Published Online
on February 26, 2004

A more recent version of this article appeared on April 1, 2004

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Submitted on December 19, 2003
Accepted on December 22, 2003

Contrast Enhancement and Contrast Extravasation on Computed Tomography After Intra-Arterial Thrombolysis in Patients With Acute Ischemic Stroke

Woong Yoon MD^*; Jeong Jin Seo MD; Jae Kyu Kim MD; Ki Hyeon Cho MD; Jin Gyoon Park MD; and Heoung Keun Kang MD

From the Departments of Radiology (W.Y., J.J.S., J.K.K., J.G.P., H.K.K.) and Neurology (K.H.C.), Chonnam National University Medical School, Chonnam National University Hospital, Dong-gu, Gwangju, South Korea.

^* To whom correspondence should be addressed. E-mail: radyoon{at}cnuh.com.

Background and Purpose--The goal of this study was to determine the CT findings and clinical consequences of contrast enhancement and contrast extravasation on CT scans obtained after intra-arterial thrombolytic therapy for treatment of acute ischemic stroke.

Methods--Sixty-two patients were treated with intra-arterial thrombolysis. All patients underwent nonenhanced CT scans immediately and 24 hours after thrombolytic therapy. Contrast enhancement was defined as a hyperdense lesion that disappeared on a 24-hour follow-up CT scan. Contrast extravasation was defined as a hyperdense lesion with maximum Hounsfield unit >90 that persisted on a follow-up CT scan. We evaluated the differences in the clinical and radiological data between 3 groups: contrast enhancement, contrast extravasation, and control groups.

Results--Contrast enhancement was found in 14 of 62 patients (22.6%); contrast extravasation was seen in 7 (11.3%). Compared with the control group, the contrast enhancement group had a lower recanalization grade (64.3% versus 34.1%, P=0.048) and a lower incidence of hemorrhagic transformation (14.3% versus 43.9%, P=0.047). The contrast extravasation group had a higher incidence of both hemorrhage (100% versus 43.9%, P=0.006) and symptomatic hemorrhage (100% versus 14.6%, P<0.001) than the control group. Poor outcomes were more frequent in the contrast extravasation group (100% versus 38.9%, P=0.003) than the control group.

Conclusions--Contrast enhancement on CT scans obtained after intra-arterial thrombolysis is usually not associated with hemorrhagic complications. However, contrast extravasation is highly associated with parenchymatous hematoma and should be considered a negative prognostic sign.

Key words: blood-brain barrier • contrast media • stroke, ischemic • thrombolytic therapy • tomography, x-ray computed

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