title: Susceptibility-weighted imaging for cerebral microbleed detection in super-acute ischemic stroke patients treated with intravenous thrombolysis.
abstract: OBJECTIVE
  Fast magnetic resonance imaging (MRI) and susceptibility-weighted imaging (SWI) methods may provide more accurate detection of the highly variant time window for successful intravenous (IV) thrombolytic drug treatment (averaging 3 hours) for cerebral microbleeds (CMBs) in acute stroke patients.
  
  
  METHODS
  This prospective study applies fast MRI and SWI for examination of 279 prescreened ischemic stroke patients within 12 hours of stroke onset. One hundred and sixty-two (58.1%) of 279 patients were diagnosed with super-acute ischemic stroke with restricted diffusion, hyperintense diffusion-weighted imaging signals, and no ischemic change in T2-weighted imaging, fluid-attenuated inversion recovery, or T1-weighted imaging signals. Recombinant tissue plasminogen activator IV thrombolysis was administered to 113 (69.75%) patients (thrombolysis group). All patients underwent regular sequence MRI and SWI follow-up.
  
  
  RESULTS
  Computed tomography and MRI sequence scans revealed hemorrhagic transformations in 13 (11.50%) thrombolysis and four (8.16%) non-thrombolysis group patients. MRI-guided thrombolysis treatment produced no significant differences between the two groups. SWI revealed new CMBs in 46 (40.70%) and nine (18.37%) thrombolysis and non-thrombolysis group patients, respectively. Significantly better National Institutes of Health stroke scale (24 hours) (P<0.05), modified Rankin scale (90 days) (P<0.01), and life quality Barthal index scores were observed in CMB patients (P<0.01).
  
  
  CONCLUSIONS
  SWI revealed higher CMB incidence and clinical improvement in recombinant tissue plasminogen activator IV thrombolysis-treated super-acute ischemic stroke patients, suggesting that CMBs may indicate vascular re-canalization/reperfusion. Thus, SWI can be applied to extend individual patient windows for thrombolytic treatment beyond general recommendations of treatment within 3 hours, allowing treatment up to 12 hours from stroke onset.
authors.affiliation: Department of Neurology, Pudong People's Hospital, Shanghai, China.
authors.forename: Qingke
authors.initials: Q
authors.lastname: Bai
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Zhao
authors.forename: Haijing
authors.initials: H
authors.lastname: Sui
authors.forename: Xiuhai
authors.initials: X
authors.lastname: Xie
authors.forename: Juan
authors.initials: J
authors.lastname: Chen
authors.forename: Juan
authors.initials: J
authors.lastname: Yang
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010959:Tissue Plasminogen Activator