title: Combination of T2*W and FLAIR abnormalities for the prediction of parenchymal hematoma following thrombolytic therapy in 100 stroke patients.
abstract: BACKGROUND
  The objective of our study was to determine whether the combination of hypointense spots ("cerebral microbleeds," CMBs) with a leukoaraiosis is associated with the risk of parenchymal hematoma (PH) after thrombolytic therapy.
  
  
  METHODS
  We analyzed magnetic resonance imaging (MRI) scans acquired within 6 hours after symptom onset from 100 ischemic stroke patients. Multiparametric MRI including a T2*-weighted (T2*w) MRI and fluid attenuated inversion recovery (FLAIR) was performed before thrombolysis in all patients. Initial T2*w imaging was rated by two independent observers for the presence of CMBs smaller than 5 mm. White matter changes were evaluated using an adapted scale of Fazekas and Schmidt. PH was defined in follow-up imaging.
  
  
  RESULTS
  A PH was observed in seven per 100 patients. CMBs were detected by observer 1 in 22 and observer 2 in 20 patients. We found a very low sensitivity (0.14) for prediction of PH by the presence of CMBs. We found a concordant increase in the rate of PH when the periventricular hyperintensity in FLAIR was larger than a thin lining. Sensitivity was good-to-perfect (0.86 and 1.00, observers 1 and 2) and specificity was substantial (0.65 and 0.66). Using the combination of a periventricular matter lesion (PVML)>1 and the presence of CMBs did not improve the prediction of PH.
  
  
  CONCLUSIONS
  A marked periventricular hyperintensity in FLAIR imaging seems to be associated with a substantially increased risk of PH. A combination of CMBs with leukoaraiosis scores did not appear to be beneficial for prognosis.
authors.affiliation: Department of Neuroradiology, University Medical Care Hamburg-Eppendorf, Hamburg, Germany. jfiehler@uke.unihamburg.de
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Susanne
authors.initials: S
authors.lastname: Siemonsen
authors.forename: Goetz
authors.initials: G
authors.lastname: Thomalla
authors.forename: Till
authors.initials: T
authors.lastname: Illies
authors.forename: Thomas
authors.initials: T
authors.lastname: Kucinski
mesh_terms: D001921:Brain / Q000187:drug effects / Q000473:pathology*; D002545:Brain Ischemia / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000175:diagnosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000188:drug therapy / Q000473:pathology; D015912:Thrombolytic Therapy / Q000009:adverse effects*