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Updated: May 8, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prediction of poststroke hemorrhagic transformation using computed tomography perfusion
Nawaf Yassi1, Mark W Parsons, Søren Christensen
1From the Departments of Medicine and Neurology, Melbourne Brain Centre (N.Y., A.B., S.M.D., B.C.V.C.), and Department of Radiology (N.Y., S.C., G.S., P.M.D., B.C.V.C.), Royal Melbourne Hospital, and Florey Institute of Neuroscience and Mental Health (G.A.D.), University of Melbourne, Parkville, Victoria, Australia; and Priority Research Centre for Translational Neuroscience and Mental Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia (M.W.P., C.R.L.).
Time to maximum (Tmax) >14 seconds is the optimal computed tomography perfusion parameter for predicting parenchymal hematoma after stroke thrombolysis. This finding aids in better patient selection for stroke treatment.
Area of Science:
- Neurology
- Radiology
- Stroke Medicine
Background:
- Intracerebral hemorrhage (ICH) is a significant risk following thrombolysis for acute ischemic stroke.
- Accurate prediction of hemorrhagic transformation is crucial for patient safety and treatment decisions.
Purpose of the Study:
- To identify the optimal computed tomography perfusion (CTP) parameter for predicting parenchymal hematoma (PH) in acute ischemic stroke patients.
- To compare the predictive value of relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), and time to maximum (Tmax) for PH development.
Main Methods:
- Whole-brain CTP was performed in patients with hyperacute ischemic stroke.
- Hemorrhagic transformation was assessed using follow-up computed tomography or MRI.
- Receiver operating characteristic analysis and multivariate logistic regression were used to evaluate CTP parameters and their association with PH.
Main Results:
- Of 132 patients, 14 (10.6%) developed PH. Thrombolysis and baseline NIH Stroke Scale score predicted PH.
- Tmax >14 seconds (AUC=0.748) and rCBF <30% (AUC=0.689) were optimal thresholds for PH prediction.
- Tmax >14 seconds volumes >5 mL predicted PH with 79% sensitivity and 68% specificity.
- Tmax >14 seconds volume and thrombolysis were independent predictors of PH.
Conclusions:
- Tmax >14 seconds is the CTP parameter most strongly associated with PH after ischemic stroke.
- This parameter offers superior prediction of PH compared to rCBF, which approximates ischemic core volume.
- Severe hypoperfusion on Tmax may better predict the location of potential hemorrhage, improving pretreatment risk assessment.
