Andrea Kassner1,2, Rebecca E. Thornhill1,2, Swati Matta1, Fang Liu1, David J. Mikulis1,3
1Medical Imaging, University of Toronto, Toronto, Ontario, Canada; 2Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; 3Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada
Thrombolytic therapy is known to increase the risk of hemorrhagic transformation (HT) in acute ischemic stroke (AIS). Accurate and robust methods for predicting HT are required for improving treatment guidance. Model-based permeability estimation with dynamic contrast-enhanced MRI can predict HT, but the estimates (KPS coefficients) are sensitive to noise and require an arterial input function. However, studies of tumors suggest that a model-free measure, the initial area under the contrast-concentration curve (IAUC) is more robust. We evaluated both KPS and IAUC in AIS patients and found that only KPS successfully delineated HT. Model-based estimates are recommended over IAUC in AIS.