Sonia Francesca Calloni1, Pietro Panni2, Francesca Calabrese2, Anna Del Poggio2, Luisa Roveri3, Silvia Squarza4, Guglielmo Carlo Pero4, Aldo Paolucci5, Massimo Filippi3, Andrea Falini2, Nicoletta Anzalone2. 1. Department of Neuroradiology, San Raffaele Scientific Institute and University Hospital, Via Olgettina 60, 20132, Milan, Italy. Calloni.sonia@hsr.it. 2. Department of Neuroradiology, San Raffaele Scientific Institute and University Hospital, Via Olgettina 60, 20132, Milan, Italy. 3. Department of Neurology, San Raffaele Scientific Institute and University Hospital, Milan, Italy. 4. Department of Neuroradiology, Ospedale Niguarda Ca' Granda, Milan, Italy. 5. Diagnostic and Interventional Radiology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Abstract
OBJECTIVES: To investigate the clinical meaning of brain parenchymal computed-tomography hyperdensities (CTHD) in patients treated of anterior circulation acute stroke with reperfusion therapy. METHODS: Patients were retrospectively enrolled from three different hospitals. Brain CT scans were assessed at four time points: We recorded ASPECT scores of pre-treatment CTs, assessed ASPECT scores and the presence of CTHD on post-treatment CTs acquired within 24-30 h and 24-72 h, and examined a one-month CTs follow-up to determine the ischemic evolution of CTHD. We correlated the presence of CTHD with clinical and radiological data to define its predictive and prognostic factors. RESULTS: In total, 165 patients were evaluated. At post-treatment CTs acquired within 24-30 h, 68 (41%) patients showed the presence of CTHD. On post-treatment CTs acquired within 24-72 h, 43 (63%) of the CTHD showed hemorrhagic transformation. Sixty-five (95%) out of the 68 CTHD evolved in a final ischemic brain area. Multivariate statistical analysis identified puncture to recanalization time to be the only independent factors predicting the presence of CTHD (p = 0.045). The presence of CTHD at the first post-treatment CTs was an independent factor for clinical outcome determined with mRS scores at 3-month follow-up (p = 0.05). Outcomes were worse for hemorrhagic transformation at follow-up CTs compared to the ischemic evolution of the CTHD (p = 0.01). CONCLUSIONS: The presence of CTHD at CTs imaging acquired within 24-30 h after reperfusion therapy is an independent prognostic factor of a worse clinical outcome, regardless of its ASPECT score at baseline CTs and of its hemorrhagic evolution.
OBJECTIVES: To investigate the clinical meaning of brain parenchymal computed-tomography hyperdensities (CTHD) in patients treated of anterior circulation acute stroke with reperfusion therapy. METHODS: Patients were retrospectively enrolled from three different hospitals. Brain CT scans were assessed at four time points: We recorded ASPECT scores of pre-treatment CTs, assessed ASPECT scores and the presence of CTHD on post-treatment CTs acquired within 24-30 h and 24-72 h, and examined a one-month CTs follow-up to determine the ischemic evolution of CTHD. We correlated the presence of CTHD with clinical and radiological data to define its predictive and prognostic factors. RESULTS: In total, 165 patients were evaluated. At post-treatment CTs acquired within 24-30 h, 68 (41%) patients showed the presence of CTHD. On post-treatment CTs acquired within 24-72 h, 43 (63%) of the CTHD showed hemorrhagic transformation. Sixty-five (95%) out of the 68 CTHD evolved in a final ischemic brain area. Multivariate statistical analysis identified puncture to recanalization time to be the only independent factors predicting the presence of CTHD (p = 0.045). The presence of CTHD at the first post-treatment CTs was an independent factor for clinical outcome determined with mRS scores at 3-month follow-up (p = 0.05). Outcomes were worse for hemorrhagic transformation at follow-up CTs compared to the ischemic evolution of the CTHD (p = 0.01). CONCLUSIONS: The presence of CTHD at CTs imaging acquired within 24-30 h after reperfusion therapy is an independent prognostic factor of a worse clinical outcome, regardless of its ASPECT score at baseline CTs and of its hemorrhagic evolution.
Authors: O Nikoubashman; F Jablawi; S Dekeyzer; A M Oros-Peusquens; Z Abbas; J Lindemeyer; A E Othman; N J Shah; M Wiesmann Journal: AJNR Am J Neuroradiol Date: 2016-03-31 Impact factor: 3.825