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 cm3 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 cm3 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 numberNCT01614080.

中文翻译：

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使用MRI预测脑缺血溶栓后的症状性出血性转化。

背景和目的在使用CT扫描的研究中确定了静脉内重组组织纤溶酶原激活剂（rt-PA）后脑缺血的症状性出血性转化（s-HT）的预测指标。我们评估了MRI是否可以识别其他预测因子。方法我们分析了基线时MRI后接受静脉rt-PA进行脑缺血的连续患者队列中s-HT的预测因素。我们使用接收器工作特性曲线，将曲线下的面积（AUC）设为0.70或更高，这表明可接受的辨别力。结果在944例患者中，有49例（5.2％）患了s-HT。与s-HT独立相关的临床因素包括年龄（调整后的OR（adjOR）1.03，持续1年增加； 95％CI为1.01至1.05），饮酒过量（adjOR 3.13； 95％CI为1.32至7.42），最近的短暂性脑缺血发作（adjOR 2.88； 95％CI 1.04至7.95）和基线国家卫生研究院卒中量表评分（adjOR 1.06升高1分； 95％CI 1.02至1.10）。MRI预测指标为血管高强度（adjOR 3.89; 95％CI 1.50至10.08），陈旧性梗塞（adjOR 2.01; 95％CI 1.11至3.66）和弥散加权成像（DWI）异常量（adjOR 1.02每增加1 cm3; 95） ％CI 1.01至1.03）。唯一具有可接受辨别力的变量是DWI异常的体积（AUC 0.72； 95％CI 0.64至0.79），其值为4 cm3预测s-HT的敏感性为78％，特异性为58％。仅能通过MRI评估的变量不能预测s-HT。结论尽管DWI异常的数量可以预测s-HT，