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Hyperdensity on non-contrast CT immediately after intra-arterial revascularization

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Abstract

Non-contrast enhanced computed tomography (NCCT) is usually performed to estimate bleeding complications immediately after procedures. However, hyperdense areas on NCCT have not yet been understood; different interpretations have been reported in the literature. It remains unclear whether NCCT performed immediately after intra-arterial revascularization (IAR) could be useful for predicting hemorrhagic transformation (HT) or clinical outcomes. Therefore, we investigated the diagnostic values of hyperdense areas on NCCT images obtained immediately after IAR. This was a retrospective study of acute ischemic stroke patients who underwent IAR between October 2007 and December 2010. NCCT scans were routinely obtained immediately after IAR and additional follow-up imaging protocols included diffusion weighted imaging (DWI)/gradient echo imaging (GRE) 24 h after IAR. HT was assessed by means of GRE obtained 24 h after IAR. Hounsfield Unit (HU) of the hyperdensity was measured in the manually drawn regions of interest. A total of 68 patients were analyzed in this study. Twenty-nine patients (42.6%) developed HT on follow-up images. Thirty-eight patients had hyperdense areas on NCCT immediately after IAR. Hyperdensity on NCCT performed immediately after IAR revealed 23 (60.5%) of the 38 patients with six false negative areas. NCCT performed immediately after IAR showed a sensitivity of 79.3%, a specificity of 61.5%, a positive predictive value of 60.5% and a negative predictive value of 80% for HT. The HU value was a predictor of HT without statistical significance (area under curve of 0.629; 95% CI: 0.49–0.76; p = 0.068). In addition, an HU of >90 poorly predicted HT with a low sensitivity (23%) and a high specificity (94%). In conclusion, our results showed that although hyperdensity on NCCT images obtained immediately after IAR had a moderate predictive value for HT, there were limitations to the prediction of subsequent parenchymal hematoma and symptomatic intracranial hemorrhage, with a low specificity and a low positive predictive value.

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References

  1. (1995) Tissue plasminogen activator for acute ischemic stroke. The national institute of neurological disorders and stroke rt-PA stroke study group. N Engl J Med 333:1581–1587

  2. Adams HP Jr, Woolson RF, Clarke WR, Davis PH, Bendixen BH, Love BB, Wasek PA, Grimsman KJ (1997) Design of the trial of org 10172 in acute stroke treatment (TOAST). Control Clin Trials 18:358–377

    Article  PubMed  Google Scholar 

  3. Brekenfeld C, Remonda L, Nedeltchev K, Arnold M, Mattle HP, Fischer U, Kappeler L, Schroth G (2007) Symptomatic intracranial haemorrhage after intra-arterial thrombolysis in acute ischaemic stroke: assessment of 294 patients treated with urokinase. J Neurol Neurosurg Psychiatry 78:280–285

    Article  PubMed  CAS  Google Scholar 

  4. del Zoppo GJ, Mabuchi T (2003) Cerebral microvessel responses to focal ischemia. J Cereb Blood Flow Metab 23:879–894

    Article  PubMed  Google Scholar 

  5. Dijkhuizen RM, Asahi M, Wu O, Rosen BR, Lo EH (2002) Rapid breakdown of microvascular barriers and subsequent hemorrhagic transformation after delayed recombinant tissue plasminogen activator treatment in a rat embolic stroke model. Stroke 33:2100–2104

    Article  PubMed  CAS  Google Scholar 

  6. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian acute stroke study investigators. Lancet 352:1245–1251

    Article  PubMed  CAS  Google Scholar 

  7. Jang YM, Lee DH, Kim HS, Ryu CW, Lee JH, Choi CG, Kim SJ, Suh DC (2006) The fate of high-density lesions on the non-contrast CT obtained immediately after intra-arterial thrombolysis in ischemic stroke patients. Korean J Radiol 7:221–228

    Article  PubMed  Google Scholar 

  8. Kastrup A, Groschel K, Ringer TM, Redecker C, Cordesmeyer R, Witte OW, Terborg C (2008) Early disruption of the blood-brain barrier after thrombolytic therapy predicts hemorrhage in patients with acute stroke. Stroke 39:2385–2387

    Article  PubMed  CAS  Google Scholar 

  9. Kim JT, Yoon W, Park MS, Nam TS, Choi SM, Lee SH, Kim BC, Kim MK, Cho KH (2009) Early outcome of combined thrombolysis based on the mismatch on perfusion CT. Cerebrovasc Dis 28:259–265

    Article  PubMed  Google Scholar 

  10. Komiyama M, Nishijima Y, Nishio A, Khosla VK (1993) Extravasation of contrast medium from the lenticulostriate artery following local intracarotid fibrinolysis. Surg Neurol 39:315–319

