Bang Oh Young, Buck Brian H, Saver Jeffrey L, Alger Jeffry R, Yoon Sa Rah, Starkman Sidney, Ovbiagele Bruce, Kim Doojin, Ali Latisha K, Sanossian Nerses, Jahan Reza, Duckwiler Gary R, Viñuela Fernando, Salamon Noriko, Villablanca J Pablo, Liebeskind David S
Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA.
Ann Neurol. 2007 Aug;62(2):170-6. doi: 10.1002/ana.21174.
Predicting hemorrhagic transformation (HT) is critical in the setting of recanalization therapy for acute stroke. Dedicated magnetic resonance imaging (MRI) sequences for detection of increased blood-brain barrier (BBB) permeability recently have been developed. We evaluated the ability of a novel MRI permeability technique to detect baseline derangements predictive of various forms of HT after recanalization therapy.
We retrospectively analyzed the clinical and pretreatment MRI data on patients undergoing recanalization therapy for acute cerebral ischemia at a university medical center from January 2004 to November 2006. Pretreatment MRI permeability images derived from perfusion source data were compared with posttreatment imaging to evaluate whether baseline BBB permeability derangements may predict HT after recanalization therapy. The use of a novel permeability technique to illustrate BBB derangements was based on the detection of decreased signal intensity at later time points in perfusion MRI acquisition, signifying continued local accumulation of contrast caused by leakage.
Among 32 patients, some degree of HT occurred in 12. Permeability image abnormalities at baseline were present in 7 of 12 patients with HT and none of the 20 patients without HT on follow-up images. The sensitivity of permeability abnormality for parenchymal hematoma was 83%. False-negative findings were noted in five cases, most commonly asymptomatic or minor HT after mechanical clot retrieval.
Permeability images derived from pretreatment perfusion MRI source data may identify patients at risk for HT with high specificity. Our preliminary demonstration of permeability imaging based on standard perfusion data for prediction of hemorrhage merits further study with dedicated MRI BBB permeability acquisitions and multicenter validation.
在急性卒中再通治疗中，预测出血性转化（HT）至关重要。最近已开发出用于检测血脑屏障（BBB）通透性增加的专用磁共振成像（MRI）序列。我们评估了一种新型MRI通透性技术检测基线紊乱的能力，这种紊乱可预测再通治疗后各种形式的HT。
我们回顾性分析了2004年1月至2006年11月在一所大学医学中心接受急性脑缺血再通治疗患者的临床和治疗前MRI数据。将源自灌注源数据的治疗前MRI通透性图像与治疗后成像进行比较，以评估基线BBB通透性紊乱是否可预测再通治疗后的HT。使用一种新型通透性技术来说明BBB紊乱是基于在灌注MRI采集中较晚时间点检测到信号强度降低，这表明由于渗漏导致对比剂持续局部积聚。
32例患者中，12例出现了某种程度的HT。12例发生HT的患者中有7例在基线时存在通透性图像异常，而20例未发生HT的患者在随访图像中均未出现异常。实质血肿通透性异常的敏感性为83%。有5例出现假阴性结果
