title: Risk assessment of symptomatic intracerebral hemorrhage after thrombolysis using DWI-ASPECTS.
abstract: OBJECTIVE
  Pretreatment lesion size on diffusion-weighted imaging (DWI) is a risk factor for symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic treatment. Here, we investigated whether the Alberta Stroke Programme Early CT Score (ASPECTS) applied to DWI images (DWI-ASPECTS) predicts sICH risk accurately.
  
  
  METHODS
  In this retrospective multicenter study, prospectively collected data of 217 patients with anterior circulation stroke treated with intravenous or intraarterial thrombolysis within 6 hours after symptom onset were analyzed. Pretreatment DWI-ASPECTS scores were assessed by 2 independent investigators. For bleeding risk analysis, DWI-ASPECTS scores were either categorized into 0 to 7 (n=105) or 8 to 10 (n=112) or in 3 groups of similar sample size (DWI-ASPECTS 0 to 5 [n=69], 6 to 7 [n=70], and 8 to 10 [n=78]).
  
  
  RESULTS
  DWI-ASPECTS scores correlated well with the DWI lesion volume (r=0.77, P<0.001, Spearman Rank test). Interobserver reliability for the assessment of DWI-ASPECTS was moderate (weighted kappa 0.441 [95% CI 0.373 to 0.509]). Twenty-three (10.6%) patients developed sICH. The sICH rate was significantly higher in patients with DWI-ASPECTS scores 0 to 7 (n=21, 15.1%) as compared to patients with DWI-ASPECTS scores 8 to 10 (n=2, 2.6%, P=0.004). sICH risk was 20.3%, 10%, and 2.6% in the 0 to 5, 6 to 7, and 8 to 10 DWI-ASPECTS groups, respectively. DWI-ASPECTS remained an independent prognostic factor for sICH after adjustment for clinical baseline variables (age, NIHSS, time to thrombolysis).
  
  
  CONCLUSIONS
  DWI-ASPECTS predicts sICH risk after thrombolysis and may be helpful to contributing to quick sICH risk assessment before thrombolytic therapy.
authors.affiliation: Department of Neurology, J.W. Goethe-University Frankfurt am Main, Schleusenweg 2-16, D-60528 Frankfurt/Main, Germany. o.singer@em.uni-frankfurt.de
authors.forename: Oliver C
authors.initials: OC
authors.lastname: Singer
authors.forename: Wiebke
authors.initials: W
authors.lastname: Kurre
authors.forename: Marek C
authors.initials: MC
authors.lastname: Humpich
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Lorenz
authors.forename: Andreas
authors.initials: A
authors.lastname: Kastrup
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.forename: Goetz
authors.initials: G
authors.lastname: Thomalla
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Tobias
authors.initials: T
authors.lastname: Neumann-Haefelin
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis* / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors