Background
It is still controversial whether early fluid-attenuated inversion recovery (FLAIR)
hyperintensity within acute ischemic lesions carries the risk of hemorrhagic transformation
(HT) after reperfusion therapy. Furthermore, the association between the location
of FLAIR hyperintensity and HT has not been investigated.
Methods
We retrospectively reviewed patients who underwent reperfusion therapy within 6 hours
of stroke onset and magnetic resonance imaging including a FLAIR sequence before completing
reperfusion therapy. FLAIR hyperintensity within the diffusion-weighted imaging (DWI)
lesion was rated qualitatively, and HT was assessed on follow-up gradient echo imaging.
The location of the FLAIR change and HT was classified as subcortical, cortical, or
cortico–subcortical.
Results
Of 134 patients with acute ischemic stroke included in this study, early FLAIR changes
within DWI lesions were identified in 56 (41.8%) patients, and HT was noted in 51
(38.1%) patients. FLAIR change was independently associated with HT (odds ratio: 4.37,
95% confidence interval: 1.72-11.12). Geographically, 48.2% of the patients with a
FLAIR change developed a matched HT (restricted to the region with the FLAIR change),
and the risk of HT was further increased in patients with a FLAIR change in the cortico–subcortical
region (68.8%).
Conclusions
In patients in the acute stage of stroke, an early FLAIR change is associated with
the risk of HT following reperfusion therapy with a highly matched geographic relationship
and common risk factors. Thus, identification of FLAIR change may be a useful surrogate
marker to assess the likelihood of subsequent HT in patients treated with reperfusion
therapy.
Key Words
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Article info
Publication history
Published online: October 19, 2016
Accepted:
September 15,
2016
Received in revised form:
September 13,
2016
Received:
August 10,
2016
Footnotes
Sources of funding: This study was supported by grants from the National Research Foundation of Korea (NRF) funded by the Korea government (MEST) (NRF-2014R1A2A1A11051280) and the Korea Health Technology R&D Project, Ministry for Health & Welfare, Republic of Korea (HI12C1847, HI14C1983).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.024
Copyright
© 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
