Abstract:
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Purpose: Hemorrhagic transformation (HT) is a major complication of reperfusion therapy for acute ischemic stroke. Our purpose was to assess the clinical utility of CT perfusion in differentiating infarctions that will undergo hemorrhagic transformation from those that will not in patients treated with intra-arterial thrombolysis, and/or clot retrieval.
Methods and Materials: Quantitative CT perfusion images were obtained in 8 patients with proximal MCA emboli who presented within 6 hours of stroke onset and who were treated with intra-arterial thrombolysis and/or clot retrieval. Follow-up CT or T2 weighted MR images were obtained at 1 to 8 days. 5 of 8 MCA infarctions had hemorrhagic transformation. Regions of interest (ROI's) were drawn around the whole region of low cerebral blood flow (CBF) on each slice in each patient and were copied onto the cerebral blood volume (CBV) maps. The CBF and CBV for each pixel within the ROI's were calculated. Subsequently, the percentage of pixels with a CBF of less than 4 ml/100 g/min and the percentage of pixels with a CBV of less than 1 ml/100 g were calculated
Results: A significantly greater percentage of pixels possessed lower CBF's (less than 4 ml/100 g/min) in HT lesions compared with non-HT lesions (35% versus 17%, p<0.001). A significantly greater percentage of pixels possessed lower CBV's (less than 1 ml/100 g) in HT lesions compared with non-HT lesions (44% versus 31%, p<0.001).
Conclusion: Acute infarctions that undergo hemorrhagic transformation have a significantly higher percentage of pixels with low CBF's and CBV's. CBF and CBV values may be useful in differentiating ischemic tissue likely to hemorrhage from ischemic tissue that is not likely to hemorrhage, and may be important in differentiating patients likely to benefit from reperfusion therapy from those not likely to benefit.
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Schaefer MD, P,
Hemorrhagic Transformation after Intra-Arterial Reperfusion Therapy: Clinical Utility of Pre-Treatment CT Perfusion. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3104468.html
