Sulcal Hyperintensity on Fluid-Attenuated Inversion Recovery Imaging in Acute Ischemic Stroke Patients Treated With Intra-Arterial Thrombolysis

Kim, Eung Yeop; Kim, Sam Soo; Na, Dong Gyu; Roh, Hong Gee; Ryoo, Jae Wook; Kim, Ho Kyun

doi:10.1097/01.rct.0000155669.05643.49

Cited by 25 publications

(21 citation statements)

References 14 publications

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“…There is a significant difference in the frequencies of HTs between CT-and GRE-based studies; HTs on CT have been reported to range between 25% and 37% 3,9,23,24 l however, they are more commonly observed on GRE ranging between 37% to 43% (Supplemental Table I). 11,[25][26][27][28] The frequencies of HTs in the present data were consistent with those of previous GRE-based studies.…”

Section: Discussion the Frequencies Of Ht Types On Gresupporting

confidence: 82%

Impact of Baseline Tissue Status (Diffusion-Weighted Imaging Lesion) Versus Perfusion Status (Severity of Hypoperfusion) on Hemorrhagic Transformation

Bang

Liebeskind

Ovbiagele

et al. 2010

Stroke

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for the UCLA-Samsung Stroke CollaboratorsBackground and Purpose-The frequency of hemorrhagic transformation (HT) on gradient echo imaging and its impact on stroke outcomes continues to be debated. We investigated the factors associated with HTs and the influence of the HTs observed on gradient echo imaging on the early course after a stroke. Methods-We analyzed the data from a prospectively maintained registry of patients who were eligible for recanalization therapy. Serial diffusion-weighted imaging and perfusion-weighted imaging were performed, and HTs were assessed on follow-up gradient echo imaging. Tmax perfusion lesion maps were generated and hypoperfused regions were divided into severe (Tmax Ն8 seconds) delay and mild (Tmax Ն2 seconds but Tmax Ͻ8 seconds) delay. The factors associated with HTs, including the mode of recanalization therapy, pretreatment diffusion-weighted imaging and perfusionweighted imaging lesion volumes, and reperfusion indices, were evaluated. The early clinical outcome was assessed during the first 7 days of admission. Results-A total of 184 patients were included in this study. HTs were noted in 73 (39.7%) patients. Multiple logistic regression analysis identified aggressive treatment (OR, 5.12; 95% CI, 1.73 to 15.18) and a large area of severe perfusion delay (OR for highest quartile of Tmax Ͼ8 seconds, 12.91; 95% CI, 3.69 to 45.17) as independent predictors of HTs. Neither risk factor profiles nor diffusion-weighted imaging lesion volumes were associated with HTs. There was a poor correlation between the radiological (HT types) and clinical (asymptomatic or symptomatic) categories of HTs. Even a parenchymal hematoma was not always associated with symptomatic worsening or affected the early clinical outcomes. Conclusion-The results of this study indicate that the perfusion status (severe perfusion delay) rather than the tissue status (diffusion-weighted imaging lesions) and aggressive treatment were independently associated with HTs. HT on gradient echo imaging was common but usually associated with severe hypoperfusion and not always associated with clinical deterioration. (Stroke. 2010;41:e135-e142.)

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Section: Discussion the Frequencies Of Ht Types On Gresupporting

confidence: 82%

Impact of Baseline Tissue Status (Diffusion-Weighted Imaging Lesion) Versus Perfusion Status (Severity of Hypoperfusion) on Hemorrhagic Transformation

Bang

Liebeskind

Ovbiagele

et al. 2010

Stroke

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“…The limited number of patients precluded further stratification of the hemorrhagic infarction and parenchymal hematoma groups into subgroups. MR imaging has also been used to study BBB breakdown in patients with acute stroke (35)(36)(37). In particular, Latour et al (35) found the hyperintense acute reperfusion marker (HARM) to be a useful early marker of BBB breakdown in their MR-based natural history examination of acute stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Transformation of Ischemic Stroke: Prediction with CT Perfusion

Aviv

d’Esterre²,

Murphy³

et al. 2009

Radiology

151

112

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Purpose:To determine whether admission computed tomography (CT) perfusion-derived permeability-surface area product (PS) maps differ between patients with hemorrhagic acute stroke and those with nonhemorrhagic acute stroke. Materials and Methods:This prospective study was institutional review board approved, and all participants gave written informed consent. Forty-one patients who presented with acute stroke within 3 hours after stroke symptom onset underwent two-phase CT perfusion imaging, which enabled PS measurement. Patients were assigned to groups according to whether they had hemorrhage transformation (HT) at follow-up magnetic resonance (MR) imaging and CT and/or whether they received tissue plasminogen activator (TPA) treatment. Clinical, demographic, and CT perfusion variables were compared between the HT and non-HT patient groups. Associations between PS and HT were tested at univariate and multivariate logistic regression analyses and receiver operating characteristic (ROC) analysis. Results:HT developed in 23 (56%) patients. Patients with HT had higher National Institutes of Health Stroke Scale (NIHSS) scores (P ϭ .005), poorer outcomes (P ϭ .001), and a higher likelihood of having received TPA (P ϭ .005) compared with patients without HT. Baseline blood flow (P ϭ .17) and blood volume (P ϭ .11) defects and extent of flow reduction (P ϭ .27) were comparable between the two groups. The mean PS for the HT group, 0.49 mL ⅐ min Ϫ1 ⅐ (100 g) Ϫ1 , was significantly higher than that for the non-HT group, 0.09 mL ⅐ min Ϫ1 ⅐ (100 g) Ϫ1 (P Ͻ .0001). PS (odds ratio, 3.5; 95% confidence interval [CI]: 1.69, 7.06; P ϭ .0007) and size of hypoattenuating area at nonenhanced admission CT (odds ratio, 0.4; 95% CI: 0.2, 0.7; P ϭ .002) were the only independent variables associated with HT at stepwise multivariate analysis. The mean area under the ROC curve was 0.918 (95% CI: 0.828, 1.00). The PS threshold of 0.23 mL ⅐ min Ϫ1 ⅐ (100 g) Ϫ1 had 77% sensitivity and 94% specificity for detection of HT. Conclusion:Admission PS measurement appears promising for distinguishing patients with acute stroke who are likely from those who are not likely to develop HT.

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“…14 It has also been described as a diagnostic pitfall in patients undergoing an MR imaging with supplemental oxygen 15 and in those patients who have previously received iodinated contrast material. 16 It can be seen as a susceptibility artifact if there is adjacent metal. A few case reports have described increased signal intensity in the SAS on FLAIR imaging in patients with renal failure who had previously received gadolinium.…”

mentioning

confidence: 99%

Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging Associated with the Clearance Dynamics of Gadolinium Chelate: A Potential Diagnostic Pitfall

Morris¹,

Miller²

2007

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Hyperintense CSF in the subarachnoid space (SAS) on fluid-attenuated inversion recovery (FLAIR) imaging has been reported in numerous pathologic conditions, including subarachnoid hemorrhage, meningitis, meningeal carcinomatosis, superior sagittal thrombosis, adjacent tumors, status epilepticus, and stroke. It has also been reported in otherwise healthy patients undergoing anesthesia with supplemental oxygen. We present a series of 11 patients with hyperintense CSF signal intensity in the SAS on FLAIR imaging after previous administration of gadolinium chelate.

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Sulcal Hyperintensity on Fluid-Attenuated Inversion Recovery Imaging in Acute Ischemic Stroke Patients Treated With Intra-Arterial Thrombolysis

Abstract: In acute ischemic patients treated with intra-arterial thrombolysis, sulcal hyperintensity on FLAIR imaging may be caused by iodinated contrast medium, which should not be considered SAH. Sulcal hyperintensity is significantly associated with subsequent HT.

Cited by 25 publications

References 14 publications

Impact of Baseline Tissue Status (Diffusion-Weighted Imaging Lesion) Versus Perfusion Status (Severity of Hypoperfusion) on Hemorrhagic Transformation

Impact of Baseline Tissue Status (Diffusion-Weighted Imaging Lesion) Versus Perfusion Status (Severity of Hypoperfusion) on Hemorrhagic Transformation

Hemorrhagic Transformation of Ischemic Stroke: Prediction with CT Perfusion

Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging Associated with the Clearance Dynamics of Gadolinium Chelate: A Potential Diagnostic Pitfall

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