Combination of T2*W and FLAIR abnormalities for the prediction of parenchymal hematoma following thrombolytic therapy in 100 stroke patients

J Neuroimaging. 2009 Oct;19(4):311-6. doi: 10.1111/j.1552-6569.2008.00240.x.


Introduction: The objective of our study was to determine whether the combination of hypointense spots ("cerebral microbleeds," CMBs) with a leukoaraiosis is associated with the risk of parenchymal hematoma (PH) after thrombolytic therapy.

Patients and methods: We analyzed magnetic resonance imaging (MRI) scans acquired within 6 hours after symptom onset from 100 ischemic stroke patients. Multiparametric MRI including a T2*-weighted (T2*w) MRI and fluid attenuated inversion recovery (FLAIR) was performed before thrombolysis in all patients. Initial T2*w imaging was rated by two independent observers for the presence of CMBs smaller than 5 mm. White matter changes were evaluated using an adapted scale of Fazekas and Schmidt. PH was defined in follow-up imaging.

Findings: A PH was observed in seven per 100 patients. CMBs were detected by observer 1 in 22 and observer 2 in 20 patients. We found a very low sensitivity (0.14) for prediction of PH by the presence of CMBs. We found a concordant increase in the rate of PH when the periventricular hyperintensity in FLAIR was larger than a thin lining. Sensitivity was good-to-perfect (0.86 and 1.00, observers 1 and 2) and specificity was substantial (0.65 and 0.66). Using the combination of a periventricular matter lesion (PVML)>1 and the presence of CMBs did not improve the prediction of PH.

Discussion: A marked periventricular hyperintensity in FLAIR imaging seems to be associated with a substantially increased risk of PH. A combination of CMBs with leukoaraiosis scores did not appear to be beneficial for prognosis.

MeSH terms

  • Brain / drug effects
  • Brain / pathology*
  • Brain Ischemia / drug therapy
  • Brain Ischemia / pathology
  • Female
  • Follow-Up Studies
  • Hematoma / chemically induced
  • Hematoma / diagnosis
  • Hematoma / pathology*
  • Humans
  • Intracranial Hemorrhages / chemically induced
  • Intracranial Hemorrhages / diagnosis
  • Intracranial Hemorrhages / pathology*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Nerve Fibers, Myelinated / pathology
  • Prognosis
  • Risk Factors
  • Sensitivity and Specificity
  • Stroke / drug therapy
  • Stroke / pathology
  • Thrombolytic Therapy / adverse effects*