Background and Purpose: Arterial spin-labeling (ASL) MRI is sensitive for detecting hyperemic lesions (HLs) in patients with acute ischemic stroke (AIS). We evaluated whether HLs could predict blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) in AIS patients.
Methods: In a retrospective study, ASL was performed within 6 hours of symptom onset before revascularization treatment in 25 patients with anterior circulation large vessel occlusion on baseline MR angiography. All patients underwent angiographic procedures intended for endovascular therapy and a noncontrast CT scan immediately after treatment. BBB disruption was defined as a hyperdense lesion present on the posttreatment CT scan. A subacute MRI or CT scan was performed during the subacute phase to assess HTs. The relationship between HLs and BBB disruption and HT was examined using the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) locations in the symptomatic hemispheres.
Results: A HL was defined as a region where CBFrelative≥1.4 (CBFrelative=CBFHL/CBFcontralateral). HLs, BBB disruption and HT were found in 9, 15, and 15 patients, respectively. Compared with the patients without HLs, the patients with HLs had a higher incidence of both BBB disruption (100% versus 37.5%, P=0.003) and HT (100% versus 37.5%, P=0.003). Based on the ASPECTS locations, 21 regions of interests (ROIs) displayed HLs. Compared with the ROIs without HLs, the ROIs with HLs had a higher incidence of both BBB disruption (42.8% versus 3.9%, P<0.001) and HT (85.7% versus 7.8%, P<0.001).
Conclusion: HLs detected on pretreatment ASL maps may enable the prediction and localization of subsequent BBB disruption and HT.