13010156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Background: Existing studies indicate that some computed tomography perfusion (CTP) parameters may predict hemorrhagic transformation (HT) after acute ischemic stroke (AIS), but there is an inconsistency in the conclusions alongside a lack of comprehensive comparison. Objective: To comprehensively evaluate the predictive value of CTP parameters in HT after AIS. Data sources: A systematical literature review of existing studies was conducted up to 1st October 2022 in six mainstream databases that included original data on the CTP parameters of HT and non-HT groups or on the diagnostic performance of relative cerebral blood flow (rCBF), relative permeability-surface area product (rPS), or relative cerebral blood volume (rCBV) in patients with AIS that completed CTP within 24 h of onset. Data Synthesis: Eighteen observational studies were included. HT and non-HT groups had statistically significant differences in CBF, CBV, PS, rCBF, rCBV, and rPS (p < 0.05 for all). The hierarchical summary receiver operating characteristic (HSROC) revealed that rCBF (area under the curve (AUC) = 0.9), rPS (AUC = 0.89), and rCBV (AUC = 0.85) had moderate diagnostic performances in predicting HT. The pooled sensitivity and specificity of rCBF were 0.85 (95% CI, 0.75−0.91) and 0.83 (95% CI, 0.63−0.94), respectively. Conclusions: rCBF, rPS, and rCBV had moderate diagnostic performances in predicting HT, and rCBF had the best pooled sensitivity and specificity.
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Han S, Huang R, Yao F, Lu Z, Zhu J, Wang H, Li Y. Pre-treatment spectral CT combined with CT perfusion can predict hemorrhagic transformation after thrombolysis in patients with acute ischemic stroke. Eur J Radiol 2022; 156:110543. [PMID: 36179464 DOI: 10.1016/j.ejrad.2022.110543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the value of pre-treatment spectral CT angiography (CTA) in predicting hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) treatment in acute ischemic stroke (AIS) patients. MATERIALS AND METHODS AIS patients who underwent IVT with recombinant tissue plasminogen activator and pre-treatment head and neck spectral CTA and head CT perfusion (CTP) from January 2018 to June 2020 were reviewed retrospectively. Finally, 20 patients were included in the HT group and 22 age-matched patients were included in the non-HT group. Spectral and CTP parameters of the region of interest on pre-treatment CTA axial raw images and CTP images, including the infarct core (IC) and ischemic penumbral (IP) regions, were recorded. The differences in clinical variables, CTP, collateral scores and spectral parameters between the two groups were analyzed. Three multivariate logistic regression models were then developed, where model 1 included clinical and spectral parameters, model 2 included clinical and CTP parameters and a combined model included clinical, CTP, and spectral parameters. Receiver operating characteristic analysis was used to evaluate the performance of the multivariate model. RESULTS Patients with HT had higher Safe Implementation of Treatments in Stroke (SITS) score (p = 0.023), the volume of perfusion lesions (p = 0.005), the volume of IP (p = 0.003), the mean transit time (MIT) in the IC area (p = 0.012), as well as the TTP in IP area (p = 0.015) compared with patients without HT. The HT group showed significantly lower CBF in the IC area (p = 0.019), iodine concentration (p = 0.017) and the effective atomic number (p = 0.024) in the IP area than non-HT group. And the slope of the spectral curve of the HT group in the IP region was larger than that of the non-HT group (p = 0.023). Gender, age, SITS score, the volume of entire perfusion lesion, CBF and MIT in the IC area, TTP in the IP area, as well as iodine concentration in the IP area were included in the final multivariate model for predicting HT. And CBF in the IC area (OR = 0.779, 95 % CI:0.609-0.996, p = 0.046) as well as the iodine concentration of IP area (OR = 0.343, 95 % CI: 0.131-0.901, p = 0.030) were proved to be independent predictors for HT. The combined model including clinical, spectral, and CTP parameters, showed improved accuracy compared to the other two models, while the Delong test did not suggest a statistically significant difference (both p values > 0.05). CONCLUSIONS The iodine concentration of IP area derived from pre-treatment spectral CTA was an independent predictor of HT after IVT treatment for AIS patients. Moreover, multivariate models combined with clinical, spectral, and CTP parameters may be able to predict HT.
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Affiliation(s)
- Shuting Han
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China
| | - Renjun Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China
| | - Feirong Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China
| | - Ziwei Lu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China
| | - Jingfen Zhu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China
| | - Hui Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China.
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China; Institute of Medical Imaging, Soochow University, Suzhou City, Jiangsu Province 215000, PR China; National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou City, Jiangsu Province 215000, PR China.
