Greer David M, Koroshetz Walter J, Cullen Sean, Gonzalez R Gilberto, Lev Michael H
Department of Neurology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
Stroke. 2004 Feb;35(2):491-5. doi: 10.1161/01.STR.0000114201.11353.C5. Epub 2004 Jan 22.
Unenhanced CT is routinely performed after intra-arterial (IA) thrombolysis. The presence of residual contrast causing staining of injured brain may mimic intracerebral hemorrhage (ICH). We evaluated MRI with diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) for detection of ICH after IA thrombolysis, specifically in equivocal areas of hyperdensity seen on postprocedure CT, to help guide the decision to use anticoagulation or antiplatelet therapy after the IA thrombolysis.
We performed a retrospective analysis of 15 consecutive patients who underwent IA thrombolysis for acute stroke between September 2000 and March 2003. Inclusion criteria required an immediate postprocedure CT with a questionable hyperdensity and, within the next 48 hours, an MRI with DWI and/or SWI.
All patients had CT regions of hyperdensity that were equivocal for the presence of ICH. All patients subsequently underwent DWI, and 11 also underwent SWI. Eleven of 15 patients had magnetic susceptibility-induced hypointensity in DWI hyperintensity regions, signifying the presence of acute deoxyhemoglobin. Nine of these patients also received SWI, which confirmed the presence of blood within these regions. Follow-up CT on all 11 patients confirmed ICH. In the 4 patients without DWI susceptibility change, 0 were found to have ICH on either SWI (performed in 2 patients) or follow-up CT. MRI reliably detected the presence of ICH in all patients, whereas CT failed to differentiate contrast staining from hemorrhage in 4 of the 15 patients.
MRI is an effective means to detect the presence of blood within an equivocal region on post-IA thrombolysis CT. This may influence the decision to use anticoagulation or antiplatelet therapy.
动脉内（IA）溶栓后通常会进行平扫CT检查。残留造影剂导致受伤脑区染色可能会酷似脑出血（ICH）。我们评估了采用扩散加权成像（DWI）和磁敏感加权成像（SWI）的MRI用于检测IA溶栓后的ICH，特别是在术后CT上显示的可疑高密度区域，以帮助指导IA溶栓后使用抗凝或抗血小板治疗的决策。
我们对2000年9月至2003年3月期间连续15例接受IA溶栓治疗急性卒中的患者进行了回顾性分析。纳入标准要求术后立即进行CT检查，显示有可疑高密度影，并在接下来的48小时内进行DWI和/或SWI的MRI检查。
所有患者的CT上均有可疑ICH的高密度区域。所有患者随后均接受了DWI检查，其中11例还接受了SWI检查。15例患者中有11例在DWI高信号区域出现磁敏感诱导的低信号，提示存在急性脱氧血红蛋白。其中9例患者还接受了SWI检查，证实这些区域存在血液。所有11例患者的随访CT均证实为ICH。在4例DWI无磁敏感变化的患者中，SWI（2例患者接受此项检查）或随访CT均未发现ICH。MRI能可靠地检测出所有患者的ICH，而CT在15例患者中有4例未能区分造影剂染色与出血。
MRI是检测IA溶栓后CT上可疑区域内血液存在的有效手段。这可能会影响抗凝或抗血小板治疗的决策。
