AbstractBackground and Purpose—
Brain enhancement on contrast-enhanced T1-weighted imaging (CET1-WI) after ischemic stroke is generally accepted as an indicator of the blood–brain barrier disruption. However, this phenomenon usually starts to become visible at the subacute phase. The purpose of this study was to evaluate the time-course profiles of Ktrans, cerebral blood volume (vp), and CET1-WI with early detection of blood–brain barrier changes on Ktrans maps and their role for prediction of subsequent hemorrhagic transformation in acute middle cerebral arterial infarct.Methods—
Twenty-six patients with acute middle cerebral arterial stroke and early spontaneous reperfusion, whose MR images were obtained at predetermined stroke stages, were included. T2*-based MR perfusion-weighted images were acquired using the first-pass pharmacokinetic model to derive Ktrans and vp. Parenchymal enhancement observed on maps of Ktrans, vp, and CET1-WI at each stage was compared. Association among these measurements and hemorrhagic transformation was analyzed.Results—
Ktrans map showed significantly higher parenchymal enhancement in ischemic parenchyma as compared with that of vp map and CET1-WI at early stroke stages (P<0.05). The increased Ktrans at acute stage was not associated with parenchymal enhancement in CET1-WI at the same stage. Parenchymal enhancement in CET1-WI started to occur at the late subacute stage and tended to be luxury reperfusion–dependent. Patients with hemorrhagic transformation showed higher mean Ktrans values as compared with patients without hemorrhagic transformation (P=0.02).Conclusions—
Postischemic brain enhancement on routine CET1-WI seems to be closely related to the luxury reperfusion at the late subacute stage and is not dependent on microvascular permeability changes at the acute stage.