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<meta name="DC.Title" content="Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy" />
<meta name="DC.Date" content="2005-08-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Symptomatic hemorrhagic transformation (HT) is a significant complication of intravenous and catheter-based reperfusion. We hypothesized that the degree of vascular insufficiency, reflected as hypoattenuation on initial CT angiography (CTA) axial source images, is predictive of HT risk in stroke patients receiving intra-arterial reperfusion therapy.

METHODS: We examined initial CTA source images and follow-up CT scans in 32 consecutive patients. Regions of interest were semiautomatically segmented and reviewed. Mean intensity was determined in the region of maximal hypoattenuation and in normal contralateral tissue, and the arithmetic difference (ΔHU) calculated. Receiver operator characteristic (ROC) curves and cross-validation were used to identify threshold ΔHU values.

RESULTS: Thirteen patients had HT on follow-up CT (seven with parenchymal hematoma, six with hemorrhagic infarction). Patients with and those without HT did not differ in age, blood glucose level, lesion volume, or time to treatment or recanalization, though the former had a greater mean ΔHU (9.0 vs 6.3, P = .006). The ROC threshold at ΔHU ≥ 8.1 was 69% sensitive and 90% specific for patients who developed HT (odds ratio = 19.1; 95% confidence interval: 2.9, 125; P = .002) and was predictive of poor clinical outcome (modified Rankin scale score &gt;2, P = .03). Neither HT in general nor parenchymal hematoma subtype was associated with poor outcome.

CONCLUSION: The degree of hypoattenuation on initial CTA source images is a risk factor for HT and poor clinical outcome after intra-arterial reperfusion therapy. Prospective validation of this relationship in large populations may permit feasible real-time risk stratification." />
<meta name="DC.Contributor" content="Lee H. Schwamm" />
<meta name="DC.Contributor" content="Eric S. Rosenthal" />
<meta name="DC.Contributor" content="Clifford J. Swap" />
<meta name="DC.Contributor" content="Jonathan Rosand" />
<meta name="DC.Contributor" content="Guy Rordorf" />
<meta name="DC.Contributor" content="Ferdinando S. Buonanno" />
<meta name="DC.Contributor" content="Mark G. Vangel" />
<meta name="DC.Contributor" content="Walter J. Koroshetz" />
<meta name="DC.Contributor" content="Michael H. Lev" />
<meta name="article:published_time" content="2005-08-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy" />
<meta name="citation_abstract" lang="en" content="&lt;p&gt;&lt;i&gt;BACKGROUND AND PURPOSE:&lt;/i&gt; Symptomatic hemorrhagic transformation (HT) is a significant complication of intravenous and catheter-based reperfusion. We hypothesized that the degree of vascular insufficiency, reflected as hypoattenuation on initial CT angiography (CTA) axial source images, is predictive of HT risk in stroke patients receiving intra-arterial reperfusion therapy.&lt;/p&gt;&lt;p&gt;&lt;i&gt;METHODS:&lt;/i&gt; We examined initial CTA source images and follow-up CT scans in 32 consecutive patients. Regions of interest were semiautomatically segmented and reviewed. Mean intensity was determined in the region of maximal hypoattenuation and in normal contralateral tissue, and the arithmetic difference (ΔHU) calculated. Receiver operator characteristic (ROC) curves and cross-validation were used to identify threshold ΔHU values.&lt;/p&gt;&lt;p&gt;&lt;i&gt;RESULTS:&lt;/i&gt; Thirteen patients had HT on follow-up CT (seven with parenchymal hematoma, six with hemorrhagic infarction). Patients with and those without HT did not differ in age, blood glucose level, lesion volume, or time to treatment or recanalization, though the former had a greater mean ΔHU (9.0 vs 6.3, &lt;i&gt;P&lt;/i&gt; = .006). The ROC threshold at ΔHU ≥ 8.1 was 69% sensitive and 90% specific for patients who developed HT (odds ratio = 19.1; 95% confidence interval: 2.9, 125; &lt;i&gt;P&lt;/i&gt; = .002) and was predictive of poor clinical outcome (modified Rankin scale score &amp;gt;2, &lt;i&gt;P&lt;/i&gt; = .03). Neither HT in general nor parenchymal hematoma subtype was associated with poor outcome.&lt;/p&gt;&lt;p&gt;&lt;i&gt;CONCLUSION:&lt;/i&gt; The degree of hypoattenuation on initial CTA source images is a risk factor for HT and poor clinical outcome after intra-arterial reperfusion therapy. Prospective validation of this relationship in large populations may permit feasible real-time risk stratification.&lt;/p&gt;" />
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<meta name="citation_publication_date" content="2005/08/01" />
<meta name="citation_mjid" content="ajnr;26/7/1798" />
<meta name="citation_id" content="26/7/1798" />
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<meta name="twitter:title" content="Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Symptomatic hemorrhagic transformation (HT) is a significant complication of intravenous and catheter-based reperfusion. We hypothesized that the degree of vascular insufficiency, reflected as hypoattenuation on initial CT angiography (CTA) axial source images, is predictive of HT risk in stroke patients receiving intra-arterial reperfusion therapy.

