title: Prediction of Blood-Brain Barrier Disruption and Intracerebral Hemorrhagic Infarction Using Arterial Spin-Labeling Magnetic Resonance Imaging.
abstract: OBJECTIVE
  Arterial spin-labeling magnetic resonance imaging is sensitive for detecting hyperemic lesions (HLs) in patients with acute ischemic stroke. We evaluated whether HLs could predict blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) in acute ischemic stroke patients.
  
  
  METHODS
  In a retrospective study, arterial spin-labeling was performed within 6 hours of symptom onset before revascularization treatment in 25 patients with anterior circulation large vessel occlusion on baseline magnetic resonance angiography. All patients underwent angiographic procedures intended for endovascular therapy and a noncontrast computed tomography scan immediately after treatment. BBB disruption was defined as a hyperdense lesion present on the posttreatment computed tomography scan. A subacute magnetic resonance imaging or computed tomography scan was performed during the subacute phase to assess HTs. The relationship between HLs and BBB disruption and HT was examined using the Alberta Stroke Program Early Computed Tomography Score locations in the symptomatic hemispheres.
  
  
  RESULTS
  A HL was defined as a region where CBFrelative≥1.4 (CBFrelative=CBFHL/CBFcontralateral). HLs, BBB disruption, and HT were found in 9, 15, and 15 patients, respectively. Compared with the patients without HLs, the patients with HLs had a higher incidence of both BBB disruption (100% versus 37.5%; P=0.003) and HT (100% versus 37.5%; P=0.003). Based on the Alberta Stroke Program Early Computed Tomography Score locations, 21 regions of interests displayed HLs. Compared with the regions of interests without HLs, the regions of interests with HLs had a higher incidence of both BBB disruption (42.8% versus 3.9%; P<0.001) and HT (85.7% versus 7.8%; P<0.001).
  
  
  CONCLUSIONS
  HLs detected on pretreatment arterial spin-labeling maps may enable the prediction and localization of subsequent BBB disruption and HT.
authors.affiliation: From the Department of Neurosurgery (T.N.) and Department of Neurosurgery, Faculty of Medicine (H.T.), University of Miyazaki, Japan; and Departments of Neurosurgery (H.O., S.M.) and Radiology (I.I., K.Y.), Miyakonojo Medical Association Hospital, Japan. takeya.niibo@gmail.com.
authors.forename: Takeya
authors.initials: T
authors.lastname: Niibo
authors.affiliation: From the Department of Neurosurgery (T.N.) and Department of Neurosurgery, Faculty of Medicine (H.T.), University of Miyazaki, Japan; and Departments of Neurosurgery (H.O., S.M.) and Radiology (I.I., K.Y.), Miyakonojo Medical Association Hospital, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Ohta
authors.affiliation: From the Department of Neurosurgery (T.N.) and Department of Neurosurgery, Faculty of Medicine (H.T.), University of Miyazaki, Japan; and Departments of Neurosurgery (H.O., S.M.) and Radiology (I.I., K.Y.), Miyakonojo Medical Association Hospital, Japan.
authors.forename: Shirou
authors.initials: S
authors.lastname: Miyata
authors.affiliation: From the Department of Neurosurgery (T.N.) and Department of Neurosurgery, Faculty of Medicine (H.T.), University of Miyazaki, Japan; and Departments of Neurosurgery (H.O., S.M.) and Radiology (I.I., K.Y.), Miyakonojo Medical Association Hospital, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ikushima
authors.affiliation: From the Department of Neurosurgery (T.N.) and Department of Neurosurgery, Faculty of Medicine (H.T.), University of Miyazaki, Japan; and Departments of Neurosurgery (H.O., S.M.) and Radiology (I.I., K.Y.), Miyakonojo Medical Association Hospital, Japan.
authors.forename: Kazuchika
authors.initials: K
authors.lastname: Yonenaga
authors.affiliation: From the Department of Neurosurgery (T.N.) and Department of Neurosurgery, Faculty of Medicine (H.T.), University of Miyazaki, Japan; and Departments of Neurosurgery (H.O., S.M.) and Radiology (I.I., K.Y.), Miyakonojo Medical Association Hospital, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Takeshima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001812:Blood-Brain Barrier / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002544:Cerebral Infarction; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D016037:Single-Blind Method; D013113:Spin Labels
chemical_list: D013113:Spin Labels
keywords: blood–brain barrier; hemorrhage; infarction; ischemic stroke; perfusion imaging