title: Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke.
abstract: The purpose of this study was to investigate the relationship between hyperperfusion and hemorrhagic transformation (HT) in acute ischemic stroke (AIS). Pseudo-continuous arterial spin labeling (ASL) with background suppressed 3D GRASE was performed during routine clinical magnetic resonance imaging (MRI) on AIS patients at various time points. Arterial spin labeling cerebral blood flow (CBF) maps were visually inspected for the presence of hyperperfusion. Hemorrhagic transformation was followed during hospitalization and was graded on gradient recalled echo (GRE) scans into hemorrhagic infarction (HI) and parenchymal hematoma (PH). A total of 361 ASL scans were collected from 221 consecutive patients with middle cerebral artery stroke from May 2010 to September 2013. Hyperperfusion was more frequently detected posttreatment (odds ratio (OR) = 4.8, 95% confidence interval (CI) 2.5 to 8.9, P < 0.001) and with high National Institutes of Health Stroke Scale (NIHSS) scores at admission (P<0.001). There was a significant association between having hyperperfusion at any time point and HT (OR = 3.5, 95% CI 2.0 to 6.3, P < 0.001). There was a positive relationship between the grade of HT and time-hyperperfusion with the Spearman's rank correlation of 0.44 (P = 0.003). Arterial spin labeling hyperperfusion may provide an imaging marker of HT, which may guide the management of AIS patients post tissue-type plasminogen activator (tPA) and/or endovascular treatments. Late hyperperfusion should be given more attention to prevent high-grade HT.
authors.affiliation: Department of Neurology, UCLA, Los Angeles, California, USA.
authors.forename: Songlin
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Neurology, UCLA, Los Angeles, California, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Department of Radiology, UCLA, Los Angeles, California, USA.
authors.forename: Sumit
authors.initials: S
authors.lastname: Dua
authors.affiliation: Department of Medicine Statistics Core, UCLA, Los Angeles, California, USA.
authors.forename: Holly
authors.initials: H
authors.lastname: Wilhalme
authors.affiliation: Department of Medicine Statistics Core, UCLA, Los Angeles, California, USA.
authors.forename: David
authors.initials: D
authors.lastname: Elashoff
authors.affiliation: Department of Radiology, UCLA, Los Angeles, California, USA.
authors.forename: Xin J
authors.initials: XJ
authors.lastname: Qiao
authors.affiliation: 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, UCLA, Los Angeles, California, USA.
authors.forename: Jeffry R
authors.initials: JR
authors.lastname: Alger
authors.affiliation: Department of Neurology, UCLA, Los Angeles, California, USA.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.affiliation: 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Emergency Medicine, UCLA, Los Angeles, California, USA.
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.affiliation: Department of Neurology, UCLA, Los Angeles, California, USA.
authors.forename: Latisha K
authors.initials: LK
authors.lastname: Ali
authors.affiliation: Department of Neurology, UCLA, Los Angeles, California, USA.
authors.forename: Fabien
authors.initials: F
authors.lastname: Scalzo
authors.affiliation: 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Lou
authors.affiliation: Department of Radiology, UCLA, Los Angeles, California, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Yoo
authors.affiliation: Department of Neurology, UCLA, Los Angeles, California, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: Department of Radiology, UCLA, Los Angeles, California, USA.
authors.forename: Noriko
authors.initials: N
authors.lastname: Salamon
authors.affiliation: 1] Department of Neurology, UCLA, Los Angeles, California, USA [2] Department of Radiology, UCLA, Los Angeles, California, USA.
authors.forename: Danny J J
authors.initials: DJ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013113:Spin Labels; D020521:Stroke / Q000150:complications* / Q000503:physiopathology
chemical_list: D013113:Spin Labels