METHODS: We examined initial CTA source images and follow-up CT scans in 32 consecutive patients. Regions of interest were semiautomatically segmented and reviewed. Mean intensity was determined in the region of maximal hypoattenuation and in normal contralateral tissue, and the arithmetic difference (ΔHU) calculated. Receiver operator characteristic (ROC) curves and cross-validation were used to identify threshold ΔHU values.

RESULTS: Thirteen patients had HT on follow-up CT (seven with parenchymal hematoma, six with hemorrhagic infarction). Patients with and those without HT did not differ in age, blood glucose level, lesion volume, or time to treatment or recanalization, though the former had a greater mean ΔHU (9.0 vs 6.3, P = .006). The ROC threshold at ΔHU ≥ 8.1 was 69% sensitive and 90% specific for patients who developed HT (odds ratio = 19.1; 95% confidence interval: 2.9, 125; P = .002) and was predictive of poor clinical outcome (modified Rankin scale score &gt;2, P = .03). Neither HT in general nor parenchymal hematoma subtype was associated with poor outcome.

CONCLUSION: The degree of hypoattenuation on initial CTA source images is a risk factor for HT and poor clinical outcome after intra-arterial reperfusion therapy. Prospective validation of this relationship in large populations may permit feasible real-time risk stratification." />
<meta name="og-title" property="og:title" content="Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/26/7/1798" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Symptomatic hemorrhagic transformation (HT) is a significant complication of intravenous and catheter-based reperfusion. We hypothesized that the degree of vascular insufficiency, reflected as hypoattenuation on initial CT angiography (CTA) axial source images, is predictive of HT risk in stroke patients receiving intra-arterial reperfusion therapy.

METHODS: We examined initial CTA source images and follow-up CT scans in 32 consecutive patients. Regions of interest were semiautomatically segmented and reviewed. Mean intensity was determined in the region of maximal hypoattenuation and in normal contralateral tissue, and the arithmetic difference (ΔHU) calculated. Receiver operator characteristic (ROC) curves and cross-validation were used to identify threshold ΔHU values.

RESULTS: Thirteen patients had HT on follow-up CT (seven with parenchymal hematoma, six with hemorrhagic infarction). Patients with and those without HT did not differ in age, blood glucose level, lesion volume, or time to treatment or recanalization, though the former had a greater mean ΔHU (9.0 vs 6.3, P = .006). The ROC threshold at ΔHU ≥ 8.1 was 69% sensitive and 90% specific for patients who developed HT (odds ratio = 19.1; 95% confidence interval: 2.9, 125; P = .002) and was predictive of poor clinical outcome (modified Rankin scale score &gt;2, P = .03). Neither HT in general nor parenchymal hematoma subtype was associated with poor outcome.

CONCLUSION: The degree of hypoattenuation on initial CTA source images is a risk factor for HT and poor clinical outcome after intra-arterial reperfusion therapy. Prospective validation of this relationship in large populations may permit feasible real-time risk stratification." />
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      <h1 class="highwire-cite-title" id="page-title">Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Lee H. Schwamm</span>, <span class="highwire-citation-author" data-delta="1">Eric S. Rosenthal</span>, <span class="highwire-citation-author" data-delta="2">Clifford J. Swap</span>, <span class="highwire-citation-author" data-delta="3">Jonathan Rosand</span>, <span class="highwire-citation-author" data-delta="4">Guy Rordorf</span>, <span class="highwire-citation-author" data-delta="5">Ferdinando S. Buonanno</span>, <span class="highwire-citation-author" data-delta="6">Mark G. Vangel</span>, <span class="highwire-citation-author" data-delta="7">Walter J. Koroshetz</span> and <span class="highwire-citation-author" data-delta="8">Michael H. Lev</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2005,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">26 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1798-1803; </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-3068--62036884306" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Lee H. Schwamm </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=Lee%2BH.%2BSchwamm%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Schwamm%20LH&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ALee%2BH.%2BSchwamm%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Eric S. 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      <div class="highwire-cite-title">Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy</div>  
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    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Aug 2005, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">26 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1798-1803; </span></div>
  
  
  
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