title: Effects of microvascular permeability changes on contrast-enhanced T1 and pharmacokinetic MR imagings after ischemia.
abstract: OBJECTIVE
  Brain enhancement on contrast-enhanced T1-weighted imaging (CET1-WI) after ischemic stroke is generally accepted as an indicator of the blood-brain barrier disruption. However, this phenomenon usually starts to become visible at the subacute phase. The purpose of this study was to evaluate the time-course profiles of K(trans), cerebral blood volume (vp), and CET1-WI with early detection of blood-brain barrier changes on K(trans) maps and their role for prediction of subsequent hemorrhagic transformation in acute middle cerebral arterial infarct.
  
  
  METHODS
  Twenty-six patients with acute middle cerebral arterial stroke and early spontaneous reperfusion, whose MR images were obtained at predetermined stroke stages, were included. T2*-based MR perfusion-weighted images were acquired using the first-pass pharmacokinetic model to derive K(trans) and vp. Parenchymal enhancement observed on maps of K(trans), vp, and CET1-WI at each stage was compared. Association among these measurements and hemorrhagic transformation was analyzed.
  
  
  RESULTS
  K(trans) map showed significantly higher parenchymal enhancement in ischemic parenchyma as compared with that of vp map and CET1-WI at early stroke stages (P<0.05). The increased K(trans) at acute stage was not associated with parenchymal enhancement in CET1-WI at the same stage. Parenchymal enhancement in CET1-WI started to occur at the late subacute stage and tended to be luxury reperfusion-dependent. Patients with hemorrhagic transformation showed higher mean K(trans) values as compared with patients without hemorrhagic transformation (P=0.02).
  
  
  CONCLUSIONS
  Postischemic brain enhancement on routine CET1-WI seems to be closely related to the luxury reperfusion at the late subacute stage and is not dependent on microvascular permeability changes at the acute stage.
authors.affiliation: Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Hua-Shan
authors.initials: HS
authors.lastname: Liu
authors.forename: Hsiao-Wen
authors.initials: HW
authors.lastname: Chung
authors.forename: Ming-Chung
authors.initials: MC
authors.lastname: Chou
authors.forename: Michelle
authors.initials: M
authors.lastname: Liou
authors.forename: Chao-Ying
authors.initials: CY
authors.lastname: Wang
authors.forename: Hung-Wen
authors.initials: HW
authors.lastname: Kao
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Chiang
authors.forename: Chun-Jung
authors.initials: CJ
authors.lastname: Juan
authors.forename: Guo-Shu
authors.initials: GS
authors.lastname: Huang
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Chen
mesh_terms: D000208:Acute Disease; D000328:Adult; D002545:Brain Ischemia / Q000175:diagnosis*; D002199:Capillary Permeability / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000175:diagnosis*; D002908:Chronic Disease; D038524:Diffusion Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation / Q000379:methods*; D020244:Infarction, Middle Cerebral Artery; D020521:Stroke / Q000175:diagnosis*
keywords: Ktrans; blood–brain barrier; parenchymal enhancement