Risk Assessment of Hemorrhagic Transformation of Acute Middle Cerebral Artery Stroke Using Multimodal CT
Journal of Neuroimaging, 04/24/2012Lin K et al.
For acute middle cerebral artery (MCA) infarcts ≤9 hours, the strongest predictor of symptomatic intracerebral hemorrhage (SICH) on multimodal CT was ASPECTS on CTP maps for ischemic severity and CT angiography source images (CTA–SI).
This retrospective study included patients evaluated by baseline multimodal CT ≤ 9 hours from ictus with acute nonlacunar middle cerebral artery (MCA) territory infarction.
Two readers independently evaluated CTP maps for ischemic severity and CTA source images (CTA-SI) for infarct extent (as measured by ASPECTS).
Presence of proximal occlusion (ICA or M1) and degree of collateralization (collateral score) were also assessed on CTA.
HT was defined as SICH if associated with deterioration ≥ 4-points on NIHSS.
Multivariate logistic regression analysis identified independent predictors of SICH.
ROC curves selected optimal thresholds.
Of 84 patients reviewed, HT occurred in 22 (26.2%) and SICH in 8 (9.5%).
Univariate predictors for SICH were proximal occlusion (OR=8.65, P=.049), collateral score (OR=.34, P=.017), ASPECTS (OR=.46, P= .001), and CBV (OR=.001, P=.005).
Multivariate analysis revealed ASPECTS as the only independent predictor with optimal threshold ≤ 5 and sensitivity and specificity of 75.0% and 85.5%, respectively.
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