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Does computed tomography permeability predict hemorrhagic transformation after ischemic stroke?
Peggy Yen1, Allison Cobb1, Jai Jai Shiva Shankar1
1Peggy Yen, Allison Cobb, Jai Jai Shiva Shankar, Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia B3K 6A3, Canada.
World Journal of Radiology
|July 1, 2016
Summary
Permeability-surface area product maps can predict hemorrhagic transformation after acute ischemic stroke treatment. Higher pretreatment rPS values indicate an increased likelihood of bleeding, aiding in risk assessment.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Radiology
Background:
- Acute ischemic stroke (AIS) treatment involves thrombolysis, which carries a risk of hemorrhagic transformation (HT).
- Predicting HT is crucial for optimizing patient management and treatment strategies.
Purpose of the Study:
- To evaluate the utility of perfusion-derived permeability-surface area product (PS) maps in predicting hemorrhagic transformation (HT) following thrombolytic treatment for AIS.
- To establish the predictive accuracy of relative PS (rPS) values for HT occurrence.
Main Methods:
- Retrospective analysis of AIS patients with computed tomography perfusion (CTP) and follow-up CT.
- Calculation of PS maps for ischemic and contralateral sides, and derivation of relative PS (rPS) using the unaffected side as an internal control.
- Statistical comparison of rPS values between patients with and without HT using t-tests.
Main Results:
- A significantly higher rPS was observed in patients who developed HT (1.71 ± 1.64) compared to those who did not (1.07 ± 1.30) (P = 0.003).
- An rPS value above the mean of 1.3 increased the likelihood of HT, with a sensitivity of 71.4% and specificity of 78.6%.
- The study achieved an overall accuracy of 76.2% in predicting HT, with an odds ratio of 9.2.
Conclusions:
- Pretreatment PS maps, specifically rPS, are effective predictors of hemorrhagic transformation in AIS patients.
- The findings suggest that rPS can be a valuable tool for risk stratification and guiding treatment decisions in AIS.
- No significant difference in rPS was found between petechial and more severe hemorrhagic events.
