MR image features predicting hemorrhagic transformation in acute cerebral infarction: a multimodal study.
BACKGROUND
The aims of this study were to observe magnetic resonance imaging (MRI) features and the frequency of hemorrhagic transformation (HT) in patients with acute cerebral infarction and to identify the risk factors of HT.


METHODS
We first performed multimodal MRI (anatomical, diffusion weighted, and susceptibility weighted) scans on 87 patients with acute cerebral infarction within 24 hours after symptom onset and documented the image findings. We then performed follow-up examinations 3 days to 2 weeks after the onset or whenever the conditions of the patients worsened within 3 days. We utilized univariate statistics to identify the correlations between HT and image features and used multivariate logistical regression to correct for confounding factors to determine relevant independent image features of HT.


RESULTS
HT was observed in 17 out of total 87 patients (19.5 %). The infarct size (p = 0.021), cerebral microbleeds (CMBs) (p = 0.004), relative apparent diffusion (rADC) (p = 0.023), and venous anomalies (p = 0.000) were significantly related with HT in the univariate statistics. Multivariate analysis demonstrated that CMBs (odd ratio (OR) = 0.082; 95 % confidence interval (CI) = 0.011-0.597; p = 0.014), rADC (OR = 0.000; 95 % CI = 0.000-0.692; p = 0.041), and venous anomalies (OR = 0.066; 95 % CI = 0.011-0.403; p = 0.003) were independent risk factors for HT.


CONCLUSIONS
The frequency of HT is 19.5 % in this study. CMBs, rADC, and venous anomalies are independent risk factors for HT of acute cerebral infarction.
Department of Radiology, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
Chunming
C
Liu
Translational Imaging & MRI Unit, Department of Psychiatry, Columbia University, New York, NY, USA.|New York State Psychiatric Institute, New York, NY, USA.
Zhengchao
Z
Dong
Department of Radiology, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
Liang
L
Xu
International Medical School, Tianjin Medical University, Tianjin, China.
Aiman
A
Khursheed
Department of Radiology, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
Longchun
L
Dong
Department of Radiology, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
Zhenxing
Z
Liu
Department of Radiology, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China.
Jun
J
Yang
Department of Radiology, Tianjin Union Medicine Centre, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, People's Republic of China. cjr.liujun@vip.163.com.
Jun
J
Liu
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology*; D002544:Cerebral Infarction / Q000150:complications* / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
Acute cerebral infarction; Diffusion weighted imaging; Hemorrhagic transformation; MRI; Susceptibility weighted imaging