Prediction of Hemorrhagic Transformation in Acute Ischemic Stroke: Role of Diffusion-Weighted Imaging and Early Parenchymal Enhancement
Eung Yeop Kima,c,
Dong Gyu Nac,
Sam Soo Kima,
Kwang Ho Leeb,
Jae Wook Ryooa and
Ho Kyun Kima
a Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
b Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
c Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
d Department of Radiology, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea
View larger version (46K):
[in a new window]
|
FIG 1. A 74-year-old man with right hemiparesis and aphasia. Intravenous r-tPA was administered after nonenhanced CT was performed 2.5 hours after symptom onset.
A, DW image and ADC map obtained 3 hours after CT show ischemic edema in the left MCA territory. TTP, rCBV, and rCBF maps show perfusion abnormality.
B, Gd-enhanced T1-weighted image (T1WI) shows a focal enhancing area in the left basal ganglia (arrow). Follow-up nonenhanced CT scan (NCT) depicts a small parenchymal hematoma in the left basal ganglia that corresponds to the enhancing area.
| |
View larger version (43K):
[in a new window]
|
FIG 2. A 57-year-old woman with right hemiparesis and aphasia. Intravenous r-tPA was administered after nonenhanced CT was performed 1.5 hours after symptom onset.
A, DW image and ADC map obtained 3.7 hours after CT show ischemic edema and perfusion abnormality in the left MCA territory. TTP and rCBF maps show reperfusion in the area of parenchymal enhancement.
B, Gd-enhanced T1-weighted image (Gd-T1WI) shows parenchymal enhancement in the left perisylvian cortex and basal ganglia (arrowheads). Enhancing lesion in the right temporal lobe (white arrow) indicates subacute infarction. Patient had atrial fibrillation and infarction 2 months earlier. Follow-up EPI-GRE image shows focal hemorrhage (hemorrhagic infarct type 1) in only the left basal ganglia (black arrow). No hemorrhage is present in the rest of area of parenchymal enhancement in the left MCA territory and in right temporal lobe on the enhanced T1-weighted image.
| |
