Regional Very Low Cerebral Blood Volume Predicts Hemorrhagic Transformation Better Than Diffusion-Weighted Imaging Volume and Thresholded Apparent Diffusion Coefficient in Acute Ischemic Stroke

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dc.contributor.author Campbell, BC en
dc.contributor.author Christensen, S en
dc.contributor.author Butcher, K en
dc.contributor.author Gordon, I en
dc.contributor.author Parsons, MW en
dc.contributor.author Desmond, PM en
dc.contributor.author Barber, Peter en
dc.contributor.author Levi, CR en
dc.contributor.author Bladin, CF en
dc.contributor.author De Silva, DA en
dc.contributor.author Donnan, GA en
dc.contributor.author Davis, SM en
dc.contributor.author Investigators, for the EPITHET en
dc.date.accessioned 2012-03-12T02:27:21Z en
dc.date.issued 2010 en
dc.identifier.citation Stroke 41(1):82-88 Jan 2010 en
dc.identifier.issn 0039-2499 en
dc.identifier.uri http://hdl.handle.net/2292/13914 en
dc.description.abstract Background and Purpose— Currently, diffusion-weighted imaging (DWI) lesion volume is the most useful magnetic resonance imaging predictor of hemorrhagic transformation (HT). Preliminary studies have suggested that very low cerebral blood volume (VLCBV) predicts HT. We compared HT prediction by VLCBV and DWI using data from the EPITHET study. Methods— Normal-percentile CBV values were calculated from the nonstroke hemisphere. Whole-brain masks with CBV thresholds of the <0, 2.5, 5, and 10th percentiles were created. The volume of tissue with VLCBV was calculated within the acute DWI ischemic lesion. HT was graded as per ECASS criteria. Results— HT occurred in 44 of 91 patients. Parenchymal hematoma (PH) occurred in 13 (4 symptomatic) and asymptomatic hemorrhagic infarction (HI) in 31. The median volume of VLCBV was significantly higher in cases with PH. VLCBV predicted HT better than DWI lesion volume and thresholded apparent diffusion coefficient lesion volume in receiver operating characteristic analysis and logistic regression. A cutpoint at 2 mL VLCBV with the <2.5th percentile had 100% sensitivity for PH and, in patients treated with tissue plasminogen activator, defined a population with a 43% risk of PH (95% CI, 23% to 66%, likelihood ratio=16). VLCBV remained an independent predictor of PH in multivariate analysis with traditional clinical risk factors for HT. Conclusions— VLCBV predicted HT after thrombolysis better than did DWI or apparent diffusion coefficient volume in this large patient cohort. The advantage was greatest in patients with smaller DWI volumes. Prediction was better in patients who recanalized. If validated in an independent cohort, the addition of VLCBV to prethrombolysis decision making may reduce the incidence of HT. en
dc.publisher American Heart Association en
dc.relation.ispartofseries Stroke en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. Details obtained from http://www.sherpa.ac.uk/romeo/issn/0039-2499/ en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.title Regional Very Low Cerebral Blood Volume Predicts Hemorrhagic Transformation Better Than Diffusion-Weighted Imaging Volume and Thresholded Apparent Diffusion Coefficient in Acute Ischemic Stroke en
dc.type Journal Article en
dc.identifier.doi 10.1161/STROKEAHA.109.562116 en
pubs.issue 1 en
pubs.begin-page 82 en
pubs.volume 41 en
dc.rights.holder Copyright: American Heart Association en
dc.identifier.pmid 19959537 en
pubs.end-page 88 en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.subtype Article en
pubs.elements-id 87560 en
pubs.org-id Medical and Health Sciences en
pubs.org-id School of Medicine en
pubs.org-id Medicine Department en
pubs.record-created-at-source-date 2010-09-01 en
pubs.dimensions-id 19959537 en


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