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Published Online
on September 4, 2008

Stroke. 2008
Published online before print September 4, 2008, doi: 10.1161/STROKEAHA.108.516740
A more recent version of this article appeared on December 1, 2008
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Submitted on February 6, 2008
Accepted on February 19, 2008

Focal Fluid-Attenuated Inversion Recovery Hyperintensity Within Acute Diffusion-Weighted Imaging Lesions Is Associated With Symptomatic Intracerebral Hemorrhage After Thrombolysis

A-Hyun Cho MD; Jong S. Kim MD; Sang-Joon Kim MD; Sung-Cheol Yun PhD; Choong-Gon Choi MD; Hyoung-Ryoul Kim MD; Sun U. Kwon MD; Deok-Hee Lee MD; Eun-Kyung Kim RN; Dae-Chul Suh MD; and Dong-Wha Kang MD, PhD*

From the Departments of Neurology (A.-H.C., J.S.K., S.U.K., E.-K.K., D.-W.K.), Radiology (S.-J.K., C.-G.C., D.-H.L., D.-C.S.), and Preventive Medicine (S.-C.Y.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; and the Departments of Neurology (A.-H.C.), and Preventive Medicine (H.-R.K.), The Catholic University of Korea, St Mary's Hospital, Seoul, Korea.

* To whom correspondence should be addressed. E-mail: dwkang{at}amc.seoul.kr.

Background and Purpose—We investigated whether focal hyperintensity on fluid-attenuated inversion recovery image within acute infarcts is associated with symptomatic intracerebral hemorrhage (SICH) after thrombolysis.

Methods—Patients with acute ischemic stroke who underwent MRI screening before thrombolysis were enrolled. The presence of focal fluid-attenuated inversion recovery hyperintensity within acute infarcts did not preclude thrombolysis. SICH was defined as hemorrhagic transformation with any neurological decline (SICH-1) or with an increase in National Institutes of Health Stroke Scale of ≥4 (SICH-2) within 48 hours.

Results—Among 88 included patients, focal fluid-attenuated inversion recovery hyperintensity within acute infarct lesions was observed in 27 (30.7%) patients. Multivariate analysis showed that focal fluid-attenuated inversion recovery hyperintensity was independently associated with SICH-1 (OR, 13.64; 95% CI, 1.51 to 123.28) and SICH-2 (OR, 10.44; 95% CI, 1.11 to 98.35).

Conclusion—The presence of focal fluid-attenuated inversion recovery hyperintensity within acute infarcts may increase the risk of symptomatic intracerebral hemorrhage after thrombolysis.
Key words: acute stroke • intracerebral hemorrhage • MRI • thrombolysis






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