Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE Study
Background The characterization of hemorrhage following acute stroke intervention has largely been computed tomography (CT) based. We sought to compare magnetic resonance imaging‐ (MRI‐) and CT‐based scoring of hemorrhage after acute endovascular therapy (EVT) applying the Heidelberg Bleeding Classi...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-11-01
|
| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.124.001441 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849471498940579840 |
|---|---|
| author | Amie W. Hsia Lawrence L. Latour Sana Somani Carolyn A. Lomahan Yongwoo Kim John K. Lynch Marie Luby |
| author_facet | Amie W. Hsia Lawrence L. Latour Sana Somani Carolyn A. Lomahan Yongwoo Kim John K. Lynch Marie Luby |
| author_sort | Amie W. Hsia |
| collection | DOAJ |
| description | Background The characterization of hemorrhage following acute stroke intervention has largely been computed tomography (CT) based. We sought to compare magnetic resonance imaging‐ (MRI‐) and CT‐based scoring of hemorrhage after acute endovascular therapy (EVT) applying the Heidelberg Bleeding Classification (HBC) to assess intermodal agreement and quantify interrater agreement. Methods Consecutive patients with acute stroke were included in this retrospective study if they (1) had MRI and CT ≤12 hours of each other OR (2) had CT bracketed by MRI pre‐ and post‐CT (ie, MRI‐CT‐MRI) ≤7 days post‐EVT. The concordance of the HBC ratings by consensus panel were compared between CT and T2* gradient recalled echo MRI. Results For the 87 EVT‐treated patients included, median age was 68 years [60–74], admission National Institutes of Health Stroke Scale score 18 [13–23], 47% were treated with intravenous/intraarterial thrombolytics, and 93% were successfully recanalized (modified Thrombolysis in Cerebral Infarction 2b/3). Hemorrhage was detected on at least 1 modality in 60% (52/87) of patients. We found a 68% (59/87, 95% CI [57%–77%]) agreement overall between CT and MRI for hemorrhage classification post‐EVT. MRI had the best interrater agreement for HBC 0 (no hemorrhage) with excellent concordance (ĸ = 0.882), compared with CT (ĸ = 0.683). T2* gradient recalled echo MRI tended to have increased sensitivity to scattered petechial hemorrhage (HBC 1a) as compared with CT with 17% (2/12) intermodal agreement. The interrater agreement of HBC class 2 (ie, parenchymal hematoma grade 2 was substantial for MRI (ĸ = 0.781) and excellent in CT (ĸ = 0.951), with 67% (8/12) intermodal agreement. Subarachnoid hemorrhage was detected in 24% (21/87) of patients on CT and/or MRI with 29% (6/21) intermodal agreement. Conclusion With the exception of subarachnoid hemorrhage and minor petechial hemorrhagic transformation, we found that MRI and CT are overall interchangeable for detecting and classifying hemorrhage after EVT. These findings are reassuring for both clinical decision‐making and research application. Given the complexity of hemorrhage subtypes post‐EVT, work to further refine a post‐EVT hemorrhage classification scale with clinical correlation would be beneficial. |
| format | Article |
| id | doaj-art-ad25fd40c9dc421faa7fbb7e11318fe9 |
| institution | Kabale University |
| issn | 2694-5746 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj-art-ad25fd40c9dc421faa7fbb7e11318fe92025-08-20T03:24:48ZengWileyStroke: Vascular and Interventional Neurology2694-57462024-11-014610.1161/SVIN.124.001441Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE StudyAmie W. Hsia0Lawrence L. Latour1Sana Somani2Carolyn A. Lomahan3Yongwoo Kim4John K. Lynch5Marie Luby6NIH/NINDS, Stroke Branch Bethesda MDNIH/NINDS, Stroke Branch Bethesda MDNIH/NINDS, Stroke Branch Bethesda MDNIH/NINDS, Stroke Branch Bethesda MDNIH/NINDS, Stroke Branch Bethesda MDNIH/NINDS, Stroke Branch Bethesda MDNIH/NINDS, Stroke Branch Bethesda MDBackground The characterization of hemorrhage following acute stroke intervention has largely been computed tomography (CT) based. We sought to compare magnetic resonance imaging‐ (MRI‐) and CT‐based scoring of hemorrhage after acute endovascular therapy (EVT) applying the Heidelberg Bleeding Classification (HBC) to assess intermodal agreement and quantify interrater agreement. Methods Consecutive patients with acute stroke were included in this retrospective study if they (1) had MRI and CT ≤12 hours of each other OR (2) had CT bracketed by MRI pre‐ and post‐CT (ie, MRI‐CT‐MRI) ≤7 days post‐EVT. The concordance of the HBC ratings by consensus panel were compared between CT and T2* gradient recalled echo MRI. Results For the 87 EVT‐treated patients included, median age was 68 years [60–74], admission National Institutes of Health Stroke Scale score 18 [13–23], 47% were treated with intravenous/intraarterial thrombolytics, and 93% were successfully recanalized (modified Thrombolysis in Cerebral Infarction 2b/3). Hemorrhage was detected on at least 1 modality in 60% (52/87) of patients. We found a 68% (59/87, 95% CI [57%–77%]) agreement overall between CT and MRI for hemorrhage classification post‐EVT. MRI had the best interrater agreement for HBC 0 (no hemorrhage) with excellent concordance (ĸ = 0.882), compared with CT (ĸ = 0.683). T2* gradient recalled echo MRI tended to have increased sensitivity to scattered petechial hemorrhage (HBC 1a) as compared with CT with 17% (2/12) intermodal agreement. The interrater agreement of HBC class 2 (ie, parenchymal hematoma grade 2 was substantial for MRI (ĸ = 0.781) and excellent in CT (ĸ = 0.951), with 67% (8