title: Brush sign on 3-T T2*-weighted MRI as a potential predictor of hemorrhagic transformation after tissue plasminogen activator therapy.
abstract: OBJECTIVE
  The brush sign (BS) is the enlargement of medullary veins on 3-T T2*-weighted MRI seen in patients with ischemic stroke because of major cerebral artery occlusion. However, the clinical relevance of BS in patients with acute stroke remains unclear. We assessed the correlation between detecting BS with the development of hemorrhagic transformation after intravenous thrombolysis.
  
  
  METHODS
  We enrolled consecutive patients with M1 or M2 occlusion treated with intravenous tissue plasminogen activator. We classified the patients into 2 groups: the group positive for BS (P-BS) and the group negative for BS (N-BS). We investigated the differences in MRI findings and the clinical outcome between the 2 groups.
  
  
  RESULTS
  The subjects consisted of 36 patients (19 men; mean age, 74.7 years). Twenty-one patients (58%) had M1 occlusion, and 15 (42%) had M2 occlusion. Twenty-five patients (69%) were classified into the P-BS group and 11 (31%) into the N-BS group. Recanalization was observed in 15 (60%) and 10 (90%) patients in the P-BS and N-BS groups, respectively (P=0.116). Hemorrhagic transformation on MRI was observed more frequently in the P-BS group than in the N-BS group (64% versus 18%; P=0.027). A good outcome (mRS, 0-1) at discharge was found in 24% of patients in the P-BS group and in 45% of patients in the N-BS group (P=0.152). A multivariate logistic regression analysis revealed that the presence of BS (odds ratio, 9.08; 95% confidence interval, 1.4-59.8; P=0.022) was independently associated with hemorrhagic transformation.
  
  
  CONCLUSIONS
  BS may predict the development of hemorrhagic transformation in patients with acute stroke treated with intravenous tissue plasminogen activator.
authors.affiliation: From the Department of Clinical Neuroscience (Y.T., N.Y., K.F., Y.I., R.K.), Department of Neurosurgery (R.M., J.S., S.N.), and Department of Radiology (M.H.), The University of Tokushima, Tokushima, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Terasawa
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Ryoma
authors.initials: R
authors.lastname: Morigaki
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Yuishin
authors.initials: Y
authors.lastname: Izumi
authors.forename: Junichiro
authors.initials: J
authors.lastname: Satomi
authors.forename: Masafumi
authors.initials: M
authors.lastname: Harada
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
authors.forename: Ryuji
authors.initials: R
authors.lastname: Kaji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020766:Intracranial Embolism / Q000150:complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: T2* weighted image; brush sign; magnetic resonance imaging; tissue plasminogen activator