Predicting Transformation to Type 2 Parenchymal Hematoma in Acute Ischemic Stroke by CT Permeability Imaging

K Lin

doi:10.3174/ajnr.a2602

Abstract

I read with great interest the retrospective study by Hom et al,[1][1] in which a model combining clinical metrics with blood-brain barrier (BBB) permeability data from dynamic CT was presented to predict symptomatic hemorrhagic transformation (HT) and malignant edema in acute ischemic stroke. The

Highlights

The authors report that 3 of the 32 patients in their cohort (9.4%) had HT that was classified as PH2, which is unusually high, especially given that not all patients received tissue plasminogen activator
The most illustrative of the 3 PH2s was used by the authors for publication in Fig 1
I believe the more appropriate classification of the HT shown in Fig 1 is HI2

Summary

Introduction

The authors report that 3 of the 32 patients in their cohort (9.4%) had HT that was classified as PH2, which is unusually high, especially given that not all patients received tissue plasminogen activator (tPA) (though the exact number of patients who did was not reported). PH2 is an uncommon event, occurring only in 1.7% of the 6444 intravenous tPA-treated patients in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study[4] and in 1.9% of the 418 intravenous tPA-treated patients in ECASS III.[5] Presumably, the most illustrative of the 3 PH2s was used by the authors for publication in Fig 1 (http:// www.ajnr.org/cgi/content/full/32/1/41/F1).

Results

Conclusion