title: Contrast staining on CT after DSA in ischemic stroke patients progresses to infarction and rarely hemorrhages.
abstract: Contrast staining of brain parenchyma identified on non-contrast CT performed after DSA in patients with acute ischemic stroke (AIS) is an incompletely understood imaging finding. We hypothesize contrast staining to be an indicator of brain injury and suspect the fate of involved parenchyma to be cerebral infarction. Seventeen years of AIS data were retrospectively analyzed for contrast staining. Charts were reviewed and outcomes of the stained parenchyma were identified on subsequent CT and MRI. Thirty-six of 67 patients meeting inclusion criteria (53.7%) had contrast staining on CT obtained within 72 hours after DSA. Brain parenchyma with contrast staining in patients with AIS most often evolved into cerebral infarction (81%). Hemorrhagic transformation was less likely in cases with staining compared with hemorrhagic transformation in the cohort that did not have contrast staining of the parenchyma on post DSA CT (6% versus 25%, respectively, OR 0.17, 95% CI 0.017 - 0.98, p = 0.02). Brain parenchyma with contrast staining on CT after DSA in AIS patients was likely to infarct and unlikely to hemorrhage.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA - matthew.amans@ucsf.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Amans
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Cooke
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Vella
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Dowd
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA.
authors.forename: Van V
authors.initials: VV
authors.lastname: Halbach
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA.
authors.forename: Randall T
authors.initials: RT
authors.lastname: Higashida
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California; San Francisco, California, USA.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hetts
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism; D002533:Cerebral Angiography / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism*; D003287:Contrast Media / Q000493:pharmacokinetics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism*; D014018:Tissue Distribution; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media
keywords: angiography; contrast media; contrast stain; interventional neuroradiology; radiology; stroke recovery