    Article  PubMed  CAS  Google Scholar 

  11. Nogueira RG, Liebeskind DS, Sung G, Duckwiler G, Smith WS (2009) Predictors of good clinical outcomes, mortality, and successful revascularization in patients with acute ischemic stroke undergoing thrombectomy: pooled analysis of the mechanical embolus removal in cerebral ischemia (MERCI) and multi MERCI trials. Stroke 40:3777–3783

    Article  PubMed  Google Scholar 

  12. Sheehan FH, Braunwald E, Canner P, Dodge HT, Gore J, Van Natta P, Passamani ER, Williams DO, Zaret B (1987) The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the thrombolysis in myocardial infarction (TIMI Phase I) trial. Circulation 75:817–829

    Article  PubMed  CAS  Google Scholar 

  13. Singer OC, Berkefeld J, Lorenz MW, Fiehler J, Albers GW, Lansberg MG, Kastrup A, Rovira A, Liebeskind DS, Gass A, Rosso C, Derex L, Kim JS, Neumann-Haefelin T (2009) Risk of symptomatic intracerebral hemorrhage in patients treated with intra-arterial thrombolysis. Cerebrovasc Dis 27:368–374

    Article  PubMed  CAS  Google Scholar 

  14. Singer OC, Humpich MC, Fiehler J, Albers GW, Lansberg MG, Kastrup A, Rovira A, Liebeskind DS, Gass A, Rosso C, Derex L, Kim JS, Neumann-Haefelin T (2008) Risk for symptomatic intracerebral hemorrhage after thrombolysis assessed by diffusion-weighted magnetic resonance imaging. Ann Neurol 63:52–60

    Article  PubMed  Google Scholar 

  15. Vora NA, Gupta R, Thomas AJ, Horowitz MB, Tayal AH, Hammer MD, Uchino K, Wechsler LR, Jovin TG (2007) Factors predicting hemorrhagic complications after multimodal reperfusion therapy for acute ischemic stroke. AJNR Am J Neuroradiol 28:1391–1394

    Article  PubMed  CAS  Google Scholar 

  16. Wang X, Tsuji K, Lee SR, Ning M, Furie KL, Buchan AM, Lo EH (2004) Mechanisms of hemorrhagic transformation after tissue plasminogen activator reperfusion therapy for ischemic stroke. Stroke 35:2726–2730

    Article  PubMed  CAS  Google Scholar 

  17. Wildenhain SL, Jungreis CA, Barr J, Mathis J, Wechsler L, Horton JA (1994) CT after intracranial intraarterial thrombolysis for acute stroke. AJNR Am J Neuroradiol 15:487–492

    PubMed  CAS  Google Scholar 

  18. Yoon W, Park MS, Cho KH (2010) Low-dose intra-arterial urokinase and aggressive mechanical clot disruption for acute ischemic stroke after failure of intravenous thrombolysis. AJNR Am J Neuroradiol 31:161–164

    Article  PubMed  CAS  Google Scholar 

  19. Yoon W, Seo JJ, Kim JK, Cho KH, Park JG, Kang HK (2004) Contrast enhancement and contrast extravasation on computed tomography after intra-arterial thrombolysis in patients with acute ischemic stroke. Stroke 35:876–881

    Article  PubMed  Google Scholar 

  20. Zaidat OO, Suarez JI, Santillan C, Sunshine JL, Tarr RW, Paras VH, Selman WR, Landis DM (2002) Response to intra-arterial and combined intravenous and intra-arterial thrombolytic therapy in patients with distal internal carotid artery occlusion. Stroke 33:1821–1826

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A102065).

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Authors and Affiliations

  1. Department of Neurology, Cerebrovascular Center, Chonnam National University Hospital, Gwangju, Korea

    Joon-Tae Kim, Bang-Hoon Cho, Seong-Min Choi, Seung-Han Lee, Man-Seok Park & Ki-Hyun Cho

  2. Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun, Korea

    Suk-Hee Heo

  3. Department of Radiology, Chonnam National University Hospital, Gwangju, Korea

    Woong Yoon

  4. Department of Neurology, Chonnam National University Medical School, 8 Hak-dong, Dong-gu, Gwangju, 501-757, Korea

    Joon-Tae Kim

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  1. Joon-Tae Kim
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  2. Suk-Hee Heo
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  4. Seong-Min Choi
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  5. Seung-Han Lee
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Correspondence to Joon-Tae Kim.

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Kim, JT., Heo, SH., Cho, BH. et al. Hyperdensity on non-contrast CT immediately after intra-arterial revascularization. J Neurol 259, 936–943 (2012). https://doi.org/10.1007/s00415-011-6281-9

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  • DOI: https://doi.org/10.1007/s00415-011-6281-9

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