Contrast-enhanced MR imaging in acute ischemic stroke: T2* measures of blood-brain barrier permeability and their relationship to T1 estimates and hemorrhagic transformation.
OBJECTIVE
rtPA is an effective treatment for AIS, yet it is substantially underused due to the increased risk of HT. Recent work suggests that permeability-related information can be extracted from routine T2*-based perfusion images by measuring the rR of the contrast agent. Given that other T2*-based measures have recently been proposed, the purpose of this study was to evaluate 4 such permeability measures in identifying patients with AIS who will proceed to HT.


METHODS
Eighteen patients with AIS were examined within a mean of 3.3 +/- 1.4 hours postonset. Dynamic T2*-weighted imaging consisted of a single-shot EPI following a bolus of gadodiamide. HT was determined on follow-up CT or MR imaging at 24-72 hours. Mean values of rR, Peak Height, Recovery, as well as Slope were calculated and analyzed on the basis of follow-up HT status.


RESULTS
Eight patients proceeded to HT. The mean rR for patients with HT was significantly greater than that for patients without HT (0.22 +/- 0.06 versus 0.14 +/- 0.06, P = .006), while there was a trend toward decreased %Recovery in patients with HT (76 +/- 6 versus 82 +/- 11%, P = .092). There was a significant negative correlation between %Recovery and rR (r = -0.88, P < .001). No significant differences or trends were detected with respect to Peak Height or Slope.


CONCLUSIONS
Both rR and %Recovery can be readily extracted from a routine perfusion MR imaging dataset and show potential for identifying HT during the acute phase poststroke.
Thornhill
R E
RE
Department of Medical Imaging, University of Toronto, 150 College Street, Toronto, Ontario, Canada.
Chen
S
S
Rammo
W
W
Mikulis
D J
DJ
Kassner
A
A
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000378:metabolism / Q000473:pathology*; D002545:Brain Ischemia / Q000378:metabolism / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000378:metabolism / Q000473:pathology*; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D020127:Recovery of Function; D012189:Retrospective Studies; D020521:Stroke / Q000378:metabolism / Q000473:pathology*
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA