BACKGROUND AND PURPOSE: Thrombolytic treatment of stroke carries the risk of hemorrhagic transformation. Therefore, the potential of MRI for prediction of recombinant tissue plasminogen activator (rtPA)-induced bleeding is explored to identify patients in whom rtPA treatment may provoke such complications. METHODS: Spontaneously hypertensive rats (SHR) (n=9) were submitted to middle cerebral artery (MCA) clot embolism, followed 3 hours later by intra-arterial infusion of 10 mg/kg rtPA. Untreated SHR (n=9) were infused with saline. MRI imaging was performed before treatment and included apparent diffusion coefficient (ADC), T2, and perfusion mapping and contrast enhancement with gadolinium-DTPA. The distribution of intracerebral hemorrhages was studied 3 days later by histological staining. RESULTS: Clot embolism led to the rapid decline of ADC in the territory of the occluded artery. Tissue lesion volume derived from ADC imaging increased by 155+/-69% in the untreated animals and by 168+/-87% in the treated animals (P=NS), determined on the histological sections after 3 days. This same lesion growth in both groups indicated absence of therapeutic effect after 3-hour treatment delay. Hemorrhagic transformations were significantly more frequent in treated SHR (P<0.05). In untreated rats, hemorrhages were found in the border zone of the ischemic territory; in treated animals, hemorrhagic transformations occurred in the ischemic core region. rtPA-induced hemorrhages were predicted by a disturbance of the blood-brain barrier in 3 of 4 animals before treatment by Gd-DTPA contrast enhancement but not by ADC, T2, or perfusion imaging. The region of contrast enhancement colocalized with subsequent bleeding in these animals. CONCLUSIONS: The disturbance of blood-brain barrier but not of other MR parameters allows risk assessment for hemorrhagic transformation induced by subsequent thrombolytic treatment.
BACKGROUND AND PURPOSE: Thrombolytic treatment of stroke carries the risk of hemorrhagic transformation. Therefore, the potential of MRI for prediction of recombinant tissue plasminogen activator (rtPA)-induced bleeding is explored to identify patients in whom rtPA treatment may provoke such complications. METHODS: Spontaneously hypertensiverats (SHR) (n=9) were submitted to middle cerebral artery (MCA) clot embolism, followed 3 hours later by intra-arterial infusion of 10 mg/kg rtPA. Untreated SHR (n=9) were infused with saline. MRI imaging was performed before treatment and included apparent diffusion coefficient (ADC), T2, and perfusion mapping and contrast enhancement with gadolinium-DTPA. The distribution of intracerebral hemorrhages was studied 3 days later by histological staining. RESULTS: Clot embolism led to the rapid decline of ADC in the territory of the occluded artery. Tissue lesion volume derived from ADC imaging increased by 155+/-69% in the untreated animals and by 168+/-87% in the treated animals (P=NS), determined on the histological sections after 3 days. This same lesion growth in both groups indicated absence of therapeutic effect after 3-hour treatment delay. Hemorrhagic transformations were significantly more frequent in treated SHR (P<0.05). In untreated rats, hemorrhages were found in the border zone of the ischemic territory; in treated animals, hemorrhagic transformations occurred in the ischemic core region. rtPA-induced hemorrhages were predicted by a disturbance of the blood-brain barrier in 3 of 4 animals before treatment by Gd-DTPA contrast enhancement but not by ADC, T2, or perfusion imaging. The region of contrast enhancement colocalized with subsequent bleeding in these animals. CONCLUSIONS: The disturbance of blood-brain barrier but not of other MR parameters allows risk assessment for hemorrhagic transformation induced by subsequent thrombolytic treatment.
Authors: Angelika Hoffmann; Jörg Bredno; Michael F Wendland; Nikita Derugin; Jason Hom; Tibor Schuster; Hua Su; Peter T Ohara; William L Young; Max Wintermark Journal: Stroke Date: 2011-06-02 Impact factor: 7.914
Authors: Michal Rozanski; Martin Ebinger; Wolf U Schmidt; Benjamin Hotter; Sandra Pittl; Peter U Heuschmann; Jan G Jungehuelsing; Jochen B Fiebach Journal: Eur Radiol Date: 2010-07-21 Impact factor: 5.315
Authors: Mark Jrj Bouts; Ivo Acw Tiebosch; Umesh S Rudrapatna; Annette van der Toorn; Ona Wu; Rick M Dijkhuizen Journal: J Cereb Blood Flow Metab Date: 2016-01-01 Impact factor: 6.200
Authors: Angelika Hoffmann; Jörg Bredno; Michael F Wendland; Nikita Derugin; Jason Hom; Tibor Schuster; Claus Zimmer; Hua Su; Peter T Ohara; William L Young; Max Wintermark Journal: Transl Stroke Res Date: 2012-09-16 Impact factor: 6.829
Authors: T A Tomsick; L D Foster; D S Liebeskind; M D Hill; J Carrozella; M Goyal; R von Kummer; A M Demchuk; I Dzialowski; V Puetz; T Jovin; H Morales; Y Y Palesch; J Broderick; P Khatri; S D Yeatts Journal: AJNR Am J Neuroradiol Date: 2015-07-30 Impact factor: 3.825