Premium
Predicting intracerebral hemorrhage by baseline magnetic resonance imaging in stroke patients undergoing systemic thrombolysis
Author(s) -
Hobohm C.,
Fritzsch D.,
Budig S.,
Classen J.,
Hoffmann K.T.,
Michalski D.
Publication year - 2014
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12272
Subject(s) - thrombolysis , intracerebral hemorrhage , magnetic resonance imaging , medicine , stroke (engine) , cardiology , functional magnetic resonance imaging , radiology , subarachnoid hemorrhage , mechanical engineering , myocardial infarction , engineering
Objectives Intracerebral hemorrhage ( ICH ) remains a serious complication in ischemic stroke patients undergoing systemic thrombolysis. Here, we examined whether the risk of treatment‐associated hemorrhage can be predicted from magnetic resonance imaging ( MRI ) using fluid‐attenuated inversion recovery ( FLAIR ) and diffusion‐weighted imaging ( DWI ) within 3 h after symptom onset. Methods In this single‐center observational study involving 122 ischemic stroke patients between J anuary 2005 and D ecember 2008, the incidence of FLAIR ‐positive lesions within diffusion‐restricted areas was determined on baseline MRI , which was carried out prior to treatment with tissue plasminogen activator (Actilyse ® ) within 3 h from symptom onset. The rate of ICH was assessed by computed tomography performed within 24 h after treatment. Relationships between FLAIR ‐positive lesions, DWI lesion size, proportion of FLAIR/DWI‐positive lesions, and occurrence of bleeding were explored. Results Data from 97 patients were evaluated. FLAIR ‐positive lesions were present in 25 patients (25.8%) and ICH occurred in 32 patients (33.0%). FLAIR ‐positive lesions were associated with a bleeding rate of 80.0% compared with 16.7% in FLAIR ‐negative patients ( P < 0.001; odds ratio 20.0, positive predictive value 0.8). DWI lesion size was significantly correlated with the rate of ICH ( P = 0.001). In contrast, FLAIR / DWI proportion was not associated with ICH ( P = 0.788). Conclusions In ischemic stroke patients within 3 h from symptom onset, the existence of FLAIR ‐positive lesions on pretreatment MRI is significantly associated with an increased bleeding risk due to systemic thrombolysis. Therefore, considering FLAIR ‐positive lesions on baseline MRI might guide treatment decisions in ischemic stroke.