Abstract
chymal haematoma (PH 1,2) indicates blood clot with mass effect. Results: Imaging data was complete (pre and post tPA/placebo PWI and DWI) in 96 of 100 patients. HT occurred in 46 of 96 patients. Parenchymal haematomas (PH 1,2) occurred in 14 (4 symptomatic), asymptomatic haemorrhagic infarcts (HI 1,2) in 32. All VLCBV thresholds had similar results the <2.5 percentile is reported here. Median volume of VLCBV (mL) was significantly higher in HT compared with non-HT (4.04mL Vs 0.43mL p < 0.001) and in PH compared with non-PH patients (7.47mL Vs 1.22mL p = 0.003). There was a trend towards higher VLCBV volume in PH compared to HI (7.47 Vs 3.29 p = 0.11). Using VLCBV volume in ROC analysis gave an AUC of 0.74 for HT Vs no HT and 0.75 for PH Vs no PH indicating good performance as a predictive test. In subgroup analysis VLCBV was a better predictor of HT Vs no HT in reperfused patients (AUC 0.80) compared to non-reperfused patients (AUC 0.65) and in tPA treated patients (AUC 0.82) compared to untreated patients (AUC 0.68). A cut-point at 1 mL VLCBV had sensitivity 91%, specificity 73%, PPV 74%, NPV 90% for any HT and 100% NPV for PH. DWI volume correlated with VLCBV (R = 0.78) but was less accurate in predicting any HT (AUC 0.69) or PH (AUC 0.70). Univariate ordinal logistic regression using 5 HT categories as dependent variable was significant for VLCBV (coeff -1.27, p < 0.001) and DWI (coeff -0.14, p = 0.016). In multivariate analysis VLCBV (coeff -2.44, p = 0.001) was strongly predictive but DWI (coeff +0.23, p 0.06) did not improve prediction. Conclusions: This study has found that VLCBV is a better predictor of HT following thrombolysis than DWI volume in a large patient cohort. The effect holds true at a range of CBV thresholds and prediction is better in patients who reperfuse. Specificity may be improved by incorporating other predictive factors. The addition of VLCBV to pre-thrombolysis decision making could reduce the incidence of HT.
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