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Effects of Microvascular Permeability Changes on Contrast-Enhanced T1 and Pharmacokinetic MR Imagings After Ischemia

2013; Lippincott Williams & Wilkins; Volume: 44; Issue: 7 Linguagem: Inglês

10.1161/strokeaha.113.001558

1524-4628

Hua-Shan Liu, Hsiao‐Wen Chung, Ming‐Chung Chou, Michelle Liou, Chao-Ying Wang, Hung‐Wen Kao, Shih-Wei Chiang, Chun‐Jung Juan, Guo-Shu Huang, Cheng‐Yu Chen,

Acute Ischemic Stroke Management

Background and Purpose— Brain enhancement on contrast-enhanced T1-weighted imaging (CET1-WI) after ischemic stroke is generally accepted as an indicator of the blood–brain barrier disruption. However, this phenomenon usually starts to become visible at the subacute phase. The purpose of this study was to evaluate the time-course profiles of K trans , cerebral blood volume ( v p ), and CET1-WI with early detection of blood–brain barrier changes on K trans maps and their role for prediction of subsequent hemorrhagic transformation in acute middle cerebral arterial infarct. Methods— Twenty-six patients with acute middle cerebral arterial stroke and early spontaneous reperfusion, whose MR images were obtained at predetermined stroke stages, were included. T2*-based MR perfusion-weighted images were acquired using the first-pass pharmacokinetic model to derive K trans and v p . Parenchymal enhancement observed on maps of K trans , v p , and CET1-WI at each stage was compared. Association among these measurements and hemorrhagic transformation was analyzed. Results— K trans map showed significantly higher parenchymal enhancement in ischemic parenchyma as compared with that of v p map and CET1-WI at early stroke stages ( P <0.05). The increased K trans at acute stage was not associated with parenchymal enhancement in CET1-WI at the same stage. Parenchymal enhancement in CET1-WI started to occur at the late subacute stage and tended to be luxury reperfusion–dependent. Patients with hemorrhagic transformation showed higher mean K trans values as compared with patients without hemorrhagic transformation ( P =0.02). Conclusions— Postischemic brain enhancement on routine CET1-WI seems to be closely related to the luxury reperfusion at the late subacute stage and is not dependent on microvascular permeability changes at the acute stage.