Abstract
Objective
The hyperintense acute reperfusion marker (HARM) on fluid-attenuated inversion recovery (FLAIR) images is associated with blood-brain barrier (BBB) permeability changes. The aim of this study was to examine the influence of contrast agent dosage on HARM incidence in acute ischaemic stroke patients.
Methods
We prospectively included 529 acute ischaemic stroke patients (204 females, median age 71 years). Patients underwent a first stroke-MRI within 24 hours from symptom onset and had a follow-up on day 2. The contrast agent Gadobutrol was administered to the patients for perfusion imaging or MR angiography. The total dosage was calculated as ml/kg body weight and ranged between 0.04 and 0.31 mmol/kg on the first examination. The incidence of HARM was evaluated on day 2 FLAIR images.
Results
HARM was detected in 97 patients (18.3 %). HARM incidence increased significantly with increasing dosages of Gadobutrol. Also, HARM positive patients were significantly older. HARM was not an independent predictor of worse clinical outcome, and we did not find an association with increase risk of haemorrhagic transformation.
Conclusions
A higher dosage of Gadobutrol in acute stroke patients on initial MRI is associated with increased HARM incidence on follow-up. MRI studies on BBB should therefore standardize contrast agent dosages.
Key Points
• Hyperintense acute reperfusion marker on MRI indicates blood-brain barrier disruption.
• This observational study on stroke patients characterizes HARM.
• Incidence depends on contrast agent dosage on the previous day.
• HARM is also associated with older age and poor kidney function.
• Interpretation of HARM must take dosage into consideration.
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Abbreviations
- HARM:
-
Hyperintense acute reperfusion marker
- FLAIR:
-
Fluid-attenuated inversion recovery
- CSF:
-
Cerebrospinal fluid
- BBB:
-
Blood-brain barrier
- DWI:
-
Diffusion-weighted imaging
- PI:
-
Perfusion imaging
- HT:
-
Haemorrhagic transformation
- PH:
-
Parenchymal haemorrhage
- NIHSS:
-
National Institutes of Health Stroke Scale
- mRS:
-
Modified Rankin Scale
- GFR:
-
Glomerular filtration rate
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Acknowledgements
The scientific guarantor of this publication is Jochen B. Fiebach. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding from the Federal Ministry of Education and Research via the Grant Center for Stroke Research Berlin (01EO0801 and 01EO1301). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients in this study. Methodology: prospective, observational study, performed at one institution.
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Ostwaldt, AC., Rozanski, M., Schaefer, T. et al. Hyperintense acute reperfusion marker is associated with higher contrast agent dosage in acute ischaemic stroke. Eur Radiol 25, 3161–3166 (2015). https://doi.org/10.1007/s00330-015-3749-5
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DOI: https://doi.org/10.1007/s00330-015-3749-5