title: Predicting intracerebral hemorrhage by baseline magnetic resonance imaging in stroke patients undergoing systemic thrombolysis.
abstract: OBJECTIVE
  Intracerebral hemorrhage (ICH) remains a serious complication in ischemic stroke patients undergoing systemic thrombolysis. Here, we examined whether the risk of treatment-associated hemorrhage can be predicted from magnetic resonance imaging (MRI) using fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging (DWI) within 3 h after symptom onset.
  
  
  METHODS
  In this single-center observational study involving 122 ischemic stroke patients between January 2005 and December 2008, the incidence of FLAIR-positive lesions within diffusion-restricted areas was determined on baseline MRI, which was carried out prior to treatment with tissue plasminogen activator (Actilyse(®) ) within 3 h from symptom onset. The rate of ICH was assessed by computed tomography performed within 24 h after treatment. Relationships between FLAIR-positive lesions, DWI lesion size, proportion of FLAIR/DWI-positive lesions, and occurrence of bleeding were explored.
  
  
  RESULTS
  Data from 97 patients were evaluated. FLAIR-positive lesions were present in 25 patients (25.8%) and ICH occurred in 32 patients (33.0%). FLAIR-positive lesions were associated with a bleeding rate of 80.0% compared with 16.7% in FLAIR-negative patients (P < 0.001; odds ratio 20.0, positive predictive value 0.8). DWI lesion size was significantly correlated with the rate of ICH (P = 0.001). In contrast, FLAIR/DWI proportion was not associated with ICH (P = 0.788).
  
  
  CONCLUSIONS
  In ischemic stroke patients within 3 h from symptom onset, the existence of FLAIR-positive lesions on pretreatment MRI is significantly associated with an increased bleeding risk due to systemic thrombolysis. Therefore, considering FLAIR-positive lesions on baseline MRI might guide treatment decisions in ischemic stroke.
authors.affiliation: Department of Neurology, University of Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hobohm
authors.forename: D
authors.initials: D
authors.lastname: Fritzsch
authors.forename: S
authors.initials: S
authors.lastname: Budig
authors.forename: J
authors.initials: J
authors.lastname: Classen
authors.forename: K-T
authors.initials: KT
authors.lastname: Hoffmann
authors.forename: D
authors.initials: D
authors.lastname: Michalski
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology*; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: diffusion-weighted imaging; fluid-attenuated inversion recovery; intracerebral hemorrhage; ischemic stroke; magnetic resonance imaging; thrombolysis