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Timing of anticoagulation after acute ischemic stroke in patients with atrial fibrillation. Neurol Sci 2022:1-12. [PMID: 35762354 DOI: 10.1017/cjn.2022.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Cao YZ, Zhao LB, Jia ZY, Liu QH, Xu XQ, Shi HB, Liu S. Cerebral blood volume Alberta Stroke Program Early Computed Tomography Score predicts intracranial hemorrhage after thrombectomy in patients with acute ischemic stroke in an extended time window. Acta Radiol 2022; 63:393-400. [PMID: 33541090 DOI: 10.1177/0284185121990843] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Higher baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) was associated with a lower probability of hemorrhagic transformation in patients with acute ischemic stroke (AIS). PURPOSE To investigate the predictive value of cerebral blood volume (CBV)-ASPECTS of intracranial hemorrhage (ICH) in AIS treated with thrombectomy selected by computed tomographic perfusion (CTP) in an extended time window. MATERIAL AND METHODS A total of 91 consecutive patients with AIS with large vessel occlusion in the anterior circulation after thrombectomy in an extended time window were enrolled between January 2018 and September 2019. ICH was diagnosed according to Heidelberg Bleeding Classification. CBV-ASPECTS was assessed by evaluating each ASPECTS region for relatively low CBV value compared with the mirror region in the contralateral hemisphere. Demographic characteristics, clinical data, CBV-ASPECTS, and procedure process and results were compared between patients with ICH and those without. RESULTS ICH occurred in 31/91 (34.1%) patients with AIS. Symptomatic ICH (sICH) was observed in 4 (4.4%) patients, while asymptomatic ICH (aICH) was seen in 27 (29.7%). In univariate analysis, both ICH and aICH were associated with high admission NIHSS score (P<0.001 and P<0.001, respectively), more passes of retriever (P = 0.007 and P = 0.019, respectively), low NCCT-ASPECTS (P = 0.013 and P = 0.034, respectively), and low CBV-ASPECTS (P < 0.001 and P < 0.001, respectively). After multivariable analysis, low CBV-ASPECTS remained an independent predictor of ICH (odds ratio [OR] 0.521, 95% confidence interval [CI] 0.371-0.732, P < 0.001) and aICH (OR 0.532, 95% CI 0.376-0.752, P < 0.001), respectively. CONCLUSION Low CBV-ASPECTS independently predicts ICH in patients with AIS treated with thrombectomy selected by CTP in an extended time window.
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Affiliation(s)
- Yue-Zhou Cao
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Lin-Bo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Zhen-Yu Jia
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Qiang-Hui Liu
- Department of Emergency, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Xiao-Quan Xu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, PR China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, PR China
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Novel Imaging Biomarker Prediction of Parenchymal Hemorrhage after Mechanical Thrombectomy in Patients with Large Ischemic Core. J Stroke Cerebrovasc Dis 2021; 31:106125. [PMID: 34706293 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recently studies have shown that select acute ischemic stroke (AIS) patients with large ischemic core could be deemed as reasonable candidates to receive mechanical thrombectomy (MT) with low risk of developing parenchymal hemorrhage (PH) or symptomatic intracerebral hemorrhage (sICH); however, the selection criterion remains lacking. Our study aims to investigate the relationship between a novel imaging biomarker of largest core mass volume (LCMV) and development of PH in stroke patients with large ischemic core who have undergone MT. METHODS A total of 26 AIS patients with large ischemic core (defined as ischemic core volume ≧ 50 ml) were enrolled in the study. Volume of ischemic core and the LCMV measured with Mistar software were measured in all patients. Fourteen patients with AIS developed PH while 12 patients showed no signs of PH based on CT imaging obtained between 24 h and 3 day after MT. We compared the volume of ischemic core and LCMV between two groups. RESULTS Volume of ischemic core showed no significant difference between the PH and no PH group [105.5 (62.4-131.5) vs 75.0 (56.3-102.2), p = 0.105], whereas LCMV was significantly higher in the PH (14.80 ± 5.23) vs. no PH group (8.40 ± 2.61, p = 0.001). ROC analysis revealed that LCMV was positively correlated with PH (area under the curve = 0.905). The optimal LCMV associated with PH was ≧ 9.67 ml. CONCLUSION LCMV is an effective and easy-to-use imaging biomarker to predict PH after MT in AIS patients with large ischemic core.
