MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p> Hemorrhagic transformation increases mortality and morbidity in patients with acute ischemic stroke. </jats:p></jats:sec><jats:sec><jats:title>Purpose</jats:title><jats:p> The purpose of this study is to evaluate the diagnostic performance of magnetic resonance imaging (MRI) for prediction of hemorrhagic transformation in acute ischemic stroke. </jats:p></jats:sec><jats:sec><jats:title>Material and Methods</jats:title><jats:p> A systematic literature search of MEDLINE and EMBASE was performed up to 27 July 2018, including the search terms “acute ischemic stroke,” “hemorrhagic transformation,” and “MRI.” Studies evaluating the diagnostic performance of MRI for prediction of hemorrhagic transformation in acute ischemic stroke were included. Diagnostic meta-analysis was conducted with a bivariate random-effects model to calculate the pooled sensitivity and specificity. Subgroup analysis was performed including studies using advanced MRI techniques including perfusion-weighted imaging, diffusion-weighted imaging, and susceptibility-weighted imaging. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Nine original articles with 665 patients were included. Hemorrhagic transformation is associated with high permeability, hypoperfusion, low apparent diffusion coefficient (ADC), and FLAIR hyperintensity. The pooled sensitivity was 82% (95% confidence interval [CI] 61–93) and the pooled specificity was 79% (95% CI 71–85). The area under the hierarchical summary receiver operating characteristic curve was 0.85 (95% CI 0.82–0.88). Although study heterogeneity was present in both sensitivity (I<jats:sup>2</jats:sup>=67.96%) and specificity (I<jats:sup>2</jats:sup>=78.93%), a threshold effect was confirmed. Studies using advanced MRI showed sensitivity of 92% (95% CI 70–98) and specificity of 78% (95% CI 65–87) to conventional MRI. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> MRI may show moderate diagnostic performance for predicting hemorrhage in acute ischemic stroke although the clinical significance of this hemorrhage is somewhat uncertain. </jats:p></jats:sec>

Pathophysiology of Blood–Brain Barrier Permeability Throughout the Different Stages of Ischemic Stroke and Its Implication on Hemorrhagic Transformation and Recovery

“…Furthermore, a higher BBBP is associated with not only the severity of but also the likelihood to develop HT ( 64 , 124 , 125 ). This association has been shown by two systematic reviews studying the prediction of HT with MRI ( 126 ) and computed tomography (CT) imaging ( 127 ). The pathophysiology of HT is multifactorial and has not yet been clearly elucidated, but it is linked to processes that alter the integrity of the BBB and basal lamina matrix ( 121 ).…”

“…A recent meta-analysis on the prognostic performance of MRI on HT prediction in AIS patients showed that MRI has a specificity of 79% and a sensitivity of 82%. These values increased when perfusion imaging was studied alone, with 92% specificity and 80% sensitivity in terms of HT prediction ( 126 ).…”

Permeability of the blood-brain barrier through the phases of ischaemic stroke and relation with clinical outcome: protocol for a systematic review

“…11 39 40 In clinical practice this information has been used as a diagnostic tool for differential diagnosis, and also to support decisions for safer and improved recanalisation therapies for patients who had a stroke in an extended time window. 7-9 11 38 41-43 Nonetheless, although there are important systematic reviews that focus on the implications of imaging and increased permeability on stroke outcome, 44 45 and on the utility of perfusion imaging in determining treatment eligibility in patients who had an acute stroke, 46 to date there are no systematic reviews, to our knowledge, focusing on the development of the BBBP during the phases of AIS.…”

“…Nonetheless, although there are important systematic reviews that focus on the implications of imaging and increased permeability on stroke outcome, 44 45 and on the utility of perfusion imaging in determining treatment eligibility in patients who had an acute stroke, 46 to date there are no systematic reviews, to our knowledge, focusing on the development of the BBBP during the phases of AIS.…”

Scale Invariant Feature Transformation Algorithm-Based Magnetic Resonance Imaging-Assisted Diagnosis of Patients with Stroke and Rehabilitation Nursing

“…Stroke is an acute cerebrovascular disease caused by different etiology, and its clinical features had acute and persistent onset accompanied by focal neurological function defects including ischemic stroke and hemorrhagic stroke [1][2][3]. Stroke has the characteristics of high incidence, high mortality, and high disability rate.…”