Abstract:
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Purpose: To investigate MR predictors of hemorrhagic transformation (HT) in hyperacute ischemic stroke.
Methods and Materials: We retrospectively reviewed 52 consecutive patients with acute middle cerebral artery (MCA) ischemic stroke (National Institutes of Health Stroke Scale (NIHSS) score ³ 4) who underwent MR imaging including gadolinium (Gd)-enhanced T1, echo-planar gradient-echo (EPI-GRE), and T2*-weighted gradient-echo (GRE) imaging within 6 hours after symptom onset. Recombinant tissue plasminogen activator (rtPA) therapy was performed in 15 patients. Hemorrhagic transformation (HT) was determined on follow-up CT or MR at 24 (n = 41) and 48-72 hours (n = 11), and it was categorized into hemorrhagic infarct (HI) and parenchymal hematoma (PH). We assessed the presence of Gd-enhancement within an ischemic lesion, old microbleeds (< 0.5 cm), and old hemorrhage on hyperacute MR images. Unenhanced CT was obtained before MR imaging in all patients.
Results: HT was found in 17 (32.7%) patients (HI, 11; PH, 6). Old microbleeds, old hemorrhage, and Gd-enhancement were seen in 12, 5, and 4 patients, respectively. HT occurred in two (16.7%) with microbleeds, three (60%) with old hemorrhage, and 4 (100%) patients with Gd-enhancement. The site of HT corresponded to that of Gd-enhancement in 100%, but only in one to microbleeds and none to old hemorrhage. PH was found in one (8.3%) with microbleeds, one (20%) with old hemorrhage, and in two (50%) patients with Gd-enhancement. Three of 6 patients (50%) with PH showed Gd-enhancement (n = 2) and old hemorrhage with microbleeds (n = 1).
Conclusion: Early enhancement of ischemic lesion is highly specific predictor of hemorrhagic transformation. Gd-enhancement of ischemic tissue or old hemorrhage may be an indicator of increased risk of parenchymal hematoma. Pretreatment MRI with Gd-enhancement and gradient-echo sequence may be useful for prediction of hemorrhage after thrombolytic therapy.
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Kim MD, E,
Prediction of Hemorrhagic Transformation in Hyperacute MCA Infarction: Emphasis on Gd-enhancement, Old Microbleeds, and Old Hemorrhage on MR Imaging. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3104763.html