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Liu C, Xie J, Sun S, Li H, Li T, Jiang C, Chen X, Wang J, Le A, Wang J, Li Z, Wang J, Wang W. Hemorrhagic Transformation After Tissue Plasminogen Activator Treatment in Acute Ischemic Stroke. Cell Mol Neurobiol 2020; 42:621-646. [PMID: 33125600 DOI: 10.1007/s10571-020-00985-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022]
Abstract
Hemorrhagic transformation (HT) is a common complication after thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in ischemic stroke. In this article, recent research progress of HT in vivo and in vitro studies was reviewed. We have discussed new potential mechanisms and possible experimental models of HT development, as well as possible biomarkers and treatment methods. Meanwhile, we compared and analyzed rodent models, large animal models and in vitro BBB models of HT, and the limitations of these models were discussed. The molecular mechanism of HT was investigated in terms of BBB disruption, rt-PA neurotoxicity and the effect of neuroinflammation, matrix metalloproteinases, reactive oxygen species. The clinical features to predict HT were represented including blood biomarkers and clinical factors. Recent progress in neuroprotective strategies to improve HT after stroke treated with rt-PA is outlined. Further efforts need to be made to reduce the risk of HT after rt-PA therapy and improve the clinical prognosis of patients with ischemic stroke.
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Affiliation(s)
- Chengli Liu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jie Xie
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Shanshan Sun
- Department of Ultrasound Imaging, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Hui Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Tianyu Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xuemei Chen
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China
| | - Junmin Wang
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China
| | - Anh Le
- Washington University in St. Louis, Saint Louis, MO, 63130, USA
| | - Jiarui Wang
- The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Zhanfei Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jian Wang
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China.
| | - Wei Wang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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Elsaid N, Mustafa W, Saied A. Radiological predictors of hemorrhagic transformation after acute ischemic stroke: An evidence-based analysis. Neuroradiol J 2020; 33:118-133. [PMID: 31971093 PMCID: PMC7140299 DOI: 10.1177/1971400919900275] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hemorrhagic transformation (HT) is one of the most common adverse events related to acute ischemic stroke (AIS) that affects the treatment plan and clinical outcome. Identification of a sensitive radiological marker may influence the controversial thrombolytic decision in the setting of AIS and may at a minimum indicate more intensive monitoring or further prophylactic interventions. In this article we summarize possible radiological biomarkers and the role of different radiological modalities including computed tomography (CT), magnetic resonance imaging, angiography, and ultrasound in predicting HT. Different radiological indices of early ischemic changes, large ischemic lesion volume, severe blood flow restriction, blood-brain barrier disruption, poor collaterals and high blood flow velocities have been reported to be associated with higher risk of HT. The current levels of evidence of the available studies highlight the role of the different CT perfusion parameters in predicting HT. Further large standardized studies are recommended to compare the sensitivity and specificity of the different radiological markers combined and delineate the most reliable predictor.
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Affiliation(s)
- Nada Elsaid
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Wessam Mustafa
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
| | - Ahmed Saied
- Department of Neurology, University of Mansoura
Faculty of Medicine, Egypt
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Adebayo OD, Culpan G. Diagnostic accuracy of computed tomography perfusion in the prediction of haemorrhagic transformation and patient outcome in acute ischaemic stroke: A systematic review and meta-analysis. Eur Stroke J 2019; 5:4-16. [PMID: 32232165 DOI: 10.1177/2396987319883461] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 09/23/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy of computed tomography brain perfusion in the prediction of haemorrhagic transformation and patient outcome in acute ischaemic stroke. Method Electronic databases and grey literature published over the last 10 years related to healthcare and radiology were searched using the key terms: 'computed tomography perfusion', 'haemorrhagic transformation', 'acute ischaemic stroke', 'functional outcome' and their synonyms using both UK and American spellings. Inclusion criteria were: sample size at least 30 patients, original research, evaluate ability of computed tomography perfusion to predict haemorrhagic transformation, reports diagnostic accuracy or provide relevant data for a 2 × 2 contingency table, use follow-up non-contrast computed tomography (NCCT) or magnetic resonance imaging as reference standard. Findings Twelve studies were included in the review; studies cover a total of 808 patients. Haemorrhagic transformation occurred in 30.2% of patients. Pooled sensitivity and specificity were 85.9% (95% CI; 65-97%), 73.9% (95% CI; 45-92%) and accuracy of 79.1% (95% CI; 57-98%). Pooled NPV was 92.9% with a high false positive rate (19.8%), which could be explained in terms of outcome classification, acquisition artefact and computed tomography perfusion processing algorithms. Discussion This review evaluated the importance of using pre-defined threshold measurement for optimal prediction of HT, the relevance of patient pre-treatment clinical parameters to HT occurrence, the CTP parameters and the measurements that are independent predictors of HT, the significance of rtPA rather as an exacerbator of HT and the impact of both minor and major HT/PH on patient 20 functional outcome. Conclusion Computed tomography perfusion has a high sensitivity and moderately high specificity for prediction of haemorrhagic transformation in acute ischaemic stroke. Pre-treatment clinical decision making requires consideration of clinical factors in addition to imaging findings. This systematic review and meta-analysis highlights that pre-treatment computed tomography perfusion adds to clinical confidence by predicting potential for haemorrhage, both in thrombolysed and un-thrombolysed patients, and also influences decisions about alternative treatments for acute ischaemic stroke patients.
