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Predicting intracerebral hemorrhage by baseline magnetic resonance imaging in stroke patients undergoing systemic thrombolysis.

Hobohm C, Fritzsch D, Budig S, Classen J, Hoffmann KT, Michalski D - Acta Neurol. Scand. (2014)

Bottom Line: 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).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Leipzig, Leipzig, Germany.

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Exemplary scans from 3 ischemic stroke patients using magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) prior to systemic thrombolysis within 3 h after symptom onset. While pre-treatment MRI (T2*) was used to exclude primary hemorrhage, a computed tomography (CT) – performed within 24 after treatment – served to detect bleeding. FLAIR-positive lesions seen prior to systemic thrombolysis were associated with treatmentrelated intracerebral hemorrhage.
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fig01: Exemplary scans from 3 ischemic stroke patients using magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) prior to systemic thrombolysis within 3 h after symptom onset. While pre-treatment MRI (T2*) was used to exclude primary hemorrhage, a computed tomography (CT) – performed within 24 after treatment – served to detect bleeding. FLAIR-positive lesions seen prior to systemic thrombolysis were associated with treatmentrelated intracerebral hemorrhage.

Mentions: Representative scans from consecutive MRI and CT scans are shown in Fig.1. ICH was detected in 20 of 25 patients (80%) exhibiting FLAIR-positive lesions, while tPA administration did not result in any bleeding complication in only five patients (20%) of this group (Fig.2). Remarkably, hemorrhage was present in only 12 of 72 FLAIR-negative patients (16.7%). Statistical testing using Fisher's exact test confirmed an increased risk of tPA-related bleeding complications in patients characterized by FLAIR-positive lesions on pretreatment MRI (P < 0.001, specificity 92%, sensitivity 63%). The odds ratio of suffering from treatment-associated hemorrhage in FLAIR-positive patients was 20.0 (95% CI: 6.3–63.8), while the positive predictive value achieved 0.8 and the negative predictive value 0.83. However, in patients with FLAIR-positive lesions intracranial hemorrhage was not more frequently associated with clinical deterioration (six of 20 patients with bleeding complications, 30.0%) when compared with FLAIR-negative patients (five of 12 patients with bleeding complications, 41.6%; P = 0.703, Fisher's exact test). The rate of severe bleedings (PH-2) was not higher in patients with FLAIR-positive lesions than in FLAIR-negative patients (P = 0.144, Fisher's exact test). As an additional finding, in some cases bleeding occurred at locations outside of the FLAIR-positive region. In all of these cases, however, bleeding was also located within diffusion-restricted areas (see also Fig.1).


Predicting intracerebral hemorrhage by baseline magnetic resonance imaging in stroke patients undergoing systemic thrombolysis.

Hobohm C, Fritzsch D, Budig S, Classen J, Hoffmann KT, Michalski D - Acta Neurol. Scand. (2014)

Exemplary scans from 3 ischemic stroke patients using magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) prior to systemic thrombolysis within 3 h after symptom onset. While pre-treatment MRI (T2*) was used to exclude primary hemorrhage, a computed tomography (CT) – performed within 24 after treatment – served to detect bleeding. FLAIR-positive lesions seen prior to systemic thrombolysis were associated with treatmentrelated intracerebral hemorrhage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4269181&req=5

fig01: Exemplary scans from 3 ischemic stroke patients using magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) prior to systemic thrombolysis within 3 h after symptom onset. While pre-treatment MRI (T2*) was used to exclude primary hemorrhage, a computed tomography (CT) – performed within 24 after treatment – served to detect bleeding. FLAIR-positive lesions seen prior to systemic thrombolysis were associated with treatmentrelated intracerebral hemorrhage.
Mentions: Representative scans from consecutive MRI and CT scans are shown in Fig.1. ICH was detected in 20 of 25 patients (80%) exhibiting FLAIR-positive lesions, while tPA administration did not result in any bleeding complication in only five patients (20%) of this group (Fig.2). Remarkably, hemorrhage was present in only 12 of 72 FLAIR-negative patients (16.7%). Statistical testing using Fisher's exact test confirmed an increased risk of tPA-related bleeding complications in patients characterized by FLAIR-positive lesions on pretreatment MRI (P < 0.001, specificity 92%, sensitivity 63%). The odds ratio of suffering from treatment-associated hemorrhage in FLAIR-positive patients was 20.0 (95% CI: 6.3–63.8), while the positive predictive value achieved 0.8 and the negative predictive value 0.83. However, in patients with FLAIR-positive lesions intracranial hemorrhage was not more frequently associated with clinical deterioration (six of 20 patients with bleeding complications, 30.0%) when compared with FLAIR-negative patients (five of 12 patients with bleeding complications, 41.6%; P = 0.703, Fisher's exact test). The rate of severe bleedings (PH-2) was not higher in patients with FLAIR-positive lesions than in FLAIR-negative patients (P = 0.144, Fisher's exact test). As an additional finding, in some cases bleeding occurred at locations outside of the FLAIR-positive region. In all of these cases, however, bleeding was also located within diffusion-restricted areas (see also Fig.1).

Bottom Line: 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).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Leipzig, Leipzig, Germany.

Show MeSH
Related in: MedlinePlus