Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis.
Summary of "Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis."
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 sub-4.5 h tPA patients.
Consecutive acute stroke patients treated with IV tPA <4.5 h after onset who had MRI before and one day after thrombolysis were included. Two raters (blind to HT) independently identified FLAIR hyperintensity with reference to the 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 NIHSS and DWI lesion volume, leukoaraiosis (Wahlund score), serum glucose and reperfusion.
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 (
18; 95% CI 2 to 175, P = 0.013).
Early development of FLAIR hyperintensity within the area of diffusion-restriction is associated with increased risk of HT after thrombolysis in acute stroke patients.
International Graduate Program Medical Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany.
This article was published in the following journal.
Name: European journal of neurology : the official journal of the European Federation of Neurological Societies
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22900825
- DOI: http://dx.doi.org/10.1111/j.1468-1331.2012.03841.x
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