Clinical imaging evaluation of hemorrhagic transformation_West China Medical Journal

Authors：

YANG Simin , LIU Kangli , LIU Xiaoyu , FANG He ,  YANG Weimin

Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China;

Corresponding author：

YANG Weimin, Email: weiminyanghn@163.com

Keywords：

Acute ischemic stroke; hemorrhagic transformation; neuroimaging technique

DOI：

10.7507/1002-0179.202404051

Video：

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Hemorrhagic transformation is one of the most serious complications after endovascular treatment in patients with acute ischemic stroke, which is closely related to neurological deterioration and poor functional prognosis. Therefore, early detection and treatment of hemorrhagic transformation are of great significance for improving patient prognosis. Brain CT, CT angiography, CT perfusion imaging, MRI, diffusion weighted imaging, and susceptibility weighted imaging are relatively commonly used imaging methods in clinical practice. Reasonable use of imaging methods can reduce the risk of hemorrhagic transformation and improve patient prognosis. This article reviews common imaging evaluation techniques for hemorrhagic transformation in clinical practice in order to provide ideas for clinical diagnosis and treatment.

Citation： YANG Simin, LIU Kangli, LIU Xiaoyu, FANG He, YANG Weimin. Clinical imaging evaluation of hemorrhagic transformation. West China Medical Journal, 2024, 39(5): 681-683. doi: 10.7507/1002-0179.202404051 Copy

1.	Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology, 2021, 97(Suppl 2): S6-S16.
2.	Suh CH, Jung SC, Cho SJ, et al, Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Eur Radiol, 2019, 29(8): 4077-4087.
3.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性脑梗死后出血转化诊治共识2019. 中华神经科杂志, 2019, 52(4): 252-265.
4.	李文君, 刘俊艳. 卒中后出血转化的影像学评估. 中国卒中杂志, 2019, 14(8): 803-808.
5.	Wang T, Ding W, Chen Q, et al. Hemorrhagic transformation assessment based on dual energy CT of immediately and twenty-four hours after endovascular thrombectomy for acute ischemic stroke. Diagnostics (Basel), 2023, 13(15): 2493.
6.	孙勇, 李辉明, 王立强, 等. CTA 原始成像用于预测急性脑梗死患者的最终梗死体积. 心脑血管病防治, 2016, 16(2): 91-94, 108.
7.	Fanou EM, Knight J, Aviv RI, et al. Effect of collaterals on clinical presentation, baseline imaging, complications, and outcome in acute stroke. AJNR Am J Neuroradiol, 2015, 36(12): 2285-2291.
8.	Yu S, Liebeskind DS, Dua S, et al. Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke. J Cereb Blood Flow Metab, 2015, 35(4): 630-637.
9.	Chen H, Liu N, Li Y, et al. Mismatch of low perfusion and high permeability predicts hemorrhagic transformation region in acute ischemic stroke patients treated with intra-arterial thrombolysis. Sci Rep, 2016, 6: 27950.
