Use of MRI to predict symptomatic haemorrhagic transformation after thrombolysis for cerebral ischaemia.

Background and Objective: Predictors of symptomatic haemorrhagic transformation (s-HT) of cerebral ischaemia after intravenous recombinant tissue-plasminogen activator (rt-PA) were identified in studies using CT scans. We evaluated whether MRI can identify other predictors.
Method: We analysed predictors of s-HT in a cohort of consecutive patients who received intravenous rt-PA for cerebral ischaemia after MRI at baseline. We used receiver operating characteristic curves considering an area under the curve (AUC) of 0.70 or higher as indicating acceptable discrimination.
Results: Of 944 patients, 49 patients (5.2%) developed s-HT. Clinical factors independently associated with s-HT were age (adjusted OR (adjOR) 1.03 for 1 year increase; 95% CI 1.01 to 1.05), excessive alcohol consumption (adjOR 3.13; 95% CI 1.32 to 7.42), recent transient ischaemic attack (adjOR 2.88; 95% CI 1.04 to 7.95) and baseline national institutes of health stroke scale score (adjOR 1.06 for 1 point increase; 95% CI 1.02 to 1.10). MRI predictors were vascular hyperintensities (adjOR 3.89; 95% CI 1.50 to 10.08), old infarcts (adjOR 2.01; 95% CI 1.11 to 3.66) and volume of diffusion-weighted imaging (DWI) abnormality (adjOR 1.02 for 1 cm ³ increase; 95% CI 1.01 to 1.03). The only variable with an acceptable discrimination was volume of DWI abnormality (AUC 0.72; 95% CI 0.64 to 0.79), a value of 4 cm ³ predicting s-HT with a 78% sensitivity and 58% specificity. Variables that can be assessed only with MRI did not predict s-HT.
Conclusion: Although the volume of DWI abnormality predicts s-HT, other imaging characteristics that can only be assessed with MRI were not significantly associated with s-HT. Trial registration number NCT01614080.
Competing Interests: Competing interests: ND-P and HH reports participation in drug trials with Boehringer-Ingelheim (honoraria paid to the hospital). CC reports participation in symposia organised by Boehringer-Ingelheim and Pfizer, advisory board by BMS (honoraria paid to ADRINORD), drug trials with Boehringer-Ingelheim, Servier, Astra-Zeneca, Biogen (honoraria paid to the hospital), vice president of the European Stroke Organisation (unpaid), member of DSMBs for institutional trials (unpaid): ATTEST 2 (UK), FIV-HeMA (France). Research support from the French Ministry of Health (A3ICH). DL reports participation in symposia organised by Boehringer Ingelheim, Bayer, BMS and Pfizer (honoraria paid to Adrinord), drug trials with Boehringer-Ingelheim (honoraria paid to the hospital), vice editor of the European Stroke Journal (honoraria paid to Adrinord), vice president of the scientific committee of the Fondation de Recherche sur les AVC (unpaid) and member of the scientific committee of the Servier Institute (unpaid). Member of DSMBs for institutional trials (unpaid): INCH (Germany), TARDIS (UK), and TO-ACT (the Netherlands). Research support from a grant of the University of Heidelberg (Germany) for the ECASS4 trial.
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