AUTHOR=Wu Bing , Liu Nan , Wintermark Max , Parsons Mark W. , Chen Hui , Lin Longting , Zhou Shuai , Hu Gang , Zhang Yongwei , Hu Jun , Li Ying , Su Zihua , Wu Xinhuai , Zhu Guangming 

TITLE=Optimal Delay Time of CT Perfusion for Predicting Cerebral Parenchymal Hematoma After Intra-Arterial tPA Treatment

JOURNAL=Frontiers in Neurology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2018.00680

DOI=10.3389/fneur.2018.00680

ISSN=1664-2295

ABSTRACT=<p><bold>Background and Purpose:</bold> Cerebral hemorrhage is a serious potential complication of stroke revascularization, especially in patients receiving intra-arterial tissue-type plasminogen activator (tPA) therapy. We investigated the optimal pre-intervention delay time (DT) of computed tomography perfusion (CTP) measurement to predict cerebral parenchymal hematoma (PH) in acute ischemic stroke (AIS) patients after intra-arterial tissue plasminogen activator (tPA) treatment.</p><p><bold>Methods:</bold> The study population consisted of a series of patients with AIS who received intra-arterial tPA treatment and had CTP and follow-up computed tomography/magnetic resonance imaging (CT/MRI) to identify hemorrhagic transformation. The association of increasing DT thresholds (&gt;2, &gt;4, &gt;6, &gt;8, and &gt;10 s) with PH was examined using receiver operating characteristic (ROC) analysis and logistic regression.</p><p><bold>Results:</bold> Of 94 patients, 23 developed PH on follow-up imaging. Receiver operating characteristic analysis revealed that the greatest area under the curve for predicting PH occurred at DT &gt; 4 s (area under the curve, 0.66). At this threshold of &gt; 4 s, DT lesion volume ≥ 30.85 mL optimally predicted PH with 70% sensitivity and 59% specificity. DT &gt; 4 s volume was independently predictive of PH in a multivariate logistic regression model (<italic>P</italic> &lt; 0.05).</p><p><bold>Conclusions:</bold> DT &gt; 4 s was the parameter most strongly associated with PH. The volume of moderate, not severe, hypo-perfusion on DT is more strongly associated and may allow better prediction of PH after intra-arterial tPA thrombolysis.</p>