Advanced Imaging Improves Prediction of Hemorrhage after Stroke Thrombolysis

Show simple item record Campbell, BCV en Christensen, S en Parsons, M en Churilov, L en Desmond, PM en Barber, Peter en Butcher, KS en Levi, CR en De Silva, DA en Lansberg, MG en Mlynash, M en Olivot, JM en Straka, M en Bammer, R en Albers, GW en Donnan, GA en Davis, SM en 2016-06-29T00:40:21Z en 2013-04 en
dc.identifier.citation Annals of Neurology, 2013, 73 (4), pp. 510 - 519 en
dc.identifier.issn 0364-5134 en
dc.identifier.uri en
dc.description.abstract Objective: Very low cerebral blood volume (VLCBV), diffusion, and hypoperfusion lesion volumes have been proposed as predictors of hemorrhagic transformation following stroke thrombolysis. We aimed to compare these parameters, validate VLCBV in an independent cohort using DEFUSE study data, and investigate the interaction of VLCBV with regional reperfusion. Methods: The EPITHET and DEFUSE studies obtained diffusion and perfusion magnetic resonance imaging (MRI) in patients 3 to 6 hours from onset of ischemic stroke. EPITHET randomized patients to tissue plasminogen activator (tPA) or placebo, and all DEFUSE patients received tPA. VLCBV was defined as cerebral blood volume<2.5th percentile of brain contralateral to the infarct. Parenchymal hematoma (PH) was defined using European Cooperative Acute Stroke Study criteria. Reperfusion was assessed using subacute perfusion MRI coregistered to baseline imaging. Results: In DEFUSE, 69 patients were analyzed, including 9 who developed PH. The >2 ml VLCBV threshold defined in EPITHET predicted PH with 100% sensitivity, 72% specificity, 35% positive predictive value, and 100% negative predictive value. Pooling EPITHET and DEFUSE (163 patients, including 23 with PH), regression models using VLCBV (p<0.001) and tPA (p=0.02) predicted PH independent of clinical factors better than models using diffusion or time to maximum>8 seconds lesion volumes. Excluding VLCBV in regions without reperfusion improved specificity from 61 to 78% in the pooled analysis. Interpretation: VLCBV predicts PH after stroke thrombolysis and appears to be a more powerful predictor than baseline diffusion or hypoperfusion lesion volumes. Reperfusion of regions of VLCBV is strongly associated with post-thrombolysis PH. VLCBV may be clinically useful to identify patients at significant risk of hemorrhage following reperfusion. en
dc.description.uri en
dc.publisher Wiley en
dc.relation.ispartofseries Annals of Neurology 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 en
dc.rights.uri en
dc.title Advanced Imaging Improves Prediction of Hemorrhage after Stroke Thrombolysis en
dc.type Journal Article en
dc.identifier.doi 10.1002/ana.23837 en
pubs.issue 4 en
pubs.begin-page 510 en
pubs.volume 73 en
dc.rights.holder Copyright: American Neurological Association en
dc.identifier.pmid 23444008 en en
pubs.end-page 519 en
dc.rights.accessrights en
pubs.subtype Article en
pubs.elements-id 366333 en Medical and Health Sciences en School of Medicine en Medicine Department en
dc.identifier.eissn 1531-8249 en
pubs.record-created-at-source-date 2012-12-03 en
pubs.dimensions-id 23444008 en

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