Variable MR and pathologic patterns of hemorrhage after iodinated contrast infusion in MCA occlusion/reperfusion model

Morales, Humberto; Lu, Aiming; Kurosawa, Yuko; Clark, Joseph F.; Tomsick, Thomas A.

doi:10.1136/neurintsurg-2016-012777

Cited by 6 publications

(8 citation statements)

References 30 publications

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“…Although dual-energy CT and MRI have been indicated to be the method of choice for reliable detection of hemorrhage in patients with hyperdensities after thrombectomy, there remain questions of the value of CT findings in the first follow-up to predict hemorrhage. 10,18,19,21,35 A recent study has demonstrated that early subtle CT findings strongly predict hemorrhagic transformation, but it has not included areas of hyperdensity as a predictor. 5 Another recent study proposed a metallic hyperdense sign on CT performed immediately after thrombectomy, defined as a focal area superior to 1.0 cm in diameter with maximum CT density superior to 90 HU identified within the non-petechial intracerebral hyperdense lesion in the basal ganglia, which could predict the occurrence of parenchymal hemorrhage at 24 h. 27 However, a smaller cohort publication has questioned the use of density thresholds that would not allow a reliable differentiation between hemorrhage and contrast staining on immediate post-interventional CT. 11 In our cohort, we use the high-density sign without an HU threshold; however, logistic regression showed that increasing CT density significantly increases the odds of hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

et al. 2020

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Purpose Cerebral hyperdensities can appear on head computed tomography (CT) images performed early after endovascular treatment (EVT) in patients with acute ischemic stroke and may be secondary to contrast staining or hemorrhagic transformation. The aim of this study was to determine how the high-density sign on CT affects mortality and clinical outcome and whether CT parameters predict hemorrhagic conversion or unfavorable outcome. Methods We retrospectively reviewed a database of patients who underwent EVT with mechanical thrombectomy for acute ischemic stroke over 7 years. Included were acute stroke patients with a CT examination within 24 h post-EVT with mechanical thrombectomy, demonstrating areas of hyperdensity. We evaluated morphologic characteristics of these lesions, location, CT Hounsfield units and largest area, as well as patient demographics, EVT methods and patient outcome. Results A total of 29 patients met the strict inclusion criteria. Complete recanalization was achieved in 58.6% (17/29). Seventeen (58.6%) cases of post-intervention cerebral hyperdensities were related to contrast staining and 12 (41.4%) cases to contrast staining and hemorrhage. Patient mortality was significantly higher in the hemorrhagic group (50.0% versus 5.9%, p = 0.003). The increased density on CT was associated with higher hemorrhagic risk (odds ratio 1.05, p = 0.036). Conclusion Patients with the high-density sign on CT images after mechanical thrombectomy for acute ischemic stroke demonstrated increased mortality and worse clinical outcome, primarily when these hyperdensities were related to hemorrhage. CT imaging parameters as higher density areas can help in the differentiation of hemorrhage from contrast staining.

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Section: Discussionmentioning

confidence: 99%

“…9,12 Clinical outcomes of these hyperdensities on CT have been investigated previously; however, their relationship with hemorrhagic transformation after treatment and their prognosis value are not entirely understood. 8,12,21,22…”

Section: Introductionmentioning

confidence: 99%

Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

et al. 2020

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“…The study found that unadjusted and adjusted results for efficacy and safety end points favored the use of iodixanol and concluded that it contributed less endothelial cytotoxic effect to the thrombotic process. In a subsequent MCA occlusion/reperfusion model in rats, Morales et al 18 confirmed their previous results and hypothesized that the presence of HT may represent a direct/indirect effect of radiographic CM in the brain parenchyma, with less impact of IOCM iodixanol compared with LOCM iopamidol. These promising prior investigations have not yet been extended to larger patient cohorts in the real-world setting.…”

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confidence: 63%

Hemorrhagic Transformation Rates following Contrast Media Administration in Patients Hospitalized with Ischemic Stroke

