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Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis.
MedLine Citation:
PMID:  22900825     Owner:  NLM     Status:  Publisher    
BACKGROUND AND PURPOSE: Absence of FLAIR hyperintensity within an acute infarct is associated with stroke onset <4.5 h. However, some patients rapidly develop FLAIR hyperintensity within this timeframe. We hypothesized that development of early infarct FLAIR hyperintensity would predict hemorrhagic transformation (HT) in sub-4.5 h tPA patients. METHODS: Consecutive acute stroke patients treated with IV tPA <4.5 h after onset who had MRI before and one day after thrombolysis were included. Two raters (blind to HT) independently identified FLAIR hyperintensity with reference to the DWI lesion. HT was assessed using T2* MRI at 24 h. Hemorrhagic infarction (HI) was defined as petechial HT without mass effect, and parenchymal hematoma (PH) as HT with mass effect. Multivariable logistic regression analysis for HT included FLAIR status, baseline NIHSS and DWI lesion volume, leukoaraiosis (Wahlund score), serum glucose and reperfusion. RESULTS: Of 109 patients, 33 (30%) had acute FLAIR hyperintensity. HT occurred in 17 patients (15.6%; 15 HI, 2 PH). HT was more common in FLAIR-positive patients than FLAIR-negative patients (33.3% vs. 9.2%, P = 0.009). Median time-to-scan and median time-to-thrombolysis did not differ significantly between patients with HT and without (97 IQR[68, 155] vs. 90 IQR[73, 119], P = 0.5; 120 IQR[99, 185] vs. 125 IQR[95, 150], P = 0.6, respectively). In multivariable analysis, only FLAIR hyperintensity was independently associated with HT after thrombolysis (OR: 18; 95% CI 2 to 175, P = 0.013). CONCLUSIONS: Early development of FLAIR hyperintensity within the area of diffusion-restriction is associated with increased risk of HT after thrombolysis in acute stroke patients.
A Kufner; I Galinovic; P Brunecker; B Cheng; G Thomalla; C Gerloff; B C V Campbell; C H Nolte; M Endres; J B Fiebach; M Ebinger
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-20
Journal Detail:
Title:  European journal of neurology : the official journal of the European Federation of Neurological Societies     Volume:  -     ISSN:  1468-1331     ISO Abbreviation:  Eur. J. Neurol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9506311     Medline TA:  Eur J Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Author(s) European Journal of Neurology © 2012 EFNS.
International Graduate Program Medical Neurosciences, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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