10.	潘豪, 陈小凤, 吴晓强, 等. CT灌注联合多时相CT血管成像预测急性缺血性脑卒中患者机械取栓术后出血转化的价值. 中国医学计算机成像杂志, 2024, 30(1): 105-109.
11.	Kufner A, Galinovic I, Brunecker P, et al. Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis. Eur J Neurol, 2013, 20(2): 281-285.
12.	Suh CH, Jung SC, Cho SJ, et al. MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Acta Radiol, 2020, 61(7): 964-972.
13.	da Silva-Candal A, Pérez-Mato M, Rodríguez-Yáñez M, et al. The presence of leukoaraiosis enhances the association between sTWEAK and hemorrhagic transformation. Ann Clin Transl Neurol, 2020, 7(11): 2103-2114.
14.	Wei CC, Zhang ST, Wang YH, et al. Association between leukoaraiosis and hemorrhagic transformation after cardioembolic stroke due to atrial fibrillation and/or rheumatic heart disease. J Neurol Sci, 2017, 378: 94-99.
15.	Fierini F, Poggesi A, Pantoni L. Leukoaraiosis as an outcome predictor in the acute and subacute phases of stroke. Expert Rev Neurother, 2017, 17(10): 963-975.
16.	鲍婕妤, 赵建华, 刘娜, 等. 症状性大脑中动脉不同部位闭塞的临床和影像特征. 中风与神经疾病杂志, 2022, 39(2): 115-118.
17.	Guo G, Yang Y, Yang W. Validation of hyperintense middle cerebral artery sign in acute ischemic stroke: comparison between magnetic resonance imaging and angiography. Neural Regen Res, 2012, 7(3): 229-234.
18.	Chen L, Xu Z, Zhang C, et al. Post-ASPECTS based on hyperdensity in NCCT immediately after thrombectomy is an ultra-early predictor of hemorrhagic transformation and prognosis. Front Neurol, 2022, 13: 887277.
19.	Beslow LA, Vossough A, Ichord RN, et al. Association of pediatric ASPECTS and NIH Stroke Scale, hemorrhagic transformation, and 12-month outcome in children with acute ischemic stroke. Neurology, 2021, 97(12): e1202-e1209.
20.	吴江, 朱艳, 柏根基, 等. 治疗后DWI-ASPECTS评分对急性缺血性脑卒中的预后评估. 临床放射学杂志, 2023, 42(12): 1866-1870.
21.	吴雅蔚, 叶靖, 征锦, 等. IVIM-DWI与DCE-PWI在急性缺血性脑梗死中各灌注参数的相关性研究. 临床放射学杂志, 2020, 39(3): 596-599.
22.	田杨, 李蕾, 孟岳, 等. IVIM-DWI灌注参数与中青年急性脑梗死神经功能缺损程度及溶栓后出血性转化的相关性. 中国CT和MRI杂志, 2023, 21(11): 11-14.
23.	王川平, 严善文, 顾伟, 等. 基于SWI的静脉血管分析对急性缺血性脑卒中患者预后评价研究. 黑龙江中医药, 2022, 51(5): 342-344.
24.	崔萍, 张继, 王松, 等. SWI毛刷征诊断AIS患者静脉溶栓后出血转化的价值观察. 中国CT和MRI杂志, 2020, 18(8): 26-28, 68.
25.	徐志宾, 陈杏杏. 磁共振磁弥散成像联合磁敏感成像在急性脑梗塞出血转化诊断中的临床价值. 影像技术, 2023, 35(1): 4-9.
26.	杨千朋, 周欣, 张华文, 等. 利用SWI探讨急性脑梗死合并微出血对溶栓治疗后出血转化的影响. 医学影像学杂志, 2023, 33(2): 202-205.
27.	Nagaraja N, Tasneem N, Shaban A, et al. Cerebral microbleeds are an independent predictor of hemorrhagic transformation following intravenous alteplase administration in acute ischemic stroke. J Stroke Cerebrovasc Dis, 2018, 27(5): 1403-1411.
28.	Liu J, Wang D, Li J, et al. Cerebral microbleeds do not predict hemorrhagic transformation in acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Curr Neurovasc Res, 2017, 14(2): 104-109.

