title: Hyperintense acute reperfusion marker is associated with higher contrast agent dosage in acute ischaemic stroke.
abstract: OBJECTIVE
  The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery (FLAIR) images is associated with blood-brain barrier (BBB) permeability changes. The aim of this study was to examine the influence of contrast agent dosage on HARM incidence in acute ischaemic stroke patients.
  
  
  METHODS
  We prospectively included 529 acute ischaemic stroke patients (204 females, median age 71 years). Patients underwent a first stroke-MRI within 24 hours from symptom onset and had a follow-up on day 2. The contrast agent Gadobutrol was administered to the patients for perfusion imaging or MR angiography. The total dosage was calculated as ml/kg body weight and ranged between 0.04 and 0.31 mmol/kg on the first examination. The incidence of HARM was evaluated on day 2 FLAIR images.
  
  
  RESULTS
  HARM was detected in 97 patients (18.3%). HARM incidence increased significantly with increasing dosages of Gadobutrol. Also, HARM positive patients were significantly older. HARM was not an independent predictor of worse clinical outcome, and we did not find an association with increase risk of haemorrhagic transformation.
  
  
  CONCLUSIONS
  A higher dosage of Gadobutrol in acute stroke patients on initial MRI is associated with increased HARM incidence on follow-up. MRI studies on BBB should therefore standardize contrast agent dosages.
  
  
  CONCLUSIONS
  • Hyperintense acute reperfusion marker on MRI indicates blood-brain barrier disruption. • This observational study on stroke patients characterizes HARM. • Incidence depends on contrast agent dosage on the previous day. • HARM is also associated with older age and poor kidney function. • Interpretation of HARM must take dosage into consideration.
authors.affiliation: Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. aostwaldt@mgh.harvard.edu.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Ostwaldt
authors.affiliation: Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.|Department of Neurology, Charité Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Michal
authors.initials: M
authors.lastname: Rozanski
authors.affiliation: Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Tabea
authors.initials: T
authors.lastname: Schaefer
authors.affiliation: Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.|Department of Neurology, Charité Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Ebinger
authors.affiliation: Jüdisches Krankenhaus Berlin, Stiftung des Bürgerlichen Rechts, Heinz-Galinski-Straße 1, 13347, Berlin, Germany.
authors.forename: Gerhard J
authors.initials: GJ
authors.lastname: Jungehülsing
authors.affiliation: Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Kersten
authors.initials: K
authors.lastname: Villringer
authors.affiliation: Academic Neuroradiology, Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
authors.forename: Jochen B
authors.initials: JB
authors.lastname: Fiebach
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000378:metabolism; D002545:Brain Ischemia / Q000175:diagnosis*; D002543:Cerebral Hemorrhage / Q000175:diagnosis; D015331:Cohort Studies; D003287:Contrast Media / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium / Q000008:administration & dosage / Q000493:pharmacokinetics; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000008:administration & dosage / Q000493:pharmacokinetics; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000378:metabolism; D020521:Stroke / Q000175:diagnosis*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol; D005682:Gadolinium
keywords: Acute stroke; Blood-Brain Barrier; Dosage; Gadolinium; Magnetic Resonance Imaging