Moser

Todoran

Ryan³

et al. 2022

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Hemorrhagic transformation is a critical complication associated with ischemic stroke and has been associated with contrast media administration. The objective of our study was to use real-world in-hospital data to evaluate the correlation between contrast media type and transformation from ischemic to hemorrhagic stroke. MATERIALS AND METHODS:We obtained data on inpatient admissions with a diagnosis of ischemic stroke and a record of either iso-osmolar or low-osmolar iodinated contrast media for a stroke-related diagnostic test and a treatment procedure (thrombectomy, thrombolysis, or angioplasty). We performed multivariable regression analysis to assess the relationship between contrast media type and the development of hemorrhagic transformation during hospitalization, adjusting for patient characteristics, comorbid conditions, procedure type, a threshold for contrast media volume, and differences across hospitals. RESULTS:Inpatient visits with exclusive use of either low-osmolar (n ¼ 38,130) or iso-osmolar contrast media (n ¼ 4042) were included. We observed an overall risk reduction in hemorrhagic transformation among patients who received iso-osmolar compared with low-osmolar contrast media, with an absolute risk reduction of 1.4% (P ¼ .032), relative risk reduction of 12.5%, and number needed to prevent harm of 70. This outcome was driven primarily by patients undergoing endovascular thrombectomy (n ¼ 9211), in which iso-osmolar contrast media was associated with an absolute risk reduction of 4.6% (P ¼ .028), a relative risk reduction of 20.8%, and number needed to prevent harm of 22, compared with low-osmolar contrast media.CONCLUSIONS: Iso-osmolar contrast media was associated with a lower rate of hemorrhagic transformation compared with lowosmolar contrast media in patients with ischemic stroke. ABBREVIATIONS: CM ¼ contrast media; HT ¼ hemorrhagic transformation; IOCM ¼ iso-osmolar contrast media; LOCM ¼ low-osmolar contrast media

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“…stronger T2-shortening effect than IODNS. These results could be explained by 2 hypotheses 9,14,15 : First, the T2-shortening effect of blood caused by the paramagnetic mechanism was much stronger than that of the bound water and dipole-dipole interaction effects of the iodinated contrast agent. Second, the bound water and dipole-dipole interaction effects of the iodinated contrast agent were weaker in the blood-mixed environment than in the watermixed environment.…”

Section: Discussionmentioning

confidence: 97%

“…These results correspond well with those of earlier studies. 9,14,15 The mechanism of the T2shortening effect of the iodinated contrast agent is not well-known, but the bound water effect and dipole-dipole interaction theories have been suggested as the most important mechanisms. 16,17 In general, the T2-shortening effect is explained by 3 major mechanisms: paramagnetism, bound water effect, and dipole-dipole interaction.…”

Section: Discussionmentioning

confidence: 99%

MR Imaging for Differentiating Contrast Staining from Hemorrhagic Transformation after Endovascular Thrombectomy in Acute Ischemic Stroke: Phantom and Patient Study

You

Kim

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Early differentiation of contrast staining from hemorrhagic transformation in patients with acute ischemic stroke who have undergone endovascular treatment is critical in preventing the delayed administration of antiplatelet agents. We aimed to demonstrate the usefulness of an immediate postinterventional DWI protocol including B 0 and gradient recalled-echo sequences to discriminate those 2 conditions through phantom and preliminary retrospective patient studies. MATERIALS AND METHODS: On 3T MR imaging, the signal intensities of the phantom models consisting of iodinated contrast agents diluted with normal saline and arterial blood were compared using T1WI, T2WI, and gradient recalled-echo sequences. A total 17 patients (8 with hemorrhagic transformation and 9 with contrast staining; 8 men and 9 women; mean age, 72.00 Ϯ 10.91 years; range, 52-90 years) who underwent mechanical thrombectomy for acute ischemic stroke and showed newly appearing hyperdense lesions on immediate (Ͻ24 hours) postinterventional nonenhanced CT scans were included in this study. Immediate postinterventional DWI of patients were compared. RESULTS: In the phantom study, iodinated contrast agents diluted with normal saline showed minimal signal drop, while those diluted with arterial blood demonstrated dark signal intensity in the T2WI and gradient recalled-echo sequences. In the patient study, all hemorrhagic transformations and none of the contrast staining demonstrated dark or low signal (Ͻgray matter) intensities similar to those of the vessel in the B 0-DWI and gradient recalled-echo images. CONCLUSIONS: According to our preliminary results, contrast staining might be differentiated from hemorrhagic transformation using an immediate postinterventional DWI protocol including gradient recalled-echo sequences. It might be possible to expedite establishment of postinterventional medical treatment strategy. ABBREVIATIONS: CT FU ϭ postinterventional (24-72 hours) follow-up nonenhanced brain CT; CT imme ϭ postinterventional (Ͻ24 hours) nonenhanced brain CT; GRE ϭ gradient recalled-echo; IODBL ϭ iodinated contrast agents diluted with arterial blood; IODNS ϭ iodinated contrast agents diluted with normal saline

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Variable MR and pathologic patterns of hemorrhage after iodinated contrast infusion in MCA occlusion/reperfusion model

Cited by 6 publications

References 30 publications

Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome

Hemorrhagic Transformation Rates following Contrast Media Administration in Patients Hospitalized with Ischemic Stroke

MR Imaging for Differentiating Contrast Staining from Hemorrhagic Transformation after Endovascular Thrombectomy in Acute Ischemic Stroke: Phantom and Patient Study

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