(Stroke. 2000;31:2378.)
© 2000 American Heart Association, Inc.
Original Contributions |
Relationship Between Apparent Diffusion Coefficient and Subsequent Hemorrhagic Transformation Following Acute Ischemic Stroke
From the Stanford Stroke Center, Palo Alto, Calif (D.C.T.); Clinica Neurologica, Università di Verona, Verona, Italy (A.A.); and Department of Radiology, Stanford University Medical Center, Stanford, Calif (M.E.M., M.P.M.).
Correspondence to David C. Tong, MD, Stanford Stroke Center, 701 Welch Rd, Suite 325B, Palo Alto, CA 94304. E-mail dct{at}leland.Stanford.edu
Background and Purpose—A method for identifying patients at increased risk for developing secondary hemorrhagic transformation (HT) after acute ischemic stroke could be of significant value, particularly in patients being considered for thrombolytic therapy. We hypothesized that diffusion-weighted MRI might aid in the identification of such patients.
Methods—We retrospectively analyzed 17 patients with ischemic stroke who received diffusion-weighted MRI within 8 hours of symptom onset and who also received follow-up neuroimaging within 1 week of initial scan. The apparent diffusion coefficient (ADC) for each pixel in the whole ischemic area was calculated, generating a histogram of values. Areas subsequently experiencing HT were then compared with areas not experiencing HT to determine the relationship between ADC and subsequent HT.
Results—A significantly greater percentage of pixels possessed
lower ADCs (
550x10-6
mm2/s) in HT lesions compared with non-HT lesions (47%
versus 19%; P<0.001). Moreover, >40% of the pixels
possessed values 550x10-6
mm2/s in all lesions experiencing secondary HT, compared
with <31% of the pixels in the non-HT-destined lesions.
Conclusions—HT-destined stroke regions possess a significantly great percentage of low ADC values than non-HT-destined regions. Early measurement of ADC values may be a useful tool for assessing secondary HT risk.
Key Words: cerebral hemorrhage • magnetic resonance imaging, diffusion-weighted • stroke, acute • thrombolysis
This article has been cited by other articles:
 |
|
 |
|
  L Derex and N Nighoghossian Intracerebral haemorrhage after thrombolysis for acute ischaemic stroke: an update J. Neurol. Neurosurg. Psychiatry, October 1, 2008; 79(10): 1093 - 1099. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G. Lansberg, V. N. Thijs, R. Bammer, S. Kemp, C. A.C. Wijman, M. P. Marks, G. W. Albers, and on behalf of the DEFUSE Investigators Risk Factors of Symptomatic Intracerebral Hemorrhage After tPA Therapy for Acute Stroke Stroke, August 1, 2007; 38(8): 2275 - 2278. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann-Haefelin, S. Hoelig, J. Berkefeld, J. Fiehler, A. Gass, M. Humpich, A. Kastrup, T. Kucinski, O. Lecei, D. S. Liebeskind, et al. Leukoaraiosis Is a Risk Factor for Symptomatic Intracerebral Hemorrhage After Thrombolysis for Acute Stroke Stroke, October 1, 2006; 37(10): 2463 - 2466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The IMS Study Investigators Hemorrhage in the Interventional Management of Stroke Study Stroke, March 1, 2006; 37(3): 847 - 851. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Trouillas and R. von Kummer Classification and Pathogenesis of Cerebral Hemorrhages After Thrombolysis in Ischemic Stroke Stroke, February 1, 2006; 37(2): 556 - 561. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. H. Schwamm, E. S. Rosenthal, C. J. Swap, J. Rosand, G. Rordorf, F. S. Buonanno, M. G. Vangel, W. J. Koroshetz, and M. H. Lev Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1798 - 1803. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Y. Kim, D. G. Na, S. S. Kim, K. H. Lee, J. W. Ryoo, and H. K. Kim Prediction of Hemorrhagic Transformation in Acute Ischemic Stroke: Role of Diffusion-Weighted Imaging and Early Parenchymal Enhancement AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1050 - 1055. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fiehler, K. Knudsen, G. Thomalla, E. Goebell, M. Rosenkranz, C. Weiller, J. Rother, H. Zeumer, and T. Kucinski Vascular Occlusion Sites Determine Differences in Lesion Growth from Early Apparent Diffusion Coefficient Lesion to Final Infarct AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1056 - 1061. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Alsop, E. Makovetskaya, S. Kumar, M. Selim, and G. Schlaug Markedly Reduced Apparent Blood Volume on Bolus Contrast Magnetic Resonance Imaging as a Predictor of Hemorrhage After Thrombolytic Therapy for Acute Ischemic Stroke Stroke, April 1, 2005; 36(4): 746 - 750. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L Derex, M Hermier, P Adeleine, J-B Pialat, M Wiart, Y Berthezene, F Philippeau, J Honnorat, J-C Froment, P Trouillas, et al. Clinical and imaging predictors of intracerebral haemorrhage in stroke patients treated with intravenous tissue plasminogen activator J. Neurol. Neurosurg. Psychiatry, January 1, 2005; 76(1): 70 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fiehler, T. Kucinski, K. Knudsen, M. Rosenkranz, G. Thomalla, C. Weiller, J. Rother, and H. Zeumer Are There Time-Dependent Differences in Diffusion and Perfusion Within the First 6 Hours After Stroke Onset? Stroke, September 1, 2004; 35(9): 2099 - 2104. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Somford, M. P. Marks, V. N. Thijs, and D. C. Tong Association of Early CT Abnormalities, Infarct Size, and Apparent Diffusion Coefficient Reduction in Acute Ischemic Stroke AJNR Am. J. Neuroradiol., June 1, 2004; 25(6): 933 - 938. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Liu, J. O. Karonen, R. L. Vanninen, J. Nuutinen, A. Koskela, S. Soimakallio, and H. J. Aronen Acute Ischemic Stroke: Predictive Value of 2D Phase-Contrast MR Angiography--Serial Study with Combined Diffusion and Perfusion MR Imaging Radiology, May 1, 2004; 231(2): 517 - 527. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. D. Vo, F. Santiago, W. Lin, C. Y. Hsu, Y. Lee, and J.-M. Lee MR Imaging Enhancement Patterns as Predictors of Hemorrhagic Transformation in Acute Ischemic Stroke AJNR Am. J. Neuroradiol., April 1, 2003; 24(4): 674 - 679. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Lin, J.-M. Lee, Y. Z. Lee, K. D. Vo, T. Pilgram, and C. Y. Hsu Temporal Relationship Between Apparent Diffusion Coefficient and Absolute Measurements of Cerebral Blood Flow in Acute Stroke Patients Stroke, January 1, 2003; 34(1): 64 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Selim, J. N. Fink, S. Kumar, L. R. Caplan, C. Horkan, Y. Chen, I. Linfante, and G. Schlaug Predictors of Hemorrhagic Transformation After Intravenous Recombinant Tissue Plasminogen Activator: Prognostic Value of the Initial Apparent Diffusion Coefficient and Diffusion-Weighted Lesion Volume Stroke, August 1, 2002; 33(8): 2047 - 2052. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Moonis and M. Fisher Considering the Role of Heparin and Low-Molecular-Weight Heparins in Acute Ischemic Stroke Stroke, July 1, 2002; 33(7): 1927 - 1933. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, J. Alvarez-Sabin, J. Montaner, S. Abilleira, J. F. Arenillas, P. Coscojuela, F. Romero, and A. Codina Thrombolysis-Related Hemorrhagic Infarction: A Marker of Early Reperfusion, Reduced Infarct Size, and Improved Outcome in Patients With Proximal Middle Cerebral Artery Occlusion Stroke, June 1, 2002; 33(6): 1551 - 1556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Neumann-Haefelin, G. Brinker, U. Uhlenkuken, F. Pillekamp, K-A. Hossmann, and M. Hoehn Prediction of Hemorrhagic Transformation After Thrombolytic Therapy of Clot Embolism: An MRI Investigation in Rat Brain Stroke, May 1, 2002; 33(5): 1392 - 1398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Nighoghossian, M. Hermier, P. Adeleine, K. Blanc-Lasserre, L. Derex, J. Honnorat, F. Philippeau, J.F. Dugor, J.C. Froment, and P. Trouillas Old Microbleeds Are a Potential Risk Factor for Cerebral Bleeding After Ischemic Stroke: A Gradient-Echo T2*-Weighted Brain MRI Study Stroke, March 1, 2002; 33(3): 735 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, J. Montaner, S. Abilleira, B. Ibarra, F. Romero, J. F. Arenillas, and J. Alvarez-Sabin Timing of Spontaneous Recanalization and Risk of Hemorrhagic Transformation in Acute Cardioembolic Stroke Stroke, May 1, 2001; 32(5): 1079 - 1084. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Levine One-Stop Shopping: Stroke Questions Further Answered With Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 555 - 556. [Full Text] [PDF]
|
|
|
|
|
|
D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks Prediction of Hemorrhagic Transformation Following Acute Stroke: Role of Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 587 - 593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Neumann-Haefelin, M. Sitzer, R. du Mesnil de Rochemont, H. Lanfermann, Y. Samson, and C. Oppenheim Prediction of Malignant MCA Infarction With DWI: Pitfalls in Hyperacute Stroke Response Stroke, February 1, 2001; 32 (2): 580 - 583. [Full Text] [PDF]
|
|