1. Saini V, Guada L, Yavagal DR. Global epidemiology of stroke and access to acute ischemic stroke interventions. Neurology, 2021, 97(Suppl 2): S6-S16.
2. Suh CH, Jung SC, Cho SJ, et al, Perfusion CT for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Eur Radiol, 2019, 29(8): 4077-4087.
3. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性脑梗死后出血转化诊治共识2019. 中华神经科杂志, 2019, 52(4): 252-265.
4. 李文君, 刘俊艳. 卒中后出血转化的影像学评估. 中国卒中杂志, 2019, 14(8): 803-808.
5. Wang T, Ding W, Chen Q, et al. Hemorrhagic transformation assessment based on dual energy CT of immediately and twenty-four hours after endovascular thrombectomy for acute ischemic stroke. Diagnostics (Basel), 2023, 13(15): 2493.
6. 孙勇, 李辉明, 王立强, 等. CTA 原始成像用于预测急性脑梗死患者的最终梗死体积. 心脑血管病防治, 2016, 16(2): 91-94, 108.
7. Fanou EM, Knight J, Aviv RI, et al. Effect of collaterals on clinical presentation, baseline imaging, complications, and outcome in acute stroke. AJNR Am J Neuroradiol, 2015, 36(12): 2285-2291.
8. Yu S, Liebeskind DS, Dua S, et al. Postischemic hyperperfusion on arterial spin labeled perfusion MRI is linked to hemorrhagic transformation in stroke. J Cereb Blood Flow Metab, 2015, 35(4): 630-637.
9. Chen H, Liu N, Li Y, et al. Mismatch of low perfusion and high permeability predicts hemorrhagic transformation region in acute ischemic stroke patients treated with intra-arterial thrombolysis. Sci Rep, 2016, 6: 27950.
10. 潘豪, 陈小凤, 吴晓强, 等. CT灌注联合多时相CT血管成像预测急性缺血性脑卒中患者机械取栓术后出血转化的价值. 中国医学计算机成像杂志, 2024, 30(1): 105-109.
11. Kufner A, Galinovic I, Brunecker P, et al. Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis. Eur J Neurol, 2013, 20(2): 281-285.
12. Suh CH, Jung SC, Cho SJ, et al. MRI for prediction of hemorrhagic transformation in acute ischemic stroke: a systematic review and meta-analysis. Acta Radiol, 2020, 61(7): 964-972.
13. da Silva-Candal A, Pérez-Mato M, Rodríguez-Yáñez M, et al. The presence of leukoaraiosis enhances the association between sTWEAK and hemorrhagic transformation. Ann Clin Transl Neurol, 2020, 7(11): 2103-2114.
14. Wei CC, Zhang ST, Wang YH, et al. Association between leukoaraiosis and hemorrhagic transformation after cardioembolic stroke due to atrial fibrillation and/or rheumatic heart disease. J Neurol Sci, 2017, 378: 94-99.
15. Fierini F, Poggesi A, Pantoni L. Leukoaraiosis as an outcome predictor in the acute and subacute phases of stroke. Expert Rev Neurother, 2017, 17(10): 963-975.
16. 鲍婕妤, 赵建华, 刘娜, 等. 症状性大脑中动脉不同部位闭塞的临床和影像特征. 中风与神经疾病杂志, 2022, 39(2): 115-118.
17. Guo G, Yang Y, Yang W. Validation of hyperintense middle cerebral artery sign in acute ischemic stroke: comparison between magnetic resonance imaging and angiography. Neural Regen Res, 2012, 7(3): 229-234.
18. Chen L, Xu Z, Zhang C, et al. Post-ASPECTS based on hyperdensity in NCCT immediately after thrombectomy is an ultra-early predictor of hemorrhagic transformation and prognosis. Front Neurol, 2022, 13: 887277.
19. Beslow LA, Vossough A, Ichord RN, et al. Association of pediatric ASPECTS and NIH Stroke Scale, hemorrhagic transformation, and 12-month outcome in children with acute ischemic stroke. Neurology, 2021, 97(12): e1202-e1209.
20. 吴江, 朱艳, 柏根基, 等. 治疗后DWI-ASPECTS评分对急性缺血性脑卒中的预后评估. 临床放射学杂志, 2023, 42(12): 1866-1870.
21. 吴雅蔚, 叶靖, 征锦, 等. IVIM-DWI与DCE-PWI在急性缺血性脑梗死中各灌注参数的相关性研究. 临床放射学杂志, 2020, 39(3): 596-599.
22. 田杨, 李蕾, 孟岳, 等. IVIM-DWI灌注参数与中青年急性脑梗死神经功能缺损程度及溶栓后出血性转化的相关性. 中国CT和MRI杂志, 2023, 21(11): 11-14.
23. 王川平, 严善文, 顾伟, 等. 基于SWI的静脉血管分析对急性缺血性脑卒中患者预后评价研究. 黑龙江中医药, 2022, 51(5): 342-344.
24. 崔萍, 张继, 王松, 等. SWI毛刷征诊断AIS患者静脉溶栓后出血转化的价值观察. 中国CT和MRI杂志, 2020, 18(8): 26-28, 68.
25. 徐志宾, 陈杏杏. 磁共振磁弥散成像联合磁敏感成像在急性脑梗塞出血转化诊断中的临床价值. 影像技术, 2023, 35(1): 4-9.
26. 杨千朋, 周欣, 张华文, 等. 利用SWI探讨急性脑梗死合并微出血对溶栓治疗后出血转化的影响. 医学影像学杂志, 2023, 33(2): 202-205.
27. Nagaraja N, Tasneem N, Shaban A, et al. Cerebral microbleeds are an independent predictor of hemorrhagic transformation following intravenous alteplase administration in acute ischemic stroke. J Stroke Cerebrovasc Dis, 2018, 27(5): 1403-1411.
28. Liu J, Wang D, Li J, et al. Cerebral microbleeds do not predict hemorrhagic transformation in acute ischemic stroke patients with atrial fibrillation and/or rheumatic heart disease. Curr Neurovasc Res, 2017, 14(2): 104-109.

West China Medical Journal

Clinical imaging evaluation of hemorrhagic transformation

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