Reliability of the ECASS radiological classification of postthrombolysis brain haemorrhage: a comparison of CT and three MRI sequences.
Cerebrovasc Dis. 2010-01-01; 29(6): 597-604
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1. Cerebrovasc Dis. 2010;29(6):597-604. doi: 10.1159/000312867. Epub 2010 Apr 23.
Reliability of the ECASS radiological classification of postthrombolysis brain
haemorrhage: a comparison of CT and three MRI sequences.
Renou P(1), Sibon I, Tourdias T, Rouanet F, Rosso C, Galanaud D, Drier A, Coudert
M, Deltour S, Crozier S, Dormont D, Samson Y.
(1)APHP, Urgences Cérébro-Vasculaires, Université UPMC Paris 6, Paris, France.
Cerebrovasc Dis. 2010;29(6):605-6.
BACKGROUND: Postthrombolysis brain haemorrhagic transformations (HT) are often
categorized with the CT-based classification of the European Cooperative Acute
Stroke Study (ECASS). However, little is known about the reliability of this
classification and its extension to MRI. Our objective was to compare the inter-
and intraobserver reliability of this classification on CT and 3 MRI sequences.
METHODS: Forty-three patients with postthrombolysis HT on CT or at least 1 of the
3 MRI sequences: fluid-attenuation inversion recovery (FLAIR), diffusion-weighted
imaging (DWI), and T2* gradient recalled echo (T2*GRE) were selected. Twelve
control patients without any bleeding were added to avoid a bias based on a pure
HT-positive cohort. Each series of images were independently classified with the
ECASS method by 6 blinded observers. Inter- and intraobserver reproducibility was
categorized from poor to excellent depending on kappa values.
RESULTS: The inter- and intraobserver overall concordance of the classification
was good for T2*GRE, DWI and CT (kappa > 0.6) and moderate for FLAIR (kappa 0.8) and moderate for CT, FLAIR and DWI.
CONCLUSION: The T2*GRE sequence is the most reproducible method to categorize
postthrombolysis HT and has an excellent reliability for the severe parenchymal
haematoma category, suggesting that this sequence should be used to assess HT in
thrombolytic therapy trials.
Copyright 2010 S. Karger AG, Basel.
PMID: 20413970 [Indexed for MEDLINE]