Reperfusion after Severe Local Perfusion Deficit Precedes Hemorrhagic Transformation: An MRI Study in Acute Stroke Patients

Vol. 19, No. 2, 2005

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Original Paper

Reperfusion after Severe Local Perfusion Deficit Precedes Hemorrhagic Transformation: An MRI Study in Acute Stroke Patients
Jens Fiehler^a, Christian Remmele^b, Thomas Kucinski^a, Michael Rosenkranz^b, Götz Thomalla^b, Cornelius Weiller^b, Hermann Zeumer^a, Joachim Röther^b

Departments of
^aNeuroradiology
and
^bNeurology, University Hospital Eppendorf, University of Hamburg, Hamburg, Germany

Address of Corresponding Author

Cerebrovasc Dis 2005;19:117-124 (DOI: 10.1159/000083180)

Key Words

Stroke
Diffusion
Thrombolysis
Acute cerebral infarction

Abstract

Background: We applied magnetic resonance imaging to analyze the degree of local diffusion and perfusion abnormalities and the status of reperfusion in regions with subsequent hemorrhagic transformation (HT). Methods: 51 patients with acute ischemic stroke were studied by diffusion- and perfusion-weighted imaging within 3.0 ± 0.8 h, on day 1 and days 5-8. After realignment of the image data sets, the parameter maps of the apparent diffusion coefficient (ADC), cerebral blood flow (CBF) and cerebral blood volume (CBV), and mean transit time were analyzed in the area of subsequent HT. The degree of local diffusion and perfusion impairment in the HT area was compared with the entire diffusion and perfusion abnormality. Reperfusion status was separately assessed for the entire perfusion abnormality and the HT area. Results: HT was observed in 19/51 patients (37.2%) within 8 days after symptom onset. Areas destined for HT revealed a more severe decrease in ADC (to 70 ± 13%; p < 0.01), CBV (to 31 ± 26%; p < 0.001) and CBF (to 28 ± 19%; p < 0.001) compared to the entire perfusion abnormality. Local reperfusion in the HT area was seen in 18/19 patients. The presence of HT did not coincide with a worse clinical outcome. Discussion: HT is the result of reperfusion in the region with the most severe local perfusion impairment and does not influence the neurological outcome.

Author Contacts

Jens Fiehler, MD
Department of Neuroradiology, Universitätsklinikum Eppendorf
Martinistrasse 52
DE-20246 Hamburg (Germany)
Tel. +49 40 42803 2746, Fax +49 40 42803 4640, E-Mail fiehler@uke.uni-hamburg.de

Article Information

Received: December 17, 2003
Accepted: July 24, 2004
Published online: January 6, 2005
Number of Print Pages : 8
Number of Figures : 6, Number of Tables : 1, Number of References : 33

Medline Abstract (ID 15640606)

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