Detection of early vessel leakiness in acute ischemic stroke using computed tomography perfusion may indicate hemorrhagic transformation

Abstract

This short communication presents significantly increased permeability in two patients with acute stroke, indicating an early blood-brain barrier disruption. Neither of the patients had undergone any thrombolytic therapy and hemorrhaged later. Increased permeability was assessed in both patients using a distributed-parameter model of capillary-tissue exchange. Our findings indicate that early physiologic imaging in stroke may identify patients with a high risk of hemorrhagic transformation by revealing pathologic vascular changes and, thus, guide therapeutic options.

Dynamic Perfusion CT Assessment of the Blood-Brain Barrier Permeability: First Pass versus Delayed Acquisition

“…We did not assess other models that have been applied to PCT data to calculate BBBP, such as the distributed parameter model. 7,22 Future studies are needed to determine whether our conclusions regarding the delayed acquisition required to apply the Patlak model to PCT data also hold true for these alternative models.…”

“…Direct measurement of BBB permeability (BBBP) by using perfusion CT (PCT) has also been attempted. [6][7][8][9][10][11][12][13][14] A relatively simple and frequently applied model to calculate BBBP is the Patlak model. 15,16 Applying this model to PCT data 6,9-13 means using arterial and parenchymal contrast enhancement curves to calculate the rate of contrast transfer from an intravascular to an extravascular compartment, which is a measure of BBBP.…”

Blood-Brain Barrier Permeability Assessed by Perfusion CT Predicts Symptomatic Hemorrhagic Transformation and Malignant Edema in Acute Ischemic Stroke

“…Notably, most of the prior PCT studies have used first-pass data, [15][16][17][18] though a recent study has shown that using first-pass rather than delayedacquisition data results in inaccurate BBBP measurements. 24 One recent PCT study used delayed-acquisition data 19 ; the study involved a quantitative model that had promising predictive power for HT in general but was unable to differentiate between patients destined for PH-2, the only form of hemorrhage definitively linked to poor outcomes in major stroke trials, 6 and more minor forms of hemorrhage of the petechial variety.…”

“…Abnormally elevated BBBP measurements extracted from both PCT [15][16][17][18][19] and MR imaging studies [20][21][22] have been explored as physiologic predictors of SHT. Notably, most of the prior PCT studies have used first-pass data, [15][16][17][18] though a recent study has shown that using first-pass rather than delayedacquisition data results in inaccurate BBBP measurements.…”

“…More recently, a promising new approach involving BBBP imaging has been proposed. [15][16][17][18][19][20][21][22] It models the extravasation of a contrast agent from the intravascular space to the extravascular space and can demonstrate elevated BBBP as an indicator of ischemia-induced vascular damage in stroke. BBBP imaging provides a physiologic individualized measurement intimately connected to the underlying pathophysiology of PH-2 (ischemia-induced vascular damage followed by reperfusion) 23 and may, therefore, offer excellent sensitivity and specificity.…”