High-permeability region size on perfusion CT predicts hemorrhagic transformation after intravenous thrombolysis in stroke
Puig, Josep (Institut d'Investigació Biomèdica de Girona)
Blasco, Gerard (Institut d'Investigació Biomèdica de Girona)
Daunis-i-Estadella, Pepus (Universitat de Girona. Departament d'Informàtica, Matemàtica Aplicada i Estadística)
Eendendburg, Cecile van (Institut d'Investigació Biomèdica de Girona)
Carrillo-García, María (Hospital General Universitario Morales Meseguer (Múrcia))
Aboud, Carlos (Hospital Universitari i Politècnic La Fe (València))
Hernández-Pérez, María
Serena, Joaquín (Institut d'Investigació Biomèdica de Girona)
Biarnés, Carles (Institut d'Investigació Biomèdica de Girona)
Nael, Kambiz (Icahn School of Medicine at Mount Sinai (Nova York, Estats Units d'Amèrica))
Liebeskind, David S. (Neurovascular Imaging Research Core and UCLA Stroke Center)
Thomalla, Götz (Department of Neurology, University Medical Centre Hamburg-Eppendorf)
Menon, Bijoy K. (Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary)
Demchuk, Andrew (Calgary Stroke Program, Hotchkiss Brain Institute, University of Calgary)
Wintermark, Max (Department of Radiology, Neuroradiology Division, Stanford University, Palo Alto, California)
Pedraza, Salvador (Institut d'Investigació Biomèdica de Girona)
Castellanos, María del Mar (Instituto de Investigación Biomédica de A Coruña)

Date:	2017
Abstract:	Objective. Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain. We aimed to determine the performance of high-permeability region size on PCT (HPrs- PCT) in predicting HT after intravenous tPA administration in patients with acute stroke. Methods. We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4. 5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT. Results. The study included 156 patients (50% male, median age 75. 5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes,larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0. 84 for HT and 0. 93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0. 77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0. 68, p = 0. 045). Conclusions. HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT.
Grants:	Instituto de Salud Carlos III PI10/01309 Ministerio de Economía y Competitividad PI13/02258 Ministerio de Economía y Competitividad RD12/0014/0001 Ministerio de Economía y Competitividad RD16/0019/0004
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Published in:	PloS one, Vol. 12 Núm. 11 (november 2017) , p. 1-12, ISSN 1932-6203

DOI: 10.1371/journal.pone.0188238
PMID: 29182658

12 p, 2.7 MB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Articles > Research articles
Articles > Published articles