Measuring elevated microvascular permeability and predicting hemorrhagic transformation in acute ischemic stroke using first-pass dynamic perfusion CT imaging.
OBJECTIVE
Hemorrhagic transformation (HT) can be a devastating complication of acute ischemic stroke (AIS). The purpose of this study was to determine whether increased microvascular permeability (PS) of the blood-brain barrier was detected in early AIS by using first-pass dynamic perfusion CT (PCT) and whether PS was significantly higher in infarcts destined for HT.


METHODS
Fifty patients with AIS less than 3 hours old and evaluated by PCT were included. PS color maps were retrospectively generated from PCT data using the Patlak model. One reader analyzed each PS map by drawing 4 circular 10-mm regions of interest on any focal abnormality. The mean of these 4 regions of interest represented the PS of the infarct (PSinfarct). The mean of 4 mirror regions of interest on the nonischemic contralateral hemisphere was also obtained (PScontrol). PSinfarct and PScontrol were compared by using an exact Wilcoxon test. PSinfarct for infarcts that developed HT on follow-up (PSHT) was compared with all of the others (PSNo-HT) using an exact Mann-Whitney test.


RESULTS
Forty-four infarcts (88%) showed focal PS elevation in the region of infarct. In units of milliliters per 100 milliliters per minute, PSinfarct ranged from 0 to 13 (mean: 3.5+/-3.1) versus PScontrol of 0-0.8 (mean: 0.28+/-0.27; P<.0001). Six infarcts (12%) developed HT, all of which were within the region of PS elevation. PSHT ranged from 5.2 to 13 (mean: 9.8+/-2.9) versus PSNo-HT of 0-5.9 (mean: 2.7+/-2.0; P<.0001). Eighteen infarcts (36%) were treated with recombinant tissue plasminogen activator (rtPA). A significant difference between PSHT and PSNo-HT persisted irrespective of rtPA treatment.


CONCLUSIONS
Elevated permeability was detectable in AIS by using first-pass PCT and it predicted subsequent HT.
Lin
K
K
Department of Radiology, New York University Medical Center, New York, NY 10029, USA.
Kazmi
K S
KS
Law
M
M
Babb
J
J
Peccerelli
N
N
Pramanik
B K
BK
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D002199:Capillary Permeability; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*
Acta Neuropathol. 1985;68(2):122-9
3907257
Brain Res. 1994 Jan 7;633(1-2):41-52
8137172
AJNR Am J Neuroradiol. 2005 Oct;26(9):2213-7
16219824
J Neuroimaging. 2003 Apr;13(2):99-105
12722491
Stroke. 2006 Apr;37(4):979-85
16514093
Arch Neurol. 2000 Aug;57(8):1161-6
10927796
AJNR Am J Neuroradiol. 2000 Sep;21(8):1441-9
11003276
AJNR Am J Neuroradiol. 2003 Apr;24(4):674-9
12695202
Stroke. 1998 Jan;29(1):144-51
9445344
J Cereb Blood Flow Metab. 1983 Mar;3(1):1-7
6822610
J Magn Reson Imaging. 1999 Sep;10(3):223-32
10508281
Stroke. 2001 Jan;32(1):175-83
11136934
AJNR Am J Neuroradiol. 2004 May;25(5):746-55
15140713
Cerebrovasc Brain Metab Rev. 1993 Spring;5(1):1-16
8452759
Stroke. 2002 Jun;33(6):1551-6
12052990
Stroke. 2001 Feb;32(2):438-41
11157179
Stroke. 2004 Nov;35(11 Suppl 1):2726-30
15459442
AJNR Am J Neuroradiol. 2006 Feb;27(2):409-17
16484420
Radiology. 1980 Dec;137(3):679-86
7003648
Q J Nucl Med. 2003 Sep;47(3):171-87
12897709
AJNR Am J Neuroradiol. 2003 Oct;24(9):1869-75
14561618
AJNR Am J Neuroradiol. 2003 Sep;24(8):1554-9
13679270
Radiology. 1998 Oct;209(1):85-93
9769817
Stroke. 2002 Mar;33(3):717-24
11872894
Stroke. 2006 Feb;37(2):556-61
16397182
J Clin Invest. 2003 Nov;112(10):1533-40
14617754
Stroke. 2002 May;33(5):1392-8
11988620
Neuroimaging Clin N Am. 2005 Aug;15(3):575-87, x
16360590
J Magn Reson Imaging. 1997 Jan-Feb;7(1):91-101
9039598
AJNR Am J Neuroradiol. 2006 Jan;27(1):20-5
16418350
Radiology. 2002 Jan;222(1):227-36
11756730
Eur J Radiol. 1999 Jun;30(3):170-84
10452715
Brain Res. 1996 Nov 11;739(1-2):88-96
8955928
AJNR Am J Neuroradiol. 2000 May;21(5):891-9
10815665
Nat Med. 2003 Oct;9(10):1313-7
12960961
Radiology. 2002 Sep;224(3):797-803
12202717
Stroke. 2005 Sep;36(9):1954-9
16051896
Ann Neurol. 2004 Oct;56(4):468-77
15389899
J Comput Assist Tomogr. 1997 Nov-Dec;21(6):857-66
9386273