Eung Yup Kim MD, Presenter: Nothing to Disclose

Sam Soo Kim MD, Abstract Co-Author: Nothing to Disclose

Dong Gyu Na MD, Abstract Co-Author: Nothing to Disclose

Jae Wook Ryoo MD, Abstract Co-Author: Nothing to Disclose

Hong Gee Roh MD, Abstract Co-Author: Nothing to Disclose

Hong Sik Byun MD, Abstract Co-Author: Nothing to Disclose

Hyung-Jin Kim MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To investigate whether sulcal hyperintensity on FLAIR imaging in acute ischemic patients treated with intra-arterial (IA) thrombolysis is associated with hemorrhagic transformation (HT) and to find out the cause of this MR finding.

Enrolled were consecutive 14 patients with acute middle cerebral artery ischemic stroke treated with intra-arterial thrombolysis. All patients underwent noncontrast CT (NCT), diffusion/perfusion-weighted (DWI/PWI), gradient-echo (GRE), and Gd-enhanced T1-weighted MRI (Gd-T1WI) within 6 hours after symptom onset. Immediate follow-up NCT and MRI (FLAIR, GRE, DWI, PWI, T1WI, and Gd-T1WI) were obtained within an hour after IA thrombolysis and were evaluated to determine sulcal hyperintensity and hemorrhage in the sulcal CSF space. The same follow-up NCT and MRI were obtained at day 1, 3, and 7 and were evaluated to determine HT within 72 hours.

Sulcal hyperintensity on FLAIR imaging was found in 8 of 14 patients (57.1%) and was seen as high attenuation on immediate follow-up NCT and hyperintensity on T1WI in the corresponding sulcal CSF space in 4 of 8 patients (50%). No hemorrhage was found on GRE in patients with high attenuation on NCT, which disappeared at day 1 NCT, suggesting iodine contrast media. All patients with sulcal hyperintensity showed enhancement in the corresponding gyri on Gd-T1WI. HT developed in 5 of 8 patients with sulcal hyperintensity on FLAIR imaging and in one of 4 patients without (p = 0.031). Poor clinical outcome (modified Rankin ≥ 2) was slightly more common in patients with sulcal hyperintensity on FLAIR imaging vs. without (63% vs. 50%, p > 0.05).

Sulcal hyperintensity on FLAIR imaging in acute ischemic patients treated with intra-arterial thrombolysis is significantly associated with HT and may be caused by iodine contrast media.

Kim, E, Kim, S, Na, D, Ryoo, J, Roh, H, Byun, H, Kim, H, et al, , Sulcal Hyperintensity on FLAIR Imaging in Acute Ischemic Stroke Patients Treated with Intra-Arterial Thrombolysis: Association with Hemorrhagic Transformation.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4408165.html