Masafumi Harada MD, PhD, Presenter: Nothing to Disclose

Hitoshi Kubo, Abstract Co-Author: Nothing to Disclose

Naomi Morita MD, Abstract Co-Author: Nothing to Disclose

Hideki Otsuka MD, Abstract Co-Author: Nothing to Disclose

Kenji Matsuzaki MD, PhD, Abstract Co-Author: Nothing to Disclose

Mayumi Takeuchi MD, Abstract Co-Author: Nothing to Disclose

Hiromu Nishitani MD, PhD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

It should be evaluated whether hemorrhagic changes exist or not in patients with acute cerebral ischemia before and after the intravenous rt-PA thrombolysis (iv-rtPA). In Japan, it is approved that MRI is used as a modality to detect cerebral hemorrhage by iv-rtPA. Although a gradient echo T2*-WI (GRE-T2*WI) was reported to be more sensitive for the detection of hemorrhagic changes than CT, there is few data about the correlation between prognosis and hemorrhagic transformation (HT) observed by GRE-T2*WI after iv-rtPA. The purpose of this study is to clarify the correlation between prognosis and HT observed by GRE-T2*WI.

The subjects were consecutive 52 patients who were treated with iv-rtPA from April 2007 until March 2009. The 3T MRI measurements including DWI, GRE-T2*WI and MRA were conducted before and 24 hours after iv-rtPA. The prognosis was classified into the good and bad ones based on the change of NIHSS (“good”: improvement more than 4 scores, “bad”: worse more than 4 scores) one month later. The evaluated factors were the volume and ASPECT score by DWI abnormality at the initial and 2nd MRI study, and the re-canalization at the 2nd MRA. The existences of HT, increasing edema and mass effect due to HT were evaluated in GRE-T2*WI at the 2nd study. The correlations in variables were estimated by Logistic analysis and Spearman’s rank correlation.

The change of HT was observed at 43 % in 53 patients and the re-canalization was found at 88 % in patients with HT. The re-canalization showed a high correlation with the changes of HT (p<0.05). The "good" prognosis showed a high correlation with re-canalization, but did not demonstrate significant correlations with the existences of HT, edema and mass effect. The correlation with the "bad" prognosis was found in mass effect due to HT (p<0.01, Odds ratio[OR] 33.0) and the volume on DWI abnormality (p<0.01, OR 1.002).

The existence of HT did not become a predict variable for good prognosis of patients and would suggest that the occlusive vessel was re-canalized. Our study indicated that HT without mass effect might not influence to prognosis of patients after iv-rtPA.

The existence of mass effect with HT might indicate bad prognosis, and the effect of iv-rtPA would be evaluated by MRI.

Harada, M, Kubo, H, Morita, N, Otsuka, H, Matsuzaki, K, Takeuchi, M, Nishitani, H, et al, 0, Correlation between Prognosis and Hemorrhagic Transformation Observed by 3-Tesla Gradient Echo T2*-WI in Patients with Acute Cerebral Ischemia Treated with the Intravenous rt-PA Thrombolysis.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8012505.html