医学
溶栓
灌注扫描
灌注
冲程(发动机)
脑出血
改良兰金量表
放射科
血流动力学
组织纤溶酶原激活剂
内科学
心脏病学
作者
Josep Puig,Gerard Blasco,Pepus Daunis-i-Estadella,Cecile van Eendendburg,María Carrillo-García,Carlos Aboud,María Hernández-Pérez,Joaquín Serena,Carles Biarnes,Kambiz Nael,David S Liebeskind,Götz Thomalla,Bijoy K Menon,Andrew M. Demchuk,Max Wintermark,Salvador Pedraza,Mar Castellanos
出处
期刊:PLOS ONE
[Public Library of Science]
日期:2017-11-28
卷期号:12 (11)
被引量:12
标识
DOI:10.1371/journal.pone.0188238
摘要
Objective
Blood-brain barrier (BBB) permeability has been proposed as a predictor of hemorrhagic transformation (HT) after tissue plasminogen activator (tPA) administration; however, the reliability of perfusion computed tomography (PCT) permeability imaging for predicting HT is uncertain.
We aimed to determine the performance of high-permeability region size on PCT (HPrs-PCT) in predicting HT after intravenous tPA administration in patients with acute stroke.
Methods
We performed a multimodal CT protocol (non-contrast CT, PCT, CT angiography) to prospectively study patients with middle cerebral artery occlusion treated with tPA within 4.5 hours of symptom onset. HT was graded at 24 hours using the European-Australasian Acute Stroke Study II criteria. ROC curves selected optimal volume threshold, and multivariate logistic regression analysis identified predictors of HT.
Results
The study included 156 patients (50% male, median age 75.5 years). Thirty-seven (23,7%) developed HT [12 (7,7%), parenchymal hematoma type 2 (PH-2)]. At admission, patients with HT had lower platelet values, higher NIHSS scores, increased ischemic lesion volumes, larger HPrs-PCT, and poorer collateral status. The negative predictive value of HPrs-PCT at a threshold of 7mL/100g/min was 0.84 for HT and 0.93 for PH-2. The multiple regression analysis selected HPrs-PCT at 7mL/100g/min combined with platelets and baseline NIHSS score as the best model for predicting HT (AUC 0.77). HPrs-PCT at 7mL/100g/min was the only independent predictor of PH-2 (OR 1, AUC 0.68, p = 0.045).
Conclusions
HPrs-PCT can help predict HT after tPA, and is particularly useful in identifying patients at low risk of developing HT.
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