MRI in predication of early hemorrhagic transformation after acute stroke

Objective: To investigate the relationship among early parenchymal enhancement, post- gadolinium (Gd) hyperintense middle cerebral artery (HMCA), and subsequent hemorrhagic transformation (HT) in patients with hyperacute ischemic stroke. Methods: Twenty-four consecutive patients with ischemic stroke who underwent MRI within 6 h [(4.3±1.4) h] of symptom onset were retrospectively reviewed. All of these patients underwent at least one follow-up MRI or non-enhanced CT study at 2 to 7 days. Post-Gd T1WI were analyzed for parenchymal enhancement and hyperintense MCA. Gradient echo MRI and CT were used for assessment of HT. Results: Ten patients developed HT on follow-up imaging (hemorrhagic group). Early parenchymal enhancement was found in 6 patients with HT (P<0.01). The HMCA was in 5 patients with HT (P<0.01). In the fourteen patients without HT (nonhemorrhagic group), none showed early parenchymal enhancement and/or hyperintense MCA. Conclusions: Early parenchymal enhancement and HMCA on T1WI after Gd-DTPA administration are independent predictors of subsequent HT. (authors)