1. Use of MRI to predict symptomatic haemorrhagic transformation after thrombolysis for cerebral ischaemia
- Author
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Barbara Casolla, Jean-Pierre Pruvo, Solène Moulin, François Caparros, Didier Leys, Charlotte Cordonnier, Agathe Drelon, Grégory Kuchcinski, Nelly Dequatre-Ponchelle, and Hilde Hénon
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Thrombolytic Therapy ,Aged ,Cerebral Hemorrhage ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Area under the curve ,Brain ,Magnetic resonance imaging ,Retrospective cohort study ,Thrombolysis ,Middle Aged ,Magnetic Resonance Imaging ,Hyperintensity ,Stroke ,Psychiatry and Mental health ,Tissue Plasminogen Activator ,Predictive value of tests ,Cohort ,Cardiology ,Female ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Background and objectivePredictors of symptomatic haemorrhagic transformation (s-HT) of cerebral ischaemia after intravenous recombinant tissue-plasminogen activator (rt-PA) were identified in studies using CT scans. We evaluated whether MRI can identify other predictors.MethodWe analysed predictors of s-HT in a cohort of consecutive patients who received intravenous rt-PA for cerebral ischaemia after MRI at baseline. We used receiver operating characteristic curves considering an area under the curve (AUC) of 0.70 or higher as indicating acceptable discrimination.ResultsOf 944 patients, 49 patients (5.2%) developed s-HT. Clinical factors independently associated with s-HT were age (adjusted OR (adjOR) 1.03 for 1 year increase; 95% CI 1.01 to 1.05), excessive alcohol consumption (adjOR 3.13; 95% CI 1.32 to 7.42), recent transient ischaemic attack (adjOR 2.88; 95% CI 1.04 to 7.95) and baseline national institutes of health stroke scale score (adjOR 1.06 for 1 point increase; 95% CI 1.02 to 1.10). MRI predictors were vascular hyperintensities (adjOR 3.89; 95% CI 1.50 to 10.08), old infarcts (adjOR 2.01; 95% CI 1.11 to 3.66) and volume of diffusion-weighted imaging (DWI) abnormality (adjOR 1.02 for 1 cm3 increase; 95% CI 1.01 to 1.03). The only variable with an acceptable discrimination was volume of DWI abnormality (AUC 0.72; 95% CI 0.64 to 0.79), a value of 4 cm3 predicting s-HT with a 78% sensitivity and 58% specificity. Variables that can be assessed only with MRI did not predict s-HT.ConclusionAlthough the volume of DWI abnormality predicts s-HT, other imaging characteristics that can only be assessed with MRI were not significantly associated with s-HT.Trial registration numberNCT01614080
- Published
- 2020
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