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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain
Open Access

Focal Low and Global High Permeability Predict the Possibility, Risk, and Location of Hemorrhagic Transformation following Intra-Arterial Thrombolysis Therapy in Acute Stroke

Y. Li, Y. Xia, H. Chen, N. Liu, A. Jackson, M. Wintermark, Y. Zhang, J. Hu, B. Wu, W. Zhang, J. Tu, Z. Su and G. Zhu
American Journal of Neuroradiology September 2017, 38 (9) 1730-1736; DOI: https://doi.org/10.3174/ajnr.A5287
Y. Li
aFrom the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
dDepartment of Radiology (Y.L., M.W.), Neuroradiology Section, Stanford University, Stanford, California
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Y. Xia
bDepartment of Critical Care Medicine (Y.X.), Yantai Yuhuangding Hospital, Shandong, China
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H. Chen
aFrom the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
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N. Liu
aFrom the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
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A. Jackson
cWolfson Molecular Imaging Centre (A.J.), University of Manchester, Manchester, UK
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M. Wintermark
dDepartment of Radiology (Y.L., M.W.), Neuroradiology Section, Stanford University, Stanford, California
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Y. Zhang
eDepartment of Neurology (Y.Z.), Changhai Hospital, Second Military Medical University, Shanghai, China
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J. Hu
fDepartment of Neurology (J.H., G.Z.), Southwest Hospital, Third Military Medical University, Chongqing, China
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B. Wu
gDepartment of Radiology (B.W.), PLA Army General Hospital, Beijing, China
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W. Zhang
aFrom the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
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J. Tu
hOutpatient Department (J.T.), PLA 61889 Army, Beijing, China
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Z. Su
iGE Healthcare (Z.S.), Beijing, China.
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G. Zhu
fDepartment of Neurology (J.H., G.Z.), Southwest Hospital, Third Military Medical University, Chongqing, China
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Figures

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  • Fig 1.
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    Fig 1.

    Flow chart outlining patient selection. Tr. indicates treatment; IVT, intravenous thrombolysis; NCT, noncontrast CT.

  • Fig 2.
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    Fig 2.

    Protocol used to define ROIs (HT area and non-HT area) on Ktrans maps. First analysis: the ASPECTS system was used to manually draw the distribution of the ischemic area on Ktrans maps and determine the permeability values of each ROI. Second analysis: the entire ischemic area from PCT imaging is overlapped on the Ktrans maps to determine the ROI, and the permeability value is restricted to this area.

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    Fig 3.

    Boxplots and value distribution of Ktrans values in the ASPECTS regions. A, Boxplots of Ktrans values in the HI, PH, and non-HT ASPECTS regions. In each box, the median, 95% CI, and first and third quartile values are illustrated. B, The graph illustrates the distribution of the Ktrans values, grouped into the HI, PH, and non-HT regions.

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    Fig 4.

    Boxplots of Ktrans values of HT and non-HT regions and the receiver operating characteristic curve. A, Boxplots of Ktrans values in HT and non-HT regions. In each box, the median, 95% CI, and first and third quartile values are illustrated. B, The optimal cutoff value of the Ktrans value for the prediction of HT is identified with receiver operating characteristic curve analysis.

Tables

  • Figures
  • Predictor variables determined to be uniquely associated with different outcomes

    OutcomesVariableFactorsStandard ErrorWald χ2P ValueOROR 95%CI
    HT vs non-HTIntercept2.81.25.9.02
    ASPECTS−0.50.111.2.000.60.5–0.8
    Ktrans value at patient level1.00.45.4.022.71.2–6.5
    sICH vs non-sICHIntercept−3.00.628.8.00
    Ktrans value at patient level1.60.511.9.005.02.0–12.7
    mRS ≤2 vs mRS >2Intercept−4.61.68.9.00
    Age0.10.013.5.001.11.0–1.1
    NIHSS score on admission0.10.16.2.011.11.0–1.3
    Recanalization−2.60.811.2.000.10.0–0.3
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American Journal of Neuroradiology: 38 (9)
American Journal of Neuroradiology
Vol. 38, Issue 9
1 Sep 2017
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Y. Li, Y. Xia, H. Chen, N. Liu, A. Jackson, M. Wintermark, Y. Zhang, J. Hu, B. Wu, W. Zhang, J. Tu, Z. Su, G. Zhu
Focal Low and Global High Permeability Predict the Possibility, Risk, and Location of Hemorrhagic Transformation following Intra-Arterial Thrombolysis Therapy in Acute Stroke
American Journal of Neuroradiology Sep 2017, 38 (9) 1730-1736; DOI: 10.3174/ajnr.A5287

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Focal Low and Global High Permeability Predict the Possibility, Risk, and Location of Hemorrhagic Transformation following Intra-Arterial Thrombolysis Therapy in Acute Stroke
Y. Li, Y. Xia, H. Chen, N. Liu, A. Jackson, M. Wintermark, Y. Zhang, J. Hu, B. Wu, W. Zhang, J. Tu, Z. Su, G. Zhu
American Journal of Neuroradiology Sep 2017, 38 (9) 1730-1736; DOI: 10.3174/ajnr.A5287
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