Hypointense transcerebral veins at T2*-weighted MRI: a marker of hemorrhagic transformation risk in patients treated with intravenous tissue plasminogen activator.
Prediction of hemorrhagic transformation (HT) in patients treated by intravenous recombinant tissue-type plasminogen activator (rt-PA) is a challenging issue in acute stroke management. HT may be correlated with severe hypoperfusion. Signal changes may be observed at susceptibility-weighted magnetic resonance imaging (MRI) within large perfusion defects. A signal drop within cerebral veins at T2*-weighted gradient-echo MRI may be expected in severe ischemia, and may indicate subsequent risk of HT. The authors prospectively searched for an abnormal visibility of transcerebral veins (AVV) within the ischemic area in patients with hemispheric ischemic stroke, before they were treated with intravenous rt-PA therapy. Any correlation between AVV and baseline clinical or MRI findings, or further HT, was noted. An AVV was present in 23 of 49 patients (obvious, n = 8; moderate, n = 15), and was supported by severe hemodynamic changes at baseline MRI. The AVV was correlated with the occurrence of parenchymal hematoma type 2 at computed tomography during the first week (r = 0.44, P = 0.002). Five of six type 2 parenchymal hematomas occurred in association with obvious AVV. At multiple regression analysis, two baseline MRI factors had an independent predictive value for HT risk during the first week: the AVV and the cerebral blood volume ratio (Nagelkerke R2 = 0.48).
Hermier
Marc
M
Department of Radiology and MRI, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France. marc.hermier@club-internet.fr
Nighoghossian
Norbert
N
Derex
Laurent
L
Adeleine
Patrice
P
Wiart
Marlène
M
Berthezène
Yves
Y
Cotton
François
F
Pialat
Jean-Baptiste
JB
Dardel
Pascal
P
Honnorat
Jérôme
J
Trouillas
Paul
P
Froment
Jean-Claude
JC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D002550:Cerebral Veins / Q000473:pathology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012306:Risk; D020521:Stroke / Q000150:complications; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator