Open AccessGlobal White Matter Hypoperfusion on CT Predicts Larger Infarcts and Hemorrhagic Transformation after Acute Ischemia
Author(s) -
Bivard Andrew,
Cheng Xin,
Lin LongTing,
Levi Christopher,
Spratt Neil,
Kleinig Tim,
O'Brien Billy,
Butcher Kenneth,
Lou Min,
Zhang JingFen,
Sylaja PN,
Cao WenJie,
Jannes Jim,
Dong Qiang,
Parsons Mark
Publication year - 2016
Publication title -
cns neuroscience and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.403
H-Index - 69
eISSN - 1755-5949
pISSN - 1755-5930
DOI - 10.1111/cns.12491
Subject(s) - medicine , thrombolysis , perfusion , stroke (engine) , cardiology , white matter , magnetic resonance imaging , perfusion scanning , cerebral blood flow , hyperintensity , brain ischemia , ischemia , infarction , radiology , myocardial infarction , mechanical engineering , engineering
Summary Introduction Presence of white matter hyperintensity ( WMH ) on MRI is a marker of cerebral small vessel disease and is associated with increased small vessel stroke and increased risk of hemorrhagic transformation ( HT ) after thrombolysis. Aim We sought to determine whether white matter hypoperfusion ( WMHP ) on perfusion CT ( CTP ) was related to WMH , and if WMHP predisposed to acute lacunar stroke subtype and HT after thrombolysis. Methods Acute ischemic stroke patients within 12 h of symptom onset at 2 centers were prospectively recruited between 2011 and 2013 for the International Stroke Perfusion Imaging Registry. Participants routinely underwent baseline CT imaging, including CTP , and follow‐up imaging with MRI at 24 h. Results Of 229 ischemic stroke patients, 108 were Caucasians and 121 Chinese. In the contralateral white matter, patients with acute lacunar stroke had lower cerebral blood flow ( CBF ) and cerebral blood volume ( CBV ), compared to those with other stroke subtypes ( P = 0.041). There were 46 patients with HT , and WMHP was associated with increased risk of HT ( R 2 = 0.417, P = 0.002). Compared to previously reported predictors of HT , WMHP performed better than infarct core volume ( R 2 = 0.341, P = 0.034), very low CBV volume ( R 2 = 0.249, P = 0.026), and severely delayed perfusion (Tmax>14 second R 2 = 0.372, P = 0.011). Patients with WMHP also had larger acute infarcts and increased infarct growth compared to those without WMHP (mean 28 mL vs. 13 mL P < 0.001). Conclusion White matter hypoperfusion remote to the acutely ischemic region on CTP is a marker of small vessel disease and was associated with increased HT , larger acute infarct cores, and greater infarct growth.