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(Stroke. 2009;40:2743.)
© 2009 American Heart Association, Inc.

Original Contributions

Risk Assessment of Symptomatic Intracerebral Hemorrhage After Thrombolysis Using DWI-ASPECTS

Oliver C. Singer, MD; Wiebke Kurre, MD; Marek C. Humpich, MD; Matthias W. Lorenz, MD; Andreas Kastrup, MD; David S. Liebeskind, MD; Goetz Thomalla, MD; Jens Fiehler, MD; Joachim Berkefeld, MD; Tobias Neumann-Haefelin, MD for the MR Stroke Study Group Investigators

From the Klinik für Neurologie (O.C.S., M.C.H., M.W.L., T.N.-H.), Universitätsklinikum, Goethe-Universität, Frankfurt, Germany; the Institut für Neuroradiologie (W.K., J.B.), Universitätsklinikum, Goethe-Universität, Frankfurt, Germany; the Neurologische Klinik (A.K.), Universitätsklinikum, Jena, Germany; the Neurologische Klinik (A.K.), Universitätsklinikum, Göttingen, Germany; UCLA Stroke Center (D.S.L.), University of California, Los Angeles; the Neurologische Klinik (G.T.), Universitätsklinik Eppendorf, Hamburg, Germany; and Neuroradiologie (J.F.), Universitätsklinik Eppendorf, Hamburg, Germany.

Correspondence to Dr Oliver C. Singer, MD, Department of Neurology, J.W. Goethe-University Frankfurt am Main, Schleusenweg 2-16, D-60528 Frankfurt/Main, Germany. E-mail o.singer{at}em.uni-frankfurt.de

Background and Purpose— 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.

Key Words: stroke • acute • thrombolysis • diffusion weighted imaging • intracerebral hemorrhage • ASPECTS score