Andrew Bivard1, Xin Cheng2, Long-Ting Lin1, Christopher Levi1, Neil Spratt1, Tim Kleinig3, Billy O'Brien4, Kenneth Butcher5, Min Lou6, Jing-Fen Zhang7, P N Sylaja8, Wen-Jie Cao2, Jim Jannes9, Qiang Dong2, Mark Parsons1. 1. Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia. 2. Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China. 3. Department of Neurology, Royal Adelaide Hospital, Adelaide, NSW, Australia. 4. Department of Neurology, Gosford Hospital, Gosford, NSW, Australia. 5. Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada. 6. Department of Neurology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China. 7. Department of Neurology, Baotou Central Hospital, Baotou, China. 8. Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. 9. Department of Neurology, The Queen Elizabeth Hospital, Adelaide, NSW, Australia.
Abstract
INTRODUCTION: Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation (HT) after thrombolysis. AIM: We sought to determine whether white matter hypoperfusion (WMHP) on perfusion CT (CTP) was related to WMH, and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis. METHODS: Acute ischemic stroke patients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP, and follow-up imaging with MRI at 24 h. RESULTS: Of 229 ischemic stroke patients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow (CBF) and cerebral blood volume (CBV), compared to those with other stroke subtypes (P = 0.041). There were 46 patients with HT, and WMHP was associated with increased risk of HT (R(2) = 0.417, P = 0.002). Compared to previously reported predictors of HT, WMHP performed better than infarct core volume (R(2) = 0.341, P = 0.034), very low CBV volume (R(2) = 0.249, P = 0.026), and severely delayed perfusion (Tmax>14 second R(2) = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). CONCLUSION: White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.
INTRODUCTION: Presence of white matter hyperintensity (WMH) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation (HT) after thrombolysis. AIM: We sought to determine whether white matter hypoperfusion (WMHP) on perfusion CT (CTP) was related to WMH, and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis. METHODS: Acute ischemic strokepatients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP, and follow-up imaging with MRI at 24 h. RESULTS: Of 229 ischemic strokepatients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow (CBF) and cerebral blood volume (CBV), compared to those with other stroke subtypes (P = 0.041). There were 46 patients with HT, and WMHP was associated with increased risk of HT (R(2) = 0.417, P = 0.002). Compared to previously reported predictors of HT, WMHP performed better than infarct core volume (R(2) = 0.341, P = 0.034), very low CBV volume (R(2) = 0.249, P = 0.026), and severely delayed perfusion (Tmax>14 second R(2) = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). CONCLUSION:White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT, larger acute infarct cores, and greater infarct growth.
Authors: Norbert Nighoghossian; Fatima Abbas; Tae-Hee Cho; Ana Filipa Geraldo; Vincent Cottaz; Elie Janecek; Laura Mechtouff; Magali Bischoff; Carlos El Khoury; Anne Marie Schott; Laurent Derex; Marc Hermier; Louis Guy Tisserand; Roxana Amelie; Leila Chamard; Yves Berthezene Journal: Neuroradiology Date: 2016-07-22 Impact factor: 2.804
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