Contrast-Enhanced MR Imaging in Acute Ischemic Stroke: T2* Measures of Blood-Brain Barrier Permeability and Their Relationship to T1 Estimates and Hemorrhagic Transformation

BACKGROUND AND PURPOSE: rtPA is an effective treatment for AIS, yet it is substantially underused due to the increased risk of HT. Recent work suggests that permeability-related information can be extracted from routine T2*-based perfusion images by measuring the rR of the contrast agent. Given that other T2*-based measures have recently been proposed, the purpose of this study was to evaluate 4 such permeability measures in identifying patients with AIS who will proceed to HT.

MATERIALS AND METHODS: Eighteen patients with AIS were examined within a mean of 3.3 ± 1.4 hours postonset. Dynamic T2*-weighted imaging consisted of a single-shot EPI following a bolus of gadodiamide. HT was determined on follow-up CT or MR imaging at 24–72 hours. Mean values of rR, Peak Height, Recovery, as well as Slope were calculated and analyzed on the basis of follow-up HT status.

RESULTS: Eight patients proceeded to HT. The mean rR for patients with HT was significantly greater than that for patients without HT (0.22 ± 0.06 versus 0.14 ± 0.06, P = .006), while there was a trend toward decreased %Recovery in patients with HT (76 ± 6 versus 82 ± 11%, P = .092). There was a significant negative correlation between %Recovery and rR (r = −0.88, P < .001). No significant differences or trends were detected with respect to Peak Height or Slope.

CONCLUSIONS: Both rR and %Recovery can be readily extracted from a routine perfusion MR imaging dataset and show potential for identifying HT during the acute phase poststroke.