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(Stroke. 2008;39:1025.)
© 2008 American Heart Association, Inc.

Research Letters

MRI Detection of Early Blood-Brain Barrier Disruption

Parenchymal Enhancement Predicts Focal Hemorrhagic Transformation After Thrombolysis

Niels Hjort, MD, PhD; Ona Wu, PhD; Mahmoud Ashkanian, MD; Christine Sølling, MD; Kim Mouridsen, PhD; Søren Christensen, MSc; Carsten Gyldensted, MD, PhD; Grethe Andersen, MD, PhD Leif Østergaard, MD, PhD

From the Center of Functionally Integrative Neuroscience (N.H., O.W., M.A., C.S., K.M., S.C., C.G., L.O.), Department of Neuroradiology, Århus University Hospital, Århus C, Denmark; the Department of Neurology (N.H., G.A.), Århus University Hospital, Århus C, Denmark; the Athinoula A Martinos Center for Biomedical Imaging (O.W.), Department of Radiology, Massachusetts General Hospital, Charlestown, Mass.

Correspondence to Niels Hjort, MD, PhD, Center for Functionally Integrative Neuroscience, Århus University Hospital, Nørrebrogade 44, Building 30, 8000 Århus C, Denmark. E-mail niels{at}pet.auh.dk

Abstract

Background and Purpose— Blood-brain barrier disruption may be a predictor of hemorrhagic transformation (HT) in ischemic stroke. We hypothesize that parenchymal enhancement (PE) on postcontrast T1-weighted MRI predicts and localizes subsequent HT.

Methods— In a prospective study, 33 tPA-treated stroke patients were imaged by perfusion-weighted imaging, T1 and FLAIR before thrombolytic therapy and after 2 and 24 hours.

Results— Postcontrast T1 PE was found in 5 of 32 patients (16%) 2 hours post-thrombolysis. All 5 patients subsequently showed HT compared to 11 of 26 patients without PE (P=0.043, specificity 100%, sensitivity 31%), with exact anatomic colocation of PE and HT. Enhancement of cerebrospinal fluid on FLAIR was found in 4 other patients, 1 of which developed HT. Local reperfusion was found in 4 of 5 patients with PE, whereas reperfusion was found in all cases of cerebrospinal fluid hyperintensity.

Conclusions— PE detected 2 hours after thrombolytic therapy predicts HT with high specificity. Contrast-enhanced MRI may provide a tool for studying HT and targeting future therapies to reduce risk of hemorrhagic complications.

Key Words: blood brain barrier • brain infarction • imaging • intracerebral hemorrhage • MRI • thrombolysis