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Front. Neurol. | doi: 10.3389/fneur.2019.00897

MRI-Based Predictors of Hemorrhagic Transformation in Patients with Stroke Treated by Intravenous Thrombolysis

 Rody C. EL NAWAR1, 2, Jennifer Yeung2,  Julien Labreuche3, Marie-Laure Chadenat2, Duc Long Duong2, Maxime De Malherbe4, Yves-Sebastien Cordoliani4,  Bertrand Lapergue5, 6 and  Fernando PICO2, 6, 7*
  • 1Departement of Neurology, Gilbert and Rose-Mary Chagoury School of Medicine, Lebanese American Univeristy, Lebanon
  • 2Department of Neurology and Stroke Center, Hopital Mignot, Centre Hospitalier de Versailles, France
  • 3CHU Lille, EA 2694, Santé Publique: Épidémiologie et Qualité des Soins, Lille, France, Université de Lille, France
  • 4Department of Radiology, Centre Hospitalier de Versailles, France
  • 5Department of Neurology and Stroke Center, Hôpital Foch, France
  • 6Université de Versailles Saint-Quentin-en-Yvelines, France
  • 7INSERM U1148 LVTS (Laboratory for Vascular Translational Science), Team 5 (research into“Atherothrombotic Disease in Heart and Brain”), Hôpital Bichat-Claude-Bernard, France

Clinical and biological risk factors for hemorrhagic transformation (HT) after intravenous thrombolysis (IT) have been well established in several registries. The added value of magnetic resonance imaging (MRI) variables has been studied in small samples, and is controversial. We aimed to assess the added value of MRI variables in HT, beyond that of clinical and biological factors.
We enrolled 474 consecutive patients with brain infarction treated by IT alone at our primary stroke center between January 2011 and August 2017. Baseline demographic, clinical, biological, and imaging characteristics were collected. MRI variables were: brain infarction volume in cm3; parenchymal fluid attenuated inversion recovery (FLAIR) hyperintensity; FLAIR hyperintense vessel signs; number of microbleeds; subcortical white matter hyperintensity; and thrombus length.
Overall, 301patients were included out of 474 (64%). The main causes of exclusion were combined thrombectomy (n=98) and no MRI before IT (n=44). In the bivariate analysis, HT was significantly associated with the presence of more FLAIR hyperintense vessel signs, thrombus length (>8mm), and larger brain infarction volume (diffusion-weighted imaging (DWI) and apparent diffusion coefficient<500´10-6 mm2/s). In the multivariable analysis, only brain infarction volume was significantly associated with HT. The discrimination value of the multivariable model, including both the DWI volume and the clinical model (area under the receiver operating characteristic curve, 0.80;95%confidence interval 0.74 to 0.86), was improved significantly compared with the model based only on clinical variables (P=0.012).
Brain infarction volume on DWI was the only MRI variable that added value to clinico biological variables for predicting HT after IT.

Keywords: Hemorrhage, Stroke, thrombolysis (tPA), MRI - Magnetic resonance imaging, diffusion weighted (DW) MRI

Received: 26 Feb 2019; Accepted: 02 Aug 2019.

Edited by:

Andreas Charidimou, Massachusetts General Hospital, Harvard Medical School, United States

Reviewed by:

Vincent Thijs, Florey Institute of Neuroscience and Mental Health, Australia
Norbert Nighoghossian, Université Claude Bernard Lyon 1, France  

Copyright: © 2019 EL NAWAR, Yeung, Labreuche, Chadenat, Duong, De Malherbe, Cordoliani, Lapergue and PICO. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Fernando PICO, Centre Hospitalier de Versailles, Department of Neurology and Stroke Center, Hopital Mignot, Le Chesnay, 78150, France,