Increased Blood-Brain Barrier Permeability on Perfusion Computed Tomography Predicts Hemorrhagic Transformation in Acute Ischemic Stroke

Abstract

Background/Purpose: Perfusion computed tomography (CT) is capable of measuring the permeability surface product (PS). PS reflects the permeability of the blood-brain barrier, involved in the pathophysiology of hemorrhagic transformation (HT) of ischemic stroke. The aim of our study was to determine if an increased PS can predict HT. Methods: A total of 86 patients with ischemic stroke were included. They underwent multimodality CT, including the measurement of PS. We compared the clinical and radiological characteristics of patients who developed HT to those who did not, using univariate analysis. Multivariate regression analyses were then used to determine HT predictors. Results: HT was observed in 27 patients (31%). Infarct PS was significantly associated with HT (p = 0.047), as were atrial fibrillation (p = 0.03), admission National Institute of Health Stroke Scale score (p = 0.02), infarct volume (p = 0.0004), presence of large-vessel occlusion (p = 0.0005) and a poorer collateral status (p = 0.003). Using logistic regression modeling, an infarct PS >0.84 ml/100 g/min was an independent predictor of HT (OR 28, 95% CI 1.75-452.98; p = 0.02). Other independent predictors of HT were infarct volume and a history of atrial fibrillation. Conclusions: Our findings suggest thatinfarct PS can be a predictor of HT and may help clinicians to improve patient care around thrombolysis decisions in the acute phase of ischemic stroke.

Computed Tomography Perfusion Derived Blood-Brain Barrier Permeability Does Not Yet Improve Prediction of Hemorrhagic Transformation

“…Several papers also describe a predictive value of BBBP measurements [19-21, 32, 33]. The acquisition and post-processing techniques of assessing BBBP is different in all papers, which makes direct comparison difficult.…”

“…Disturbance of the blood-brain barrier (BBB) has been implicated in HT occurrence and can be measured with CTP [18-21]. This is based on the assumption that leakage of contrast agent into the extravascular space may indicate a disrupted BBB that may more likely evolve into a HT.…”

“…This is based on the assumption that leakage of contrast agent into the extravascular space may indicate a disrupted BBB that may more likely evolve into a HT. However, none of the papers assessing BBB permeability (BBBP) were included in the recent meta-analysis [9, 18-21]. The Patlak model is the most frequently used model to described BBBP but only considers leakage and does not take tissue perfusion into account [22].…”

Imaging predictors of procedural and clinical outcome in endovascular acute stroke therapy

“…This tool can prospectively stratify patients into those who will or will not go on to develop hemorrhagic conversion using a PS threshold of 0.23 mL/min/100 g [57]. Another study observed an odds ratio of 28 for hemorrhagic transformation discriminating with a PS of >0.84 mL/100 g/min [58].…”

Blood–Brain Barrier Imaging in Human Neuropathologies

“…Computed tomography (CT) is the routine clinical test in cases of stroke and has been used to study the occurrence and effect of BBB dysfunction in ischemic stroke (4,30–32). Specifically, dynamic contrast-enhanced CT (DCE-CT) can be used to measure vessel permeability and has been used to correlate BBB dysfunction to post-stroke complications such as hemorrhagic transformation and malignant edema (31,33). …”