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Combination of T2*W and FLAIR abnormalities for the prediction of parenchymal hematoma following thrombolytic therapy in 100 stroke patients.

AbstractINTRODUCTION:
The objective of our study was to determine whether the combination of hypointense spots ("cerebral microbleeds," CMBs) with a leukoaraiosis is associated with the risk of parenchymal hematoma (PH) after thrombolytic therapy.
PATIENTS AND METHODS:
We analyzed magnetic resonance imaging (MRI) scans acquired within 6 hours after symptom onset from 100 ischemic stroke patients. Multiparametric MRI including a T2*-weighted (T2*w) MRI and fluid attenuated inversion recovery (FLAIR) was performed before thrombolysis in all patients. Initial T2*w imaging was rated by two independent observers for the presence of CMBs smaller than 5 mm. White matter changes were evaluated using an adapted scale of Fazekas and Schmidt. PH was defined in follow-up imaging.
FINDINGS:
A PH was observed in seven per 100 patients. CMBs were detected by observer 1 in 22 and observer 2 in 20 patients. We found a very low sensitivity (0.14) for prediction of PH by the presence of CMBs. We found a concordant increase in the rate of PH when the periventricular hyperintensity in FLAIR was larger than a thin lining. Sensitivity was good-to-perfect (0.86 and 1.00, observers 1 and 2) and specificity was substantial (0.65 and 0.66). Using the combination of a periventricular matter lesion (PVML)>1 and the presence of CMBs did not improve the prediction of PH.
DISCUSSION:
A marked periventricular hyperintensity in FLAIR imaging seems to be associated with a substantially increased risk of PH. A combination of CMBs with leukoaraiosis scores did not appear to be beneficial for prognosis.
AuthorsJens Fiehler, Susanne Siemonsen, Goetz Thomalla, Till Illies, Thomas Kucinski
JournalJournal of neuroimaging : official journal of the American Society of Neuroimaging (J Neuroimaging) Vol. 19 Issue 4 Pg. 311-6 (Oct 2009) ISSN: 1552-6569 [Electronic] United States
PMID19490375 (Publication Type: Journal Article)
Topics
  • Brain (drug effects, pathology)
  • Brain Ischemia (drug therapy, pathology)
  • Female
  • Follow-Up Studies
  • Hematoma (chemically induced, diagnosis, pathology)
  • Humans
  • Intracranial Hemorrhages (chemically induced, diagnosis, pathology)
  • Magnetic Resonance Imaging (methods)
  • Male
  • Middle Aged
  • Nerve Fibers, Myelinated (pathology)
  • Prognosis
  • Risk Factors
  • Sensitivity and Specificity
  • Stroke (drug therapy, pathology)
  • Thrombolytic Therapy (adverse effects)

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