title: Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy.
abstract: Patients with acute ischemic stroke are at increased risk of developing parenchymal hemorrhage (PH), particularly in the setting of reperfusion therapies. We have developed a predictive model to examine the risk of PH using combined magnetic resonance perfusion and diffusion parameters, including cerebral blood volume (CBV), apparent diffusion coefficient, and microvascular permeability (K2).
  
  
  
  Voxel-based values of CBV, K2, and apparent diffusion coefficient from the ischemic core were obtained using pretreatment magnetic resonance imaging data from patients enrolled in the MR RESCUE clinical trial (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy). The associations between PH and extreme values of imaging parameters were assessed in univariate and multivariate analyses. Receiver-operating characteristic curve analysis was performed to determine the optimal parameter(s) and threshold for predicting PH.
  
  
  
  In 83 patients included in this analysis, 20 developed PH. Univariate analysis showed significantly lower 10th percentile CBV and 10th percentile apparent diffusion coefficient values and significantly higher 90th percentile K2 values within the infarction core of patients with PH. Using classification tree analysis, the 10th percentile CBV at threshold of 0.47 and 90th percentile K2 at threshold of 0.28 resulted in overall predictive accuracy of 88.7%, sensitivity of 90.0%, and specificity of 87.3%, which was superior to any individual or combination of other classifiers.
  
  
  
  Our results suggest that combined 10th percentile CBV and 90th percentile K2 is an independent predictor of PH in patients with acute ischemic stroke with diagnostic accuracy superior to individual classifiers alone. This approach may allow risk stratification for patients undergoing reperfusion therapies.
  
  
  
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT00389467.
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.). kambiznael@gmail.com.
authors.forename: Kambiz
authors.initials: K
authors.lastname: Nael
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: James R
authors.initials: JR
authors.lastname: Knitter
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Reza
authors.initials: R
authors.lastname: Jahan
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Jeffery
authors.initials: J
authors.lastname: Gornbein
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ajani
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Lei
authors.initials: L
authors.lastname: Feng
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Brett C
authors.initials: BC
authors.lastname: Meyer
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yoo
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Dileep R
authors.initials: DR
authors.lastname: Yavagal
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Judy
authors.initials: J
authors.lastname: Guzy
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Sidney
authors.initials: S
authors.lastname: Starkman
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Saver
authors.affiliation: From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (K.N.); the Departments of Neurology and Radiology, University of Arizona, Tucson (J.R.K., C.S.K.); the Departments of Radiology and Neurosurgery (R.J.), Biomathematics (J. Gornbein), Neurology (D.S.L., J.L.S.), and Emergency Medicine and Neurology (J. Guzy, S.S.), University of California, Los Angeles; the Departments of Neurology (Z.A.) and Radiology (L.F.), Kaiser Permanente, Los Angeles, CA; the Departments of Neurosciences and the Stroke Center University of California, San Diego (B.C.M.); the Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston (L.H.S.); Texas Stroke Institute, Dallas (A.J.Y.); the Departments of Neurology (R.S.M.) and Neurological Surgery and Radiology (P.M.M.), Columbia University College of Physicians and Surgeons, New York, NY; the Departments of Neurology and Neurosurgery, University of Miami, Jackson Memorial Hospital, FL (D.R.Y.); and the Departments of Radiology and Neurology Stanford University, CA (M.W.).
authors.forename: Chelsea S
authors.initials: CS
authors.lastname: Kidwell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume / Q000502:physiology; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology; D002560:Cerebrovascular Circulation / Q000502:physiology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D015424:Reperfusion / Q000379:methods; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: biomarkers; embolectomy; hemorrhage; permeability; stroke