Infarct-core CT perfusion parameters in predicting post-thrombolysis hemorrhagic transformation of acute ischemic stroke

• Published in: Radiology and oncology Vol. 53; no. 1; pp. 25 - 30
• Main Authors: Langel, Crt, Popovic, Katarina Surlan
• Format: Journal Article
• Language: English; Slovenian
• Published: Poland Sciendo 01.03.2019; De Gruyter Poland
• Subjects: acute ischemic stroke; Blood flow; Blood volume; Cerebral blood flow; Computed tomography; computed tomography perfusion; Hemorrhage; hemorrhagic transformation; infarct core; Intravenous administration; Ischemia; Medical imaging; Parameters; Patients; Perfusion; Predictions; Reperfusion; Signs and symptoms; Stroke; Thrombolysis; Transit time; computed tomography perfusion; infarct core; hemorrhagic transformation; acute ischemic stroke
• ISSN: 1581-3207; 1318-2099; 1581-3207; 0485-893X
• DOI: 10.2478/raon-2018-0048

Intravenous thrombolysis (IVT) is the method of choice in reperfusion treatment of patients with signs and symptoms of acute ischemic stroke (AIS) lasting less than 4.5 hours. Hemorrhagic transformation (HT) of acute ischemic stroke is a serious complication of IVT and occurs in 4.5-68.0% of clinical cases. The aim of our study was to determine the infarct core CT perfusion parameter (CTPP) most predictive of HT. Seventy-five patients with AIS who had undergone CT perfusion (CTP) imaging and were treated with IVT were enrolled in this retrospective study. Patients with and without HT after IVT were defined as cases and controls, respectively. Controls were found by matching for time from AIS symptom onset to IVT ± 0.5 h. The following CTPPs were measured: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), relative CBF (rCBF) and relative CBV (rCBV). Receiver operating characteristic analysis curves of significant CTPPs determined cut-off values that best predict HT. There was a significant difference between cases and controls for CBF (p = 0.004), CBV (p = 0.009), rCBF (p < 0.001) and rCBV (p = 0.001). Receiver operating characteristic analysis revealed that rCBF < 4.5% of the contralateral mean (area under the curve = 0.736) allowed prediction of HT with a sensitivity of 71.0% and specificity of 52.5%. CTP imaging has a considerable role in HT prediction, assisting in selection of patients that are likely to benefit from IVT. rCBF proved to have the highest HT predictive value.