Fluid-attenuated inversion recovery hyperintensity correlates with matrix metalloproteinase-9 level and hemorrhagic transformation in acute ischemic stroke

Authors

Ruchira Jha, From the Department of Neurology, Massachusetts General Hospital, Boston, MA (R.J., T.W.K.B., L.P., W.T.K.); Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L.); Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI (K.L.F.); and Department of Neurology, Yale New Haven Hospital, New Haven, CT (K.N.S.).Follow
Thomas W. Battey
Ly Pham
Svetlana Lorenzano
Karen L. Furie
Kevin N. Sheth
W Taylor Kimberly

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: Matrix metalloproteinase-9 (MMP-9) is elevated in patients with acute stroke who later develop hemorrhagic transformation (HT). It is controversial whether early fluid-attenuated inversion recovery (FLAIR) hyperintensity on brain MRI predicts hemorrhagic transformation (HT). We assessed whether FLAIR hyperintensity was associated with MMP-9 and HT. METHODS: We analyzed a prospectively collected cohort of acute stroke subjects with acute brain MRI images and MMP-9 values within the first 12 hours after stroke onset. FLAIR hyperintensity was measured using a signal intensity ratio between the stroke lesion and corresponding normal contralateral hemisphere. MMP-9 was measured using enzyme-linked immunosorbent assay. The relationships between FLAIR ratio (FR), MMP-9, and HT were evaluated. RESULTS: A total of 180 subjects were available for analysis. Patients were imaged with brain MRI at 5.6±4.3 hours from last seen well time. MMP-9 blood samples were drawn within 7.7±4.0 hours from last seen well time. The time to MRI (r=0.17, P=0.027) and MMP-9 level (r=0.29, P<0.001) were each associated with FR. The association between MMP-9 and FR remained significant after multivariable adjustment (P<0.001). FR was also associated with HT and symptomatic hemorrhage (P=0.012). CONCLUSIONS: FR correlates with both MMP-9 level and risk of hemorrhage. FLAIR changes in the acute phase of stroke may predict hemorrhagic transformation, possibly as a reflection of altered blood-brain barrier integrity.

Medical Subject Headings

Aged; Aged, 80 and over; Blood-Brain Barrier (metabolism); Brain Edema (epidemiology, metabolism); Brain Ischemia (epidemiology, metabolism); Cerebral Hemorrhage (epidemiology, metabolism); Female; Humans; Magnetic Resonance Imaging (methods); Male; Matrix Metalloproteinase 9 (metabolism); Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prospective Studies; Risk Factors; Stroke (epidemiology, metabolism)

Publication Date

4-1-2014

Publication Title

Stroke

E-ISSN

1524-4628

Volume

45

Issue

4

First Page

1040

Last Page

5

PubMed ID

24619394

Digital Object Identifier (DOI)

10.1161/STROKEAHA.113.004627

Recommended Citation

Jha, Ruchira; Battey, Thomas W.; Pham, Ly; Lorenzano, Svetlana; Furie, Karen L.; Sheth, Kevin N.; and Kimberly, W Taylor, "Fluid-attenuated inversion recovery hyperintensity correlates with matrix metalloproteinase-9 level and hemorrhagic transformation in acute ischemic stroke" (2014). Neurology. 1338.
https://scholar.barrowneuro.org/neurology/1338