Selim Magdy, Fink John N, Kumar Sandeep, Caplan Louis R, Horkan Clare, Chen Yi, Linfante Italo, Schlaug Gottfried
Department of Neurology, Division of Cerebrovascular Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass 02215, USA.
Stroke. 2002 Aug;33(8):2047-52. doi: 10.1161/01.str.0000023577.65990.4e.
Hemorrhagic transformation (HT) is a potentially dangerous complication of thrombolytic therapy. Recent studies suggest that diffusion-weighted MRI (DWI) can help to predict the risk of intracerebral hemorrhage (ICH) after thrombolysis. We sought to examine which pretreatment DWI parameters and clinical data are predictive of ICH after intravenous thrombolysis.
We retrospectively reviewed our prospective stroke database for patients with ischemic stroke treated with intravenous recombinant tissue plasminogen activator (rtPA) within 3 hours from symptom onset who had DWI before treatment and MRI with T2* sequence or CT 24 to 48 hours later to assess for ICH over the past 4 years. We measured the volumes and voxel-by-voxel apparent diffusion coefficient (ADC) values of the initial DWI lesions and retrieved demographic data, risk factors, National Institutes of Health Stroke Scale (NIHSS) scores on admission, and blood tests results. We examined several variables using univariate and multivariate regression analyses to determine predictors of ICH.
Twenty-nine patients fulfilled our inclusion criteria; 17 patients (58%) had ICH, and of these 4 (13%) had symptomatic ICH and fatal outcome. On univariate analysis, higher systolic blood pressure, NIHSS score, serum glucose level, volume of initial DWI lesion, and absolute number of voxels with ADC value < or =550x10(-6) mm2/s were statistically associated with ICH, and all were subjected to multivariate analysis. However, only the absolute number of voxels, ie, volume of ischemic tissue on DWI, with ADC < or =550x10(-6) mm2/s emerged as an independent predictor of ICH.
Our findings suggest that volumetric ADC analysis can be used to assess ICH risk after thrombolysis. This may be particularly helpful if rtPA is to be given outside the 3-hour window.
出血性转化（HT）是溶栓治疗的一种潜在危险并发症。近期研究表明，弥散加权磁共振成像（DWI）有助于预测溶栓后脑出血（ICH）的风险。我们旨在研究哪些治疗前DWI参数和临床数据可预测静脉溶栓后的ICH。
我们回顾性分析了前瞻性卒中数据库，该数据库纳入了症状发作3小时内接受静脉重组组织型纤溶酶原激活剂（rtPA）治疗的缺血性卒中患者，这些患者在治疗前进行了DWI检查，并在24至48小时后进行了T2*序列MRI或CT检查以评估ICH情况，时间跨度为过去4年。我们测量了初始DWI病变的体积和逐像素表观扩散系数（ADC）值，并获取了人口统计学数据、危险因素、入院时美国国立卫生研究院卒中量表（NIHSS）评分以及血液检查结果。我们使用单因素和多因素回归分析来研究多个变量，以确定ICH的预测因素。
29例患者符合我们的纳入标准；17例患者（58%）发生了ICH，其中4例（13%）出现症状性ICH并导致致命结局。单因素分析显示，较高的收缩压、NIHSS评分、血清葡萄糖水平、初始DWI病变体积以及ADC值≤550×10⁻⁶mm²/s的体素绝对数量与ICH在统计学上相关，所有这些因素均纳入多因素分析。然而，只有ADC值≤550×10⁻⁶mm²/s的体素绝对数量，即DWI上的缺血组织体积，成为ICH的独立预测因素。
我们的研究结果表明，体积性ADC分析可用于评估溶栓后的ICH风险。如果要在3小时时间窗之外给予rtPA，这可能会特别有帮助。
