on February 7, 2008
Published online before print February 7, 2008, doi: 10.1161/STROKEAHA.107.497719
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Submitted on July 4, 2007
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. * To whom correspondence should be addressed. E-mail: niels{at}pet.auh.dk.
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.
Accepted on August 1, 2007
MRI Detection of Early Blood-Brain Barrier Disruption. Parenchymal Enhancement Predicts Focal Hemorrhagic Transformation After Thrombolysis
Niels Hjort MD, PhD*; 
stergaard MD, PhD
Key words: blood brain barrier • brain infarction • imaging • intracerebral hemorrhage • MRI • thrombolysis
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