Musmar Basel, M Roy Joanna, Abdalrazeq Hammam, Pedapati Vinay, A Fuleihan Antony, Koduri Sravanthi, Sizdahkhani Saman, Atallah Elias, Karadimas Spyridon, I Tjoumakaris Stavropoula, Gooch Michael Reid, H Rosenwasser Robert, Jabbour Pascal
Thomas Jefferson University Hospital, Philadelphia, USA.
Neuroradiology. 2025 May 13. doi: 10.1007/s00234-025-03638-6.
Hemorrhagic transformation (HT) following mechanical thrombectomy (MT) is a critical concern in the management of ischemic stroke patients. While both CT and MRI are used to detect HT, the clinical implications of discrepancies between these modalities remain unclear. This study aims to investigate the clinical implications of discordant findings between gradient echo MRI and CT in detecting HT after MT.
In this retrospective study, patients who underwent MT for ischemic stroke between 2016 and 2023 were analyzed. Patients were categorized into two groups based on imaging results: CT negative and MRI positive versus CT positive and MRI positive.
A total of 286 patients were included in the study, with 104 in the CT negative and MRI positive group and 182 in the CT positive and MRI positive group. More patients in the CT negative and MRI positive group were started on antithrombotic medications in less than 2 days compared to the patients in the CT positive and MRI positive group (47.3% vs. 34.5%; OR: 1.94, 95% CI: 0.88-4.27, p = 0.09) and still exhibited significantly higher rates of good functional outcomes (mRS 0-2) at discharge (OR: 3.27, 95% CI: 1.03-10.36, p = 0.04). Additionally, the CT negative and MRI positive group had a lower, though not statistically significant, likelihood of readmission for diagnosis of intracranial hemorrhage (ICH) within 30 days (0% vs. 2.7%, p = 0.16).
Gradient echo MRI can detect subtle hemorrhages not seen on CT, and both modalities offer complementary insights. In our cohort of MRI-positive patients, those with CT-negative findings had better functional outcomes and earlier antithrombotic resumption without increased risk of ICH readmission. These results suggest that in select scenarios, a negative CT may help inform safe antithrombotic management, though this does not diminish the diagnostic value of MRI. Further prospective studies are warranted to establish thresholds for MRI findings and refine clinical protocols post-MT.
机械取栓（MT）后出血转化（HT）是缺血性中风患者管理中的一个关键问题。虽然CT和MRI都用于检测HT，但这些检查方式之间差异的临床意义仍不明确。本研究旨在探讨梯度回波MRI和CT在检测MT后HT时结果不一致的临床意义。
在这项回顾性研究中，分析了2016年至2023年间因缺血性中风接受MT的患者。根据影像学结果将患者分为两组：CT阴性且MRI阳性组与CT阳性且MRI阳性组。
本研究共纳入286例患者，其中CT阴性且MRI阳性组104例，CT阳性且MRI阳性组182例。与CT阳性且MRI阳性组相比，CT阴性且MRI阳性组中更多患者在不到2天内开始使用抗血栓药物（47.3%对34.5%；OR：1.94，95%CI：0.88 - 4.27，p = 0.09），且出院时仍表现出显著更高的良好功能结局（mRS 0 - 2）率（OR：3.27，95%CI：1.03 - 10.36，p = 0.04）。此外，CT阴性且MRI阳性组在30天内因颅内出血（ICH）诊断再次入院的可能性较低，尽管无统计学意义（0%对2.7%，p = 0.16）。
梯度回波MRI可检测到CT上未见的细微出血，两种检查方式提供互补信息。在我们的MRI阳性患者队列中，CT结果为阴性的患者功能结局更好，抗血栓治疗恢复更早，且ICH再次入院风险未增加。这些结果表明，在某些情况下，CT阴性可能有助于指导安全的抗血栓治疗管理，尽管这并不降低MRI的诊断价值。有必要进行进一步的前瞻性研究，以确定MRI结果的阈值并完善MT后的临床方案。
