High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
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High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke. / Puig, Josep; Blasco, Gerard; Daunis-I-Estadella, Pepus; van Eendendburg, Cecile; Carrillo-García, María; Aboud, Carlos; Hernández-Pérez, María; Serena, Joaquín; Biarnés, Carles; Nael, Kambiz; Liebeskind, David S; Thomalla, Götz; Menon, Bijoy K; Demchuk, Andrew; Wintermark, Max; Pedraza, Salvador; Castellanos, Mar.
In: PLOS ONE, Vol. 12, No. 11, 2017, p. e0188238.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
AU - Puig, Josep
AU - Blasco, Gerard
AU - Daunis-I-Estadella, Pepus
AU - van Eendendburg, Cecile
AU - Carrillo-García, María
AU - Aboud, Carlos
AU - Hernández-Pérez, María
AU - Serena, Joaquín
AU - Biarnés, Carles
AU - Nael, Kambiz
AU - Liebeskind, David S
AU - Thomalla, Götz
AU - Menon, Bijoy K
AU - Demchuk, Andrew
AU - Wintermark, Max
AU - Pedraza, Salvador
AU - Castellanos, Mar
PY - 2017
Y1 - 2017
N2 - OBJECTIVE: Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT) in predicting HT after intravenous tPA administration in patients with acute stroke.METHODS: We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT.RESULTS: The study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045).CONCLUSIONS: HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT.
AB - OBJECTIVE: Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT) in predicting HT after intravenous tPA administration in patients with acute stroke.METHODS: We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT.RESULTS: The study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045).CONCLUSIONS: HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT.
KW - Aged
KW - Aged, 80 and over
KW - Female
KW - Humans
KW - Male
KW - Stroke
KW - Thrombolytic Therapy
KW - Tomography, X-Ray Computed
KW - Journal Article
U2 - 10.1371/journal.pone.0188238
DO - 10.1371/journal.pone.0188238
M3 - SCORING: Journal article
C2 - 29182658
VL - 12
SP - e0188238
JO - PLOS ONE
JF - PLOS ONE
SN - 1932-6203
IS - 11
ER -