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Affiliation(s)
- Olushola D Adebayo
- Mercy University Hospital Cork, Cork, Republic of Ireland
- Faculty of Health Sciences, University of Bradford, Bradford, UK
| | - Gary Culpan
- Faculty of Health Sciences, University of Bradford, Bradford, UK
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15
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El Nawar R, Yeung J, Labreuche J, Chadenat ML, Duong DL, De Malherbe M, Cordoliani YS, Lapergue B, Pico F. MRI-Based Predictors of Hemorrhagic Transformation in Patients With Stroke Treated by Intravenous Thrombolysis. Front Neurol 2019; 10:897. [PMID: 31507511 PMCID: PMC6719609 DOI: 10.3389/fneur.2019.00897] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/02/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Clinical and biological risk factors for hemorrhagic transformation (HT) after intravenous thrombolysis (IT) have been well-established in several registries. The added value of magnetic resonance imaging (MRI) variables has been studied in small samples, and is controversial. We aimed to assess the added value of MRI variables in HT, beyond that of clinical and biological factors. Methods: We enrolled 474 consecutive patients with brain infarction treated by IT alone at our primary stroke center between January 2011 and August 2017. Baseline demographic, clinical, biological, and imaging characteristics were collected. MRI variables were: brain infarction volume in cm3; parenchymal fluid attenuated inversion recovery (FLAIR) hyperintensity; FLAIR hyperintense vessel signs; number of microbleeds; subcortical white matter hyperintensity; and thrombus length. Results: Overall, 301 patients were included out of 474 (64%). The main causes of exclusion were combined thrombectomy (n = 98) and no MRI before IT (n = 44). In the bivariate analysis, HT was significantly associated with the presence of more FLAIR hyperintense vessel signs, thrombus length (>8 mm), and larger brain infarction volume (diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) < 500 × 10-6 mm2/s). In the multivariable analysis, only brain infarction volume was significantly associated with HT. The discrimination value of the multivariable model, including both the DWI volume and the clinical model (area under the receiver operating characteristic curve, 0.80; 95% confidence interval 0.74-0.86), was improved significantly compared with the model based only on clinical variables (P = 0.012). Conclusions: Brain infarction volume on DWI was the only MRI variable that added value to clinico biological variables for predicting HT after IT.
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Affiliation(s)
- Rody El Nawar
- Department of Neurology and Stroke Center, Hopital Mignot, Centre Hospitalier de Versailles, Versailles, France
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Jennifer Yeung
- Department of Neurology and Stroke Center, Hopital Mignot, Centre Hospitalier de Versailles, Versailles, France
| | - Julien Labreuche
- Université de Lille, CHU Lille, EA 2694, Santé Publique: Épidémiologie et Qualité des Soins, Lille, France
| | - Marie-Laure Chadenat
- Department of Neurology and Stroke Center, Hopital Mignot, Centre Hospitalier de Versailles, Versailles, France
| | - Duc Long Duong
- Department of Neurology and Stroke Center, Hopital Mignot, Centre Hospitalier de Versailles, Versailles, France
| | - Maxime De Malherbe
- Department of Radiology, Centre Hospitalier de Versailles, Versailles, France
| | | | - Bertrand Lapergue
- Department of Neurology and Stroke Center, Hopital Foch, Suresnes, France
- Université Versailles Saint-Quentin en Yvelines et Paris Saclay, Versailles, France
| | - Fernando Pico
- Department of Neurology and Stroke Center, Hopital Mignot, Centre Hospitalier de Versailles, Versailles, France
- Université Versailles Saint-Quentin en Yvelines et Paris Saclay, Versailles, France
- INSERM U1148 LVTS (Laboratory for Vascular Translational Science), Team 5 (Research into “Atherothrombotic Disease in Heart and Brain”), Hôpital Bichat, Paris, France
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Yogendrakumar V, Al-Ajlan F, Najm M, Puig J, Calleja A, Sohn SI, Ahn SH, Mikulik R, Asdaghi N, Field TS, Jin A, Asil T, Boulanger JM, Hill MD, Demchuk AM, Menon BK, Dowlatshahi D. Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy. AJNR Am J Neuroradiol 2019; 40:655-660. [PMID: 30872416 DOI: 10.3174/ajnr.a6009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial hemorrhage is a known complication following endovascular thrombectomy. The radiologic characteristics of a CT scan may assist with hemorrhage risk stratification. We assessed the radiologic predictors of intracranial hemorrhage following endovascular therapy using data from the INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography) study. MATERIALS AND METHODS Patients undergoing endovascular therapy underwent baseline imaging, postprocedural angiography, and 24-hour follow-up imaging. The primary outcome was any intracranial hemorrhage observed on follow-up imaging. The secondary outcome was symptomatic hemorrhage. We assessed the relationship between hemorrhage occurrence and baseline patient characteristics, clinical course, and imaging factors: baseline ASPECTS, thrombus location, residual flow grade, collateralization, and clot burden score. Multivariable logistic regression with backward selection was used to adjust for relevant covariates. RESULTS Of the 199 enrolled patients who met the inclusion criteria, 46 (23%) had an intracranial hemorrhage at 24 hours. On multivariable analysis, postprocedural hemorrhage was associated with pretreatment ASPECTS (OR, 1.56 per point lost; 95% CI, 1.12-2.15), clot burden score (OR, 1.19 per point lost; 95% CI, 1.03-1.38), and ICA thrombus location (OR, 3.10; 95% CI, 1.07-8.91). In post hoc analysis, clot burden scores of ≤3 (sensitivity, 41%; specificity, 82%; OR, 3.12; 95% CI, 1.36-7.15) and pretreatment ASPECTS ≤ 7 (sensitivity, 48%; specificity, 82%; OR, 3.17; 95% CI, 1.35-7.45) robustly predicted hemorrhage. Residual flow grade and collateralization were not associated with hemorrhage occurrence. Symptomatic hemorrhage was observed in 4 patients. CONCLUSIONS Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
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Affiliation(s)
- V Yogendrakumar
- From the Department of Medicine (Neurology) (V.Y., D.D.), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - F Al-Ajlan
- Department of Neurosciences (F.A.-A.), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Najm
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - J Puig
- Institut de Diagnostic per la Imatge (J.P.), Girona Biomedical Research Institute, University Hospital Dr Josep Trueta, Girona, Spain
| | - A Calleja
- Department of Neurology (A.C.), Stroke Unit, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - S-I Sohn
- Department of Neurology (S-.I.S.), Keimyung University, Daegu, Republic of Korea
| | - S H Ahn
- Department of Neurology (S.H.A.), Chosun University School of Medicine and Hospital, Gwangju, Republic of Korea
| | - R Mikulik
- International Clinical Research Center (R.M.), St. Anne's University Hospital, Brno, Czech Republic
| | - N Asdaghi
- Department of Neurology (N.A.), Miller School of Medicine, University of Miami, Miami, Florida
| | - T S Field
- Division of Neurology (T.S.F.), Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
| | - A Jin
- Division of Neurology (A.J.), Queen's University, Kingston, Canada
| | - T Asil
- Bezmialem Vakif Üniversitesi Nöroloji (T.A., J.-M.B.), Istanbul, Turkey
| | - J-M Boulanger
- Bezmialem Vakif Üniversitesi Nöroloji (T.A., J.-M.B.), Istanbul, Turkey
- Department of Medicine (J.-M.B.), Charles LeMoyne Hospital, Greenfield Park, Canada
| | - M D Hill
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - A M Demchuk
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - B K Menon
- Calgary Stroke Program (M.N., M.D.H., A.M.D., B.K.M.), Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - D Dowlatshahi
- From the Department of Medicine (Neurology) (V.Y., D.D.), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
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Langel C, Popovic KS. Infarct-core CT perfusion parameters in predicting post-thrombolysis hemorrhagic transformation of acute ischemic stroke. Radiol Oncol 2019; 53:25-30. [PMID: 30864425 PMCID: PMC6411018 DOI: 10.2478/raon-2018-0048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 11/11/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intravenous thrombolysis (IVT) is the method of choice in reperfusion treatment of patients with signs and symptoms of acute ischemic stroke (AIS) lasting less than 4.5 hours. Hemorrhagic transformation (HT) of acute ischemic stroke is a serious complication of IVT and occurs in 4.5-68.0% of clinical cases. The aim of our study was to determine the infarct core CT perfusion parameter (CTPP) most predictive of HT. PATIENTS AND METHODS Seventy-five patients with AIS who had undergone CT perfusion (CTP) imaging and were treated with IVT were enrolled in this retrospective study. Patients with and without HT after IVT were defined as cases and controls, respectively. Controls were found by matching for time from AIS symptom onset to IVT ± 0.5 h. The following CTPPs were measured: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), relative CBF (rCBF) and relative CBV (rCBV). Receiver operating characteristic analysis curves of significant CTPPs determined cut-off values that best predict HT. RESULTS There was a significant difference between cases and controls for CBF (p = 0.004), CBV (p = 0.009), rCBF (p < 0.001) and rCBV (p = 0.001). Receiver operating characteristic analysis revealed that rCBF < 4.5% of the contralateral mean (area under the curve = 0.736) allowed prediction of HT with a sensitivity of 71.0% and specificity of 52.5%. CONCLUSIONS CTP imaging has a considerable role in HT prediction, assisting in selection of patients that are likely to benefit from IVT. rCBF proved to have the highest HT predictive value.
