Symptomatic intracerebral hemorrhage is a serious potential complication of recombinant tissue-type plasminogen activator thrombolysis in acute ischemic stroke. We investigated the optimal imaging and clinical parameters to predict symptomatic intracerebral hemorrhage in acute ischemic stroke patients after recombinant tissue-type plasminogen activator therapy. We retrospectively reviewed 151 acute ischemic stroke patients with thrombolytic therapy, who were dichotomized into symptomatic intracerebral hemorrhage group and non–symptomatic intracerebral hemorrhage group. They underwent multimodal computed tomography, including the measurement of permeability surface. We compared the clinical and radiological characteristics between symptomatic intracerebral hemorrhage group and non–symptomatic intracerebral hemorrhage group, using univariate analysis. Receiver operating characteristic analysis and multivariate logistic regression analyses were then used to determine symptomatic intracerebral hemorrhage predictors. Of 151 patients, 14 patients (9.27%) developed symptomatic intracerebral hemorrhage on follow-up imaging. Relative permeability surface (infarct permeability surface/contralateral normal permeability surface) (p < 0.05) and baseline low-density lipoprotein cholesterol level (p < 0.05) were both predictors of symptomatic intracerebral hemorrhage. Receiver operating characteristic analysis of relative permeability surface revealed an optimal relative permeability surface threshold of 2.239, with an area under the curve of 0.87 (95% confidence interval, 0.732–1.0). The relative permeability surface was 2.239, the sensitivity for symptomatic intracerebral hemorrhage was 85.7%, the specificity was 94.9%, the positive predictive value was 70.6%, and the negative predictive value was 95.5%. For low-density lipoprotein cholesterol, the optimal threshold was 2.45, with an area under the curve of 0.726 (95% confidence interval, 0.586–0.867), the sensitivity for symptomatic intracerebral hemorrhage was 73.0%, the specificity was 64.3%, the positive predictive value was 67.16%, and the negative predictive value was 79.09%. Our study demonstrated that increased infarct permeability surface and low level of low-density lipoprotein cholesterol can be two predictors of symptomatic intracerebral hemorrhage. Detection of relative permeability surface and low-density lipoprotein cholesterol may help clinicians to identify acute ischemic stroke patients with the higher risk of symptomatic intracerebral hemorrhage; intravenous thrombolytic therapy should be carefully performed for patients with high relative permeability surface and low low-density lipoprotein cholesterol. We may take relative permeability surface and low-density lipoprotein cholesterol into account to refine therapeutic decision-making in acute ischemic stroke.

症状性脑出血是急性缺血性中风重组组织型纤溶酶原激活物溶栓治疗的一种严重的潜在并发症。我们研究了重组组织型纤溶酶原激活剂治疗后预测急性缺血性中风患者症状性脑出血的最佳影像学和临床参数。我们回顾性分析了151例接受溶栓治疗的急性缺血性脑卒中患者，将其分为症状性脑出血组和无症状性脑出血组。他们接受了多模态计算机断层扫描，包括渗透性表面的测量。我们采用单变量分析比较了有症状的脑出血组和无症状的脑出血组的临床和影像学特征。然后使用受试者操作特征分析和多变量逻辑回归分析来确定有症状的脑出血预测因子。151 名患者中，14 名患者（9.27%）在随访影像学中出现症状性脑出血。相对渗透性表面（梗塞渗透性表面/对侧正常渗透性表面）（p <0.05）和基线低密度脂蛋白胆固醇水平（p <0.05）都是症状性脑出血的预测因子。相对渗透率表面的接受者操作特征分析显示，最佳相对渗透率表面阈值为 2.239，曲线下面积为 0.87（95% 置信区间，0.732–1.0）。相对通透面积为2.239，症状性脑出血的敏感性为85.7%，特异性为94.9%，阳性预测值为70.6%，阴性预测值为95.5%。对于低密度脂蛋白胆固醇，最佳阈值为2.45，曲线下面积为0.726（95%置信区间，0.586~0.867），症状性脑出血的敏感性为73.0%，特异性为64.3%，阳性预测值为67.16%，阴性预测值为79.09%。我们的研究表明，梗塞表面通透性增加和低密度脂蛋白胆固醇水平降低可能是症状性脑出血的两个预测因素。相对通透性表面和低密度脂蛋白胆固醇的检测可能有助于临床医生识别症状性脑出血风险较高的急性缺血性中风患者；对于表面相对通透性高、低密度脂蛋白胆固醇低的患者，应谨慎进行静脉溶栓治疗。我们可以考虑相对渗透性表面和低密度脂蛋白胆固醇来完善急性缺血性中风的治疗决策。