Measuring Elevated Microvascular Permeability and Predicting Hemorrhagic Transformation in Acute Ischemic Stroke Using First-Pass Dynamic Perfusion CT Imaging

• Published in: American journal of neuroradiology : AJNR 2007-08, Vol.28 (7), p.1292-1298
• Main Authors: Lin, K, Kazmi, K.S, Law, M, Babb, J, Peccerelli, N, Pramanik, B.K
• Format: Article
• Language: English
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brain; Brain Ischemia - complications; Brain Ischemia - diagnostic imaging; Capillary Permeability; Cerebral Hemorrhage - diagnostic imaging; Cerebral Hemorrhage - etiology; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Microcirculation - diagnostic imaging; Middle Aged; Nervous system; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Perfusion - methods; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiographic Image Interpretation, Computer-Assisted - methods; Reproducibility of Results; Risk Assessment - methods; Risk Factors; Sensitivity and Specificity; Stroke - complications; Stroke - diagnostic imaging; Tomography, X-Ray Computed - methods
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A0539

Hemorrhagic transformation (HT) can be a devastating complication of acute ischemic stroke (AIS). The purpose of this study was to determine whether increased microvascular permeability (PS) of the blood-brain barrier was detected in early AIS by using first-pass dynamic perfusion CT (PCT) and whether PS was significantly higher in infarcts destined for HT. Fifty patients with AIS less than 3 hours old and evaluated by PCT were included. PS color maps were retrospectively generated from PCT data using the Patlak model. One reader analyzed each PS map by drawing 4 circular 10-mm regions of interest on any focal abnormality. The mean of these 4 regions of interest represented the PS of the infarct (PSinfarct). The mean of 4 mirror regions of interest on the nonischemic contralateral hemisphere was also obtained (PScontrol). PSinfarct and PScontrol were compared by using an exact Wilcoxon test. PSinfarct for infarcts that developed HT on follow-up (PSHT) was compared with all of the others (PSNo-HT) using an exact Mann-Whitney test. Forty-four infarcts (88%) showed focal PS elevation in the region of infarct. In units of milliliters per 100 milliliters per minute, PSinfarct ranged from 0 to 13 (mean: 3.5+/-3.1) versus PScontrol of 0-0.8 (mean: 0.28+/-0.27; P