title: Very low cerebral blood volume predicts parenchymal hematoma in acute ischemic stroke.
abstract: OBJECTIVE
  Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to explore the impact of early reperfusion and recanalization.
  
  
  METHODS
  The volume of cerebral tissue with CBV≤2.5th percentile of the normal hemisphere was calculated within the acute diffusion-weighted imaging lesion. Hemorrhagic transformation was assessed on day 2 MRI according to the European Cooperative Acute Stroke Study II criteria. Recanalization and reperfusion were assessed on 3-hour follow-up MRI.
  
  
  RESULTS
  Of the 110 patients, hemorrhagic transformation occurred in 59 patients, including 7 PH. In univariate analysis, the acute National Institutes of Health Stroke Scale score (P=0.002), acute diffusion-weighted imaging lesion volume (P=0.02), and thrombolysis (P=0.03), but not very low CBV (P=0.52), were associated with hemorrhagic transformation. The volume of very low CBV was the only predictor of PH (P=0.007). Early reperfusion and recanalization had no influence on either hemorrhagic transformation or PH.
  
  
  CONCLUSIONS
  Very low CBV was the only independent predictor of PH in patients with acute stroke.
authors.affiliation: Université de Lyon, Lyon 1, CREATIS, CNRS UMR 5220-INSERM U1044, INSA-Lyon, Hospices Civils de Lyon, Lyon, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Hermitte
authors.forename: Tae-Hee
authors.initials: TH
authors.lastname: Cho
authors.forename: Brice
authors.initials: B
authors.lastname: Ozenne
authors.forename: Norbert
authors.initials: N
authors.lastname: Nighoghossian
authors.forename: Irene Klærke
authors.initials: IK
authors.lastname: Mikkelsen
authors.forename: Lars
authors.initials: L
authors.lastname: Ribe
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
authors.forename: Leif
authors.initials: L
authors.lastname: Østergaard
authors.forename: Laurent
authors.initials: L
authors.lastname: Derex
authors.forename: Niels
authors.initials: N
authors.lastname: Hjort
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Salvador
authors.initials: S
authors.lastname: Pedraza
authors.forename: Marc
authors.initials: M
authors.lastname: Hermier
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.forename: Yves
authors.initials: Y
authors.lastname: Berthezène
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume / Q000502:physiology; D002545:Brain Ischemia / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology*; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005060:Europe; D005260:Female; D006406:Hematoma / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries; D015424:Reperfusion / Q000009:adverse effects / Q000379:methods; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: cerebral hemodynamics; hemorrhage; ischemic stroke; perfusion imaging; thrombolysis