Multiparametric Magnetic Resonance Imaging for Prediction of Parenchymal Hemorrhage in Acute Ischemic Stroke After Reperfusion Therapy
| Autor: | Jeffrey L. Saver, Albert J Yoo, Reza Jahan, Chelsea S. Kidwell, Zahra Ajani, Kambiz Nael, Jeffery Gornbein, David S Liebeskind, Judy Guzy, Brett C. Meyer, Dileep R. Yavagal, James R. Knitter, Randolph S. Marshall, Sidney Starkman, Lei Feng, Max Wintermark, Lee H. Schwamm, Philip M. Meyers |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_treatment Original Contributions Embolectomy Blood volume Cardiorespiratory Medicine and Haematology 030218 nuclear medicine & medical imaging Parenchymal hemorrhage Brain Ischemia Brain ischemia 0302 clinical medicine 80 and over Tomography Stroke Acute ischemic stroke embolectomy Aged 80 and over screening and diagnosis Blood Volume Middle Aged stroke X-Ray Computed Detection Anesthesia Cerebrovascular Circulation Cardiology Female hemorrhage Cardiology and Cardiovascular Medicine 4.2 Evaluation of markers and technologies Adult medicine.medical_specialty Adolescent Clinical Sciences 03 medical and health sciences Young Adult Reperfusion therapy Internal medicine medicine Humans Multiparametric Magnetic Resonance Imaging Aged Cerebral Hemorrhage Advanced and Specialized Nursing Neurology & Neurosurgery business.industry Neurosciences biomarkers medicine.disease Brain Disorders Diffusion Magnetic Resonance Imaging ROC Curve Reperfusion Neurology (clinical) permeability business Tomography X-Ray Computed 030217 neurology & neurosurgery |
| Zdroj: | Stroke Stroke, vol 48, iss 3 |
| ISSN: | 1524-4628 |
| Popis: | Background and Purpose— Patients with acute ischemic stroke are at increased risk of developing parenchymal hemorrhage (PH), particularly in the setting of reperfusion therapies. We have developed a predictive model to examine the risk of PH using combined magnetic resonance perfusion and diffusion parameters, including cerebral blood volume (CBV), apparent diffusion coefficient, and microvascular permeability (K2). Methods— Voxel-based values of CBV, K2, and apparent diffusion coefficient from the ischemic core were obtained using pretreatment magnetic resonance imaging data from patients enrolled in the MR RESCUE clinical trial (Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy). The associations between PH and extreme values of imaging parameters were assessed in univariate and multivariate analyses. Receiver-operating characteristic curve analysis was performed to determine the optimal parameter(s) and threshold for predicting PH. Results— In 83 patients included in this analysis, 20 developed PH. Univariate analysis showed significantly lower 10th percentile CBV and 10th percentile apparent diffusion coefficient values and significantly higher 90th percentile K2 values within the infarction core of patients with PH. Using classification tree analysis, the 10th percentile CBV at threshold of 0.47 and 90th percentile K2 at threshold of 0.28 resulted in overall predictive accuracy of 88.7%, sensitivity of 90.0%, and specificity of 87.3%, which was superior to any individual or combination of other classifiers. Conclusions— Our results suggest that combined 10th percentile CBV and 90th percentile K2 is an independent predictor of PH in patients with acute ischemic stroke with diagnostic accuracy superior to individual classifiers alone. This approach may allow risk stratification for patients undergoing reperfusion therapies. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT00389467. |
| Databáze: | OpenAIRE |
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