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Affiliation(s)
- Crt Langel
- Novo Mesto General Hospital, Novo MestoSlovenia
| | - Katarina Surlan Popovic
- Institute of Radiology, University Medical Centre Ljubljana, LjubljanaSlovenia
- Assoc. Prof. Šurlan Popović Katarina, M.D., Ph.D., Institute of Radiology, University Medical Centre Ljubljana, Zaloška cesta 7, SI-1000 Ljubljana, Slovenia. Phone: +386 1 522 85 30
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Suh CH, Jung SC, Cho SJ, Kim D, Lee JB, Woo DC, Oh WY, Lee JG, Kim KW. Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Eur Radiol 2019; 29:4077-4087. [PMID: 30617485 DOI: 10.1007/s00330-018-5936-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/13/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke. METHODS A computerized literature search of Ovid MEDLINE and EMBASE was conducted up to October 29, 2018. Search terms included acute ischemic stroke, hemorrhagic transformation, and perfusion CT. Studies assessing the diagnostic performance of perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke were included. Two reviewers independently evaluated the eligibility of the studies. A bivariate random effects model was used to calculate the pooled sensitivity and pooled specificity. Multiple subgroup analyses were performed. RESULTS Fifteen original articles with a total of 1134 patients were included. High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT are associated with hemorrhagic transformation. The pooled sensitivity and specificity were 84% (95% CI, 71-91%) and 74% (95% CI, 67-81%), respectively. The area under the hierarchical summary receiver operating characteristic curve was 0.84 (95% CI, 0.81-0.87). The Higgins I2 statistic demonstrated that heterogeneity was present in the sensitivity (I2 = 80.21%) and specificity (I2 = 85.94%). CONCLUSION Although various perfusion CT parameters have been used across studies, the current evidence supports the use of perfusion CT to predict hemorrhagic transformation in acute ischemic stroke. KEY POINTS • High blood-brain barrier permeability and hypoperfusion status derived from perfusion CT were associated with hemorrhagic transformation. • Perfusion CT has moderate diagnostic performance for the prediction of hemorrhagic transformation in acute ischemic stroke. • The pooled sensitivity was 84%, and the pooled specificity was 74%.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.
| | - Se Jin Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Donghyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Jung Bin Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Dong-Cheol Woo
- Bioimaging Center, Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Woo Yong Oh
- Clinical Research Division, National Institute of Food and Drug Safety Evaluation, MFDS, Cheongju, Republic of Korea
| | - Jong Gu Lee
- Clinical Research Division, National Institute of Food and Drug Safety Evaluation, MFDS, Cheongju, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea.,Asan Image Metrics, Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
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19
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Piccardi B, Arba F, Nesi M, Palumbo V, Nencini P, Giusti B, Sereni A, Gadda D, Moretti M, Fainardi E, Mangiafico S, Pracucci G, Nannoni S, Galmozzi F, Fanelli A, Pezzati P, Vanni S, Grifoni S, Sarti C, Lamassa M, Poggesi A, Pescini F, Pantoni L, Gori AM, Inzitari D. Reperfusion Injury after ischemic Stroke Study (RISKS): single-centre (Florence, Italy), prospective observational protocol study. BMJ Open 2018; 8:e021183. [PMID: 29794101 PMCID: PMC5988101 DOI: 10.1136/bmjopen-2017-021183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Treatments aiming at reperfusion of the acutely ischaemic brain tissue may result futile or even detrimental because of the so-called reperfusion injury. The processes contributing to reperfusion injury involve a number of factors, ranging from blood-brain barrier (BBB) disruption to circulating biomarkers. Our aim is to evaluate the relative effect of imaging and circulating biomarkers in relation to reperfusion injury. METHODS AND ANALYSIS Observational hospital-based study that will include 140 patients who had ischaemic stroke, treated with systemic thrombolysis, endovascular treatment or both. BBB disruption will be assessed with CT perfusion (CTP) before treatment, and levels of a large panel of biomarkers will be measured before intervention and after 24 hours. Relevant outcomes will include: (1) reperfusion injury, defined as radiologically relevant haemorrhagic transformation at 24 hours and (2) clinical status 3 months after the index stroke. We will investigate the separate and combined effect of pretreatment BBB disruption and circulating biomarkers on reperfusion injury and clinical status at 3 months. Study protocol is registered at http://www.clinicaltrials.gov (ClinicalTrials.gov ID: NCT03041753). ETHICS AND DISSEMINATION The study protocol has been approved by ethics committee of the Azienda Ospedaliero Universitaria Careggi (Università degli Studi di Firenze). Informed consent is obtained by each patient at time of enrolment or deferred when the participant lacks the capacity to provide consent during the acute phase. Researchers interested in testing hypotheses with the data are encouraged to contact the corresponding author. Results from the study will be disseminated at national and international conferences and in medical thesis. TRIAL REGISTRATION NUMBER NCT03041753.
