Table 1.
Review of LOE of the role of CT imaging in the prediction of hemorrhagic transformation.
| Study | LOEa | No of Study Participants | Treatment Modality (%) | OR 95% CI, p | |
|---|---|---|---|---|---|
| Noncontrast CT | |||||
| Early ischemia sign | Jaillard et al.20 | IV | 237 | IV streptokinase | 2.6 (1.5–4.4), p = 0.002 |
| Hyperdense middle cerebral artery sign | Zou et al.21 | IV | 182 | IV thrombolysis (100) | 2.691 (1.231–5.882), p = 0.013 |
| Low Alberta Stroke Program Early CT Score | Barber et al.22 | IV | 203 | IV thrombolysis (100) | 14 (18–117), p = 0·012 |
| Dzialowski et al.23 | II | 800 | IV thrombolysis (100) | 18.9 (2.6–138) | |
| Lin et al.24 | IV | 83 | IV thrombolysis and/or thrombolytic or mechanical IA therapy (52.4) | 0.731 (0.561–0.953), p = 0.021 | |
| CTA | |||||
| Clot burden score | Puetz et al.25 | IV | 263 | IV thrombolysis and/or thrombolytic or mechanical IA therapy (49.8) | p = 0.003 |
| Fanou et al.26 | IV | 395 | IV thrombolysis (69.1) | 0.46 (0.23–0.90), p = 0.0253 | |
| Horsch et al.27 | IV | 545 | IV thrombolysis and/or thrombolytic or mechanical IA therapy (100) | 1.28, (1.16–1.41) | |
| Large-vessel occlusions | Sims et al.28 | IV | 47 | IV thrombolysis (100) | p = 0.04 |
| Lin et al.24 | IV | 83 | IV thrombolysis and/or thrombolytic or mechanical IA therapy (46.9) | p = 0.049 | |
| Fanou et al.26 | IV | 395 | IV thrombolysis (69.1) | 2.22 (1.21–4.12), p = 0.0102 | |
| Poor collateral vessels | Lin et al.24 | IV | 83 | IV thrombolysis and/or thrombolytic or mechanical IA therapy (46.9) | p = 0.017 |
| Fanou et al.26 | IV | 395 | IV thrombolysis (69.1) | 0.36 (0.14–0.88), p = 0.0284 | |
| van Kranendonk et al.30 | IV | 478 | IV thrombolysis and/or thrombolytic or mechanical IA therapy | 1.90 (1.05–3.42) | |
| CTP | |||||
| Decreased rCBF | Yassi et al.5 | IV | 132 | IV thrombolysis (53) | p = 0.021 |
| Langel and Popovic33 | IV | 75 | IV thrombolysis (100) | p < 0.001 | |
| Decreased CBV | Jain et al.32 | IV | 83 | IV thrombolysis (27.7) | 1.14 (1.05–1.25), p = 0.009 |
| Increased MTT | Yassi et al.5 | IV | 132 | IV thrombolysis (53) | p = 0.002 |
| Souza et al.35 | IV | 96 | IV thrombolysis and/or thrombolytic or mechanical IA therapy | 3.7, p = 0.007 | |
| Increased permeability surface product | Horsch et al.27 | IV | 545 | IV thrombolysis and/or thrombolytic or mechanical IA therapy (100) | 2.22 (1.46–3.37), p = 0.001 |
| Aviv et al.34 | IV | 41 | IV thrombolysis and/or thrombolytic or mechanical IA therapy (54) | 3.5 (1.69, 7.06) p = 0.0007 | |
| Hom et al.37 | IV | 32 | IV thrombolysis and/or thrombolytic or mechanical IA therapy | 1.71, p = 0.01 | |
| Ozkul-Wermester et al.38 | IV | 86 | IV thrombolysis (36) | 28 (1.75–452.98), p = 0.02 | |
| High BBB permeability and acute severe hypoperfusion (i.e. CBV < 0.5 ml/100 g; rCBV = 1.09; rCBF < 0.48; Tmax > 14 s; rMTT .1.3; TTP 0.27 s) | Adebayo and Culpan39 | I | 808 | IV thrombolysis and/or thrombolytic or mechanical IA therapy | (95% CI; 65%–97%) |
| SPECT | |||||
| CBF reduction | Hanson et al.40 | IV | 15 | NA | p < 0.005 |
| Ueda et al.41 | IV | 34 | IA thrombolysis | p < 0.05 | |
| Alexandrov et al.42 | IV | 185 | None | 17.40 (2.69–170.89) p < 0.05 | |
BBB: blood-brain barrier; CBF: cerebral blood flow; CBV: cerebral blood volume; CI: confidence interval; CT: computed tomography; CTA: computed tomography angiography; CTP: computed tomography perfusion; IA: intra-arterial; IV: intravenous; LOE: level of evidence; MTT: mean transit time; NA: not available; OR: odds ratio; rCBF: relative cerebral blood flow; rCBV: relative cerebral blood volume; rMTT: relative mean transit time; SPECT: single-photon emission computed tomography; TTP: time to peak. aLOE adopted from Ackley et al. as follows: level 1: systematic review or meta-analysis, level II: randomized controlled trial, level III: nonrandomized controlled trials, level IV: case-control studies, cohort studies, level V: meta-synthesis, and level VI: single descriptive or qualitative study.20