Ahmed Abdel Razek, Presenter: Nothing to Disclose

Abdel Halim Tantawy, Abstract Co-Author: Nothing to Disclose

Ahmed Azab, Abstract Co-Author: Nothing to Disclose

To assess diffusion weighted MR imaging as a predictor of hemorrhagic transformation (HT) of ischemic infarction after intravenous thrombolysis.

Retrospective analysis of 56 patients (43M, 13F aged 55-72 ys: mean 64ys) with acute ischemic stroke who treated with thrombolytic therapy and underwent diffusion weighted MR imaging before treatment and MR imaging after treatment. Diffusion MR imaging of the brain was done with single shot echo planar diffusion weighted MR imaging with b-factor of 0,500 &1000 sec/mm2. The scanning parameters were: TR= 10000 ms, TE=108ms, bandwidth= 125 kHz, slice thickness =4 mm. Apparent diffusion coefficient (ADC) maps were reconstructed. The apparent diffusion coefficient (ADC) value and the volume of the ischemic lesion were measured on ADC map. The demographic data, risk factors, National Institutes of Health Stroke Scale (NIHSS) scores and blood tests results were retrieved. Univariate and multivariate regression analysis were done to determine the most accurate predictor of HT of ischemic infarction.

Twenty-seven patients developed HT of ischemic infarction. Patients with HT showed larger volume of initial DWI lesion (P<0.001), lower NIHSS score (P<0.003), lower ADC value (P <0.04) and higher systolic blood pressure (P<0.05). The best predictor of HT was lesion volume on ADC map more than 145 cc which achieved 90% sensitivity and 70% specificity. On multivariate analysis, the combination of volume of ischemic tissue on DWI and NIHSS score are the most predictor parameter of HT of ischemic infarction (coefficient value 0.649) which reached sensitivity 95% and specificity 89%.

We concluded that combination of volume of the ischemic lesion on the ADC map and NIHSS score is the most predictive parameter for hemorrhagic transformation of ischemic infarction.  

Combined ischemic lesion volume on initial ADC map and NIHSS score can predict risk of hemorrhagic transformation of ischemic infraction after thrombolysis.  

Abdel Razek, A, Tantawy, A, Azab, A, Prediction of Hemorrhagic Transformation of Ischemic Infarction with Diffusion-weighted MR Imaging.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8000166.html