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Affiliation(s)
- Benedetta Piccardi
- Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Francesco Arba
- Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mascia Nesi
- Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Vanessa Palumbo
- Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Patrizia Nencini
- Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Betti Giusti
- Atherothrombotic Diseases Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alice Sereni
- Atherothrombotic Diseases Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Davide Gadda
- Department of Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Marco Moretti
- Department of Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Enrico Fainardi
- Department of Neuroradiology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Salvatore Mangiafico
- Azienda Ospedaliero Universitaria Careggi, Interventional Neuroradiology Unit, Florence, Italy
| | - Giovanni Pracucci
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Stefania Nannoni
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Francesco Galmozzi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Alessandra Fanelli
- Central Laboratory, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Paola Pezzati
- Central Laboratory, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Cristina Sarti
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Maria Lamassa
- Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Anna Poggesi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Francesca Pescini
- Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leonardo Pantoni
- "L. Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Florence, Italy
| | - Anna Maria Gori
- Atherothrombotic Diseases Center, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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20
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Horsch AD, Bennink E, van Seeters T, Kappelle LJ, van der Graaf Y, Mali WPTM, de Jong HWAM, Velthuis BK, Dankbaar JW. Computed Tomography Perfusion Derived Blood-Brain Barrier Permeability Does Not Yet Improve Prediction of Hemorrhagic Transformation. Cerebrovasc Dis 2018; 45:26-32. [PMID: 29402765 DOI: 10.1159/000485043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 11/03/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hemorrhagic transformation (HT) in acute ischemic stroke can occur as a result of reperfusion treatment. While withholding treatment may be warranted in patients with increased risk of HT, prediction of HT remains difficult. Nonlinear regression analysis can be used to estimate blood-brain barrier permeability (BBBP). The aim of this study was to identify a combination of clinical and imaging variables, including BBBP estimations, that can predict HT. MATERIALS AND METHODS From the Dutch acute stroke study, 545 patients treated with intravenous recombinant tissue plasminogen activator and/or intra-arterial treatment were selected, with available admission extended computed tomography (CT) perfusion and follow-up imaging. Patient admission treatment characteristics and CT imaging parameters regarding occlusion site, stroke severity, and BBBP were recorded. HT was assessed on day 3 follow-up imaging. The association between potential predictors and HT was analyzed using univariate and multivariate logistic regression. To compare the added value of BBBP, areas under the curve (AUCs) were created from 2 models, with and without BBBP. RESULTS HT occurred in 57 patients (10%). In univariate analysis, older age (OR 1.03, 95% CI 1.006-1.05), higher admission National Institutes of Health Stroke Scale (NIHSS; OR 1.13, 95% CI 1.08-1.18), higher clot burden (OR 1.28, 95% CI 1.16-1.41), poor collateral score (OR 3.49, 95% CI 1.85-6.58), larger Alberta Stroke Program Early CT Score cerebral blood volume deficit size (OR 1.26, 95% CI 1.14-1.38), and increased BBBP (OR 2.22, 95% CI 1.46-3.37) were associated with HT. In multivariate analysis with age and admission NIHSS, the addition of BBBP did not improve the AUC compared to both independent predictors alone (AUC 0.77, 95% CI 0.71-0.83). CONCLUSION BBBP predicts HT but does not improve prediction with age and admission NIHSS.
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Affiliation(s)
- Alexander D Horsch
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Edwin Bennink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom van Seeters
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugo W A M de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Ibatullin MM, Kalinin MN, Curado AT, Khasanova DR. [Neurovisualisation predictors of malignant cerebral infarction and hemorrhagic transformation]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:3-11. [PMID: 26120991 DOI: 10.17116/jnevro2015115323-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuroimaging plays a central role in the assessment of patients with acute ischemic stroke. Within a few minutes, modern multimodal imaging protocols can provide one with comprehensive information about prognosis, management, and outcome of the disease, and may detect changes in the intracranial structures reflecting severity of the ischemic injury depicted by four Ps: parenchyma (of the brain), pipes (i.e., the cerebral blood vessels), penumbra, and permeability (of the blood brain barrier). In this article, we have reviewed neuroradiological predictors of malignant middle cerebral artery infarction and hemorrhagic transformation in light of the aforementioned four Ps.
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Affiliation(s)
| | | | - A T Curado
- Interregional Clinical Diagnostic Center, Kazan
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22
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Higashida R, Alberts MJ, Alexander DN, Crocco TJ, Demaerschalk BM, Derdeyn CP, Goldstein LB, Jauch EC, Mayer SA, Meltzer NM, Peterson ED, Rosenwasser RH, Saver JL, Schwamm L, Summers D, Wechsler L, Wood JP. Interactions Within Stroke Systems of Care. Stroke 2013; 44:2961-84. [DOI: 10.1161/str.0b013e3182a6d2b2] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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23
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Jain AR, Jain M, Kanthala AR, Damania D, Stead LG, Wang HZ, Jahromi BS. Association of CT perfusion parameters with hemorrhagic transformation in acute ischemic stroke. AJNR Am J Neuroradiol 2013; 34:1895-900. [PMID: 23598828 DOI: 10.3174/ajnr.a3502] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Prediction of hemorrhagic transformation in acute ischemic stroke could help determine treatment and prognostication. With increasing numbers of patients with acute ischemic stroke undergoing multimodal CT imaging, we examined whether CT perfusion could predict hemorrhagic transformation in acute ischemic stroke. MATERIALS AND METHODS Patients with acute ischemic stroke who underwent CTP scanning within 12 hours of symptom onset were examined. Patients with and without hemorrhagic transformation were defined as cases and controls, respectively, and were matched as to IV rtPA administration and presentation NIHSS score (± 2). Relative mean transit time, relative CBF, and relative CBV values were calculated from CTP maps and normalized to the contralateral side. Receiver operating characteristic analysis curves were created, and threshold values for significant CTP parameters were obtained to predict hemorrhagic transformation. RESULTS Of 83 patients with acute ischemic stroke, 16 developed hemorrhagic transformation (19.28%). By matching, 38 controls were found for only 14 patients with hemorrhagic transformation. Among the matched patients with hemorrhagic transformation, 13 developed hemorrhagic infarction (6 hemorrhagic infarction 1 and 7 hemorrhagic infarction 2) and 1 developed parenchymal hematoma 2. There was no significant difference between cases and controls with respect to age, sex, time to presentation from symptom onset, and comorbidities. Cases had significantly lower median rCBV (8% lower) compared with controls (11% higher) (P = .009; odds ratio, 1.14 for a 0.1-U decrease in rCBV). There was no difference in median total volume of ischemia, rMTT, and rCBF among cases and controls. The area under the receiver operating characteristic was computed to be 0.83 (standard error, 0.08), with a cutoff point for rCBV of 1.09. CONCLUSIONS Of the examined CTP parameters, only lower rCBV was found to be significantly associated with a relatively higher chance of hemorrhagic transformation.
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Lee JH, Kim YJ, Choi JW, Roh HG, Chun YI, Cho HJ, Kim HY. Multimodal CT: Favorable Outcome Factors in Acute Middle Cerebral Artery Stroke with Large Artery Occlusion. Eur Neurol 2013; 69:366-74. [DOI: 10.1159/000350290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
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25
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Guo G, Yang Y, Yang W. Validation of hyperintense middle cerebral artery sign in acute ischemic stroke: Comparison between magnetic resonance imaging and angiography. Neural Regen Res 2012; 7:229-34. [PMID: 25767505 PMCID: PMC4353121 DOI: 10.3969/j.issn.1673-5374.2012.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Accepted: 11/12/2011] [Indexed: 11/18/2022] Open
Abstract
We performed a retrospective analysis of non-contrast computed tomography (CT) scans, immediately subsequent magnetic resonance imaging (MRI), and cerebral angiography data from 30 consecutive patients with acute ischemic stroke within 6 hours after symptom onset. Results showed that eleven patients developed subsequent hemorrhagic transformation at follow-up. A hyperintense middle cerebral artery sign on MRI was found in six hemorrhagic patients, all of who had acute thrombosis formation on magnetic resonance angiography and digital subtraction angiography. No patients in the non-hemorrhagic group had hyperintense middle cerebral artery sign on MRI. The sensitivity, specificity, and positive predictive values of the hyperintense middle cerebral artery sign on MRI T1-weighted image for subsequent hemorrhagic transformation were 54.5%, 100%, and 100% respectively. Hyperdense middle cerebral artery sign on non-contrast CT was observed in nine patients, five of who developed hemorrhagic transformation. These data suggest that hyperintense middle cerebral artery sign on MRI T1-weighted image is a highly specific and moderately sensitive indicator of subsequent hemorrhagic transformation in patients after acute ischemic stroke, and its specificity is superior to CT.
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Affiliation(s)
- Gang Guo
- Department of Radiology, Xiamen Second Hospital, Teaching Hospital of Fujian Medical University, Xiamen 361021, Fujian Province, China
| | - Yonggui Yang
- Department of Radiology, Xiamen Second Hospital, Teaching Hospital of Fujian Medical University, Xiamen 361021, Fujian Province, China
| | - Weiqun Yang
- Department of Radiology, Xiamen Second Hospital, Teaching Hospital of Fujian Medical University, Xiamen 361021, Fujian Province, China
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