<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_raon-2018-0048_s_006">
<h3>Background</h3>
<p>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.</p></sec>
<sec id="j_raon-2018-0048_s_007">
<h3>Patients and methods</h3>
<p>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.</p>
</sec>
<sec id="j_raon-2018-0048_s_008">
<h3>Results</h3>
<p>There was a significant difference between cases and controls for CBF (p = 0.004), CBV (p = 0.009), rCBF (p &lt; 0.001) and rCBV (p = 0.001). Receiver operating characteristic analysis revealed that rCBF &lt; 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%.</p>
</sec>
<sec id="j_raon-2018-0048_s_009">
<h3>Conclusions</h3>
<p>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.</p>
</sec>
</abstract>

Background
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.

Patients and methods
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.


Results
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%.


Conclusions
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.

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

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
Intravenous thrombolysis (IVT) is the method of choice in reperfusion treatment of patients with signs and symptoms of acute ischemic stroke (AIS)...

	AUC	cut-off value	sensitivity	specificity
CBF [mL/100 g/min]	0.691	0.35	62.0%	35.0%
CBV [mL/100g]	0.676	1.65	68.6%	40.0%
rCBF	0.736	4.5%	71.0%	52.5%
rCBV	0.704	8.5%	71.4%	42.5%

Parameter	Cases	Controls	p value
CBF (mean (SD)) [mL/100 g/min]	0.38 (0.47)	0.98 (1.37)	0.004
CBV (mean (SD)) [mL/100 g]	1.45 (1.7)	3.06 (2.99)	0.009
MTT (mean (SD)) [s]	4.27 (4.00)	4.22 (3.26)	0.718
rCBF (mean (SD))	0.03 (0.05)	0.10 (0.12)	< 0.000
rCBV (mean (SD))	0.07 (0.09)	0.10 (0.12)	0.001
rMTT (mean (SD))	2.47 (2.05)	2.36 (1.65)	0.948

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

Article Category: Research Article

Published Online: Dec 20, 2018

Page range: 25 - 30

Received: Aug 26, 2018

Accepted: Nov 11, 2018

DOI: https://doi.org/10.2478/raon-2018-0048

© 2019 Crt Langel, Katarina Surlan Popovic, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Region of interest (ROI) curve analysis results

Characteristics of study cohort