Mismatch of Low Perfusion and High Permeability Predicts Hemorrhagic Transformation Region in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolysis.
This study sought to determine whether the permeability related parameter K(trans), derived from computed tomography perfusion (CTP) imaging, can predict hemorrhagic transformation (HT) in patients with acute ischemic stroke who receive intra-arterial thrombolysis. Data from patients meeting the criterion were examined. CTP was performed and K(trans) maps were used to assess the permeability values in HT and non-HT regions. A receiver operating characteristic (ROC) curve was calculated, showing the sensitivity and specificity of K(trans) for predicting HT risk. Composite images were produced to illustrate the spatial correlations among perfusion, permeability changes and HT. This study examined 41 patients. Twenty-six patients had hemorrhagic infarction and 15 had parenchymal hemorrhage. The mean K(trans) value in HT regions was significantly lower than that in the non-HT regions (0.26 ± 0.21/min vs. 0.78 ± 0.64/min; P < 0.001). The ROC curve analysis identified an optimal cutoff value of 0.334/min for K(trans) to predict HT risk. Composite images suggested ischemic regions with low permeability, or the mismatch area of low perfusion and high permeability, more likely have HT. HT regions after intra-arterial thrombolysis had lower permeability values on K(trans) maps. The mismatch area of lower perfusion and higher permeability are more likely to develop HT.
Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
Hui
H
Chen
Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
Nan
N
Liu
Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
Ying
Y
Li
Stanford University, Department of Radiology, Neuroradiology Section, Stanford, CA, USA.
Max
M
Wintermark
Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK.
Alan
A
Jackson
Department of Radiology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
Bing
B
Wu
GE Healthcare, Beijing, China.
Zihua
Z
Su
Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
Fei
F
Chen
Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
Jun
J
Hu
Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China.
Yongwei
Y
Zhang
Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China.
Guangming
G
Zhu
D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D010539:Permeability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D014057:Tomography, X-Ray Computed