title: Patterns and predictors of blood-brain barrier permeability derangements in acute ischemic stroke.
abstract: OBJECTIVE
  MRI permeability imaging is a promising approach to identify patients with acute ischemic stroke with an increased propensity for hemorrhagic transformation (HT). Permeability imaging provides direct visualization of blood-brain barrier derangements in ischemic fields.
  
  
  METHODS
  We retrospectively analyzed clinical and MRI data on patients with acute cerebral ischemia within the middle cerebral artery territory to identify the frequency, patterns, and predictors of permeability derangements and their association with HT types.
  
  
  RESULTS
  A total of 179 permeability scans was obtained in 127 patients (59 men; mean age, 66.8 years). Among 179 image sets (82 pre-/no treatment and 97 posttreatment), permeability derangements were present in 29 images, frequently at the basal ganglia (n=23) and rarely at the juxta-cortical area (n=6). After adjusting for covariates, diastolic pressure (OR, 1.12, per 1-mm Hg increase; 95% CI, 1.02 to 1.22) and s-glucose (OR, 1.04, per 1-mg/dL increase; 95% CI, 1.01 to 1.07) were independently associated with pretreatment permeability derangements, whereas low-density lipoprotein cholesterol (OR, 0.97, per 1-mg/dL increase; 95% CI, 0.94 to 0.99), malignant MRI profile (OR, 24.84; 95% CI, 1.50 to 412.93), and time from onset to recanalization therapy (OR, 1.47, per 1-hour increase; 95% CI, 1.10 to 1.96) were independently associated with permeability derangements after recanalization therapy. Types of HT varied among the patients with permeability derangements (no HT, 4; hemorrhagic infarct type, 12; and parenchymal hematoma, 13) and transient derangements (without subsequent HT) and normalization of derangements (in the presence of HT) on permeability images was observed in several cases.
  
  
  CONCLUSIONS
  Permeability derangements, a dynamic process associated with ischemic stroke pathophysiology and recanalization therapy, vary in pattern and evolution toward HT. Several prognostic and therapeutic predictors for HT are independently associated with pre- and posttreatment permeability derangements.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University, South Korea.
authors.forename: Oh Young
authors.initials: OY
authors.lastname: Bang
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.forename: Jeffry R
authors.initials: JR
authors.lastname: Alger
authors.forename: Samir H
authors.initials: SH
authors.lastname: Shah
authors.forename: Brian H
authors.initials: BH
authors.lastname: Buck
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D001812:Blood-Brain Barrier / Q000473:pathology*; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology; D008078:Cholesterol, LDL / Q000097:blood; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D020244:Infarction, Middle Cerebral Artery / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010539:Permeability; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D008078:Cholesterol, LDL