BACKGROUND AND PURPOSE: Absence of FLAIR hyperintensity within an acute infarct is associated with stroke onset <4.5 h. However, some patients rapidly develop FLAIR hyperintensity within this timeframe. We hypothesized that development of early infarct FLAIR hyperintensity would predict hemorrhagic transformation (HT) in patients treated with tissue plasminogen activator (tPA) < 4.5 h after onset. METHODS: Consecutive acute stroke patients treated with intravenous tPA <4.5 h after onset who had MRI before and 1 day after thrombolysis were included. Two raters (blind to HT) independently identified FLAIR hyperintensity with reference to the diffusion-weighted image (DWI) lesion. HT was assessed using T2* MRI at 24 h. Hemorrhagic infarction (HI) was defined as petechial HT without mass effect, and parenchymal hematoma (PH) as HT with mass effect. Multivariable logistic regression analysis for HT included FLAIR status, baseline National Institutes of Health Stroke Scale and DWI lesion volume, leukoaraiosis (Wahlund score), serum glucose and reperfusion. RESULTS: Of 109 patients, 33 (30%) had acute FLAIR hyperintensity. HT occurred in 17 patients (15.6%; 15 HI, 2 PH). HT was more common in FLAIR-positive patients than FLAIR-negative patients (33.3% vs. 9.2%, P = 0.009). Median time-to-scan and median time-to-thrombolysis did not differ significantly between patients with HT and without [97 IQR(68, 155) vs. 90 IQR(73, 119), P = 0.5; 120 IQR(99, 185) vs. 125 IQR(95, 150), P = 0.6, respectively]. In multivariable analysis, only FLAIR hyperintensity was independently associated with HT after thrombolysis (OR 18; 95% CI 2-175, P = 0.013). CONCLUSIONS: Early development of FLAIR hyperintensity within the area of diffusion restriction is associated with increased risk of HT after thrombolysis in acute stroke patients.
BACKGROUND AND PURPOSE: Absence of FLAIR hyperintensity within an acute infarct is associated with stroke onset <4.5 h. However, some patients rapidly develop FLAIR hyperintensity within this timeframe. We hypothesized that development of early infarct FLAIR hyperintensity would predict hemorrhagic transformation (HT) in patients treated with tissue plasminogen activator (tPA) < 4.5 h after onset. METHODS: Consecutive acute strokepatients treated with intravenous tPA <4.5 h after onset who had MRI before and 1 day after thrombolysis were included. Two raters (blind to HT) independently identified FLAIR hyperintensity with reference to the diffusion-weighted image (DWI) lesion. HT was assessed using T2* MRI at 24 h. Hemorrhagic infarction (HI) was defined as petechial HT without mass effect, and parenchymal hematoma (PH) as HT with mass effect. Multivariable logistic regression analysis for HT included FLAIR status, baseline National Institutes of Health Stroke Scale and DWI lesion volume, leukoaraiosis (Wahlund score), serum glucose and reperfusion. RESULTS: Of 109 patients, 33 (30%) had acute FLAIR hyperintensity. HT occurred in 17 patients (15.6%; 15 HI, 2 PH). HT was more common in FLAIR-positive patients than FLAIR-negative patients (33.3% vs. 9.2%, P = 0.009). Median time-to-scan and median time-to-thrombolysis did not differ significantly between patients with HT and without [97 IQR(68, 155) vs. 90 IQR(73, 119), P = 0.5; 120 IQR(99, 185) vs. 125 IQR(95, 150), P = 0.6, respectively]. In multivariable analysis, only FLAIR hyperintensity was independently associated with HT after thrombolysis (OR 18; 95% CI 2-175, P = 0.013). CONCLUSIONS: Early development of FLAIR hyperintensity within the area of diffusion restriction is associated with increased risk of HT after thrombolysis in acute strokepatients.
Authors: Michael J Lyerly; J Thomas Houston; Amelia K Boehme; Karen C Albright; Reza Bavarsad Shahripour; Paola Palazzo; Muhammed Alvi; Pawan V Rawal; Niren Kapoor; April Sisson; Anne W Alexandrov; Andrei V Alexandrov Journal: J Stroke Cerebrovasc Dis Date: 2014-03-28 Impact factor: 2.136
Authors: Thomas W K Battey; Mahima Karki; Aneesh B Singhal; Ona Wu; Saloomeh Sadaghiani; Bruce C V Campbell; Stephen M Davis; Geoffrey A Donnan; Kevin N Sheth; W Taylor Kimberly Journal: Stroke Date: 2014-10-21 Impact factor: 7.914
Authors: Ruchira Jha; Thomas W K Battey; Ly Pham; Svetlana Lorenzano; Karen L Furie; Kevin N Sheth; W Taylor Kimberly Journal: Stroke Date: 2014-03-11 Impact factor: 7.914
Authors: Julia Meisterernst; Pascal P Klinger-Gratz; Lars Leidolt; Matthias F Lang; Gerhard Schroth; Pasquale Mordasini; Mirjam R Heldner; Marie-Luise Mono; Rebekka Kurmann; Monika Buehlmann; Urs Fischer; Marcel Arnold; Jan Gralla; Heinrich P Mattle; Marwan El-Koussy; Simon Jung Journal: PLoS One Date: 2017-09-28 Impact factor: 3.240
Authors: Yongwoo Kim; Marie Luby; Nina-Serena Burkett; Gina Norato; Richard Leigh; Clinton B Wright; Kyle C Kern; Amie W Hsia; John K Lynch; Malik M Adil; Lawrence L Latour Journal: Cerebrovasc Dis Date: 2021-07-20 Impact factor: 3.104