title: Early diagnosis of hemorrhagic transformation: diffusion/perfusion-weighted MRI versus CT scan.
abstract: Standard magnetic resonance imaging (MRI) techniques failed to image adequately acute hemorrhagic transformation (HT). Therefore, computed tomography (CT) is still needed to exclude intracerebral hemorrhage. New MRI techniques such as diffusion- and perfusion-weighted imaging (DWI and PWI) may improve the early detection of HT. The utility of this approach requires a direct comparison of the sensitivity of CT with these MRI techniques.
  
  
  METHODS
  Nine patients experienced an acute carotid artery territory ischemic stroke diagnosed on a first CT performed 3.8 +/- 2 h after the onset of stroke. They underwent a second CT 12 +/- 4 h after the onset of stroke, followed 35 +/- 10 min later by an MRI protocol including: (1) an axial isotropic DWI SE echo-planar imaging (EPI) sequence; (2) time of flight MR angiography (TOF MRA); (3) PWI with an axial T(2)*-weighted gradient echo EPI sequence using 20 ml gadolinium contrast agent (Gd-DTPA); HT was characterized on DWI SE EPI as a heterogeneous area of signal loss within the ischemic area; (4) at day 7, CT was also performed in all patients who had an early suspicion of bleeding according to MRI.
  
  
  RESULTS
  An HT was detected exclusively with CT in 1 out of 9 patients, while an MRI pattern of HT was found in 6 out of 9 patients. In 5 of these 6 patients, the CT scan did not show an obvious pattern of HT. Day 7 CT confirmed HT in all patients who had early suspicion of bleeding according to DWI criteria.
  
  
  CONCLUSIONS
  This study suggests that new MRI techniques may allow an early detection of HT, thus improving the management of stroke.
authors: Cerebrovascular Disease and Ataxia Research Center, Lyon, France.
authors: N
authors: N
authors: Nighoghossian
authors: M
authors: M
authors: Hermier
authors: Y
authors: Y
authors: Berthezène
authors: M
authors: M
authors: Wiart
authors: L
authors: L
authors: Derex
authors: J
authors: J
authors: Honnorat
authors: P
authors: P
authors: Trouillas
authors: F
authors: F
authors: Turjman
authors: J C
authors: JC
authors: Froment
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001037:Aphasia; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D005260:Female; D006429:Hemiplegia; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010291:Paresis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D000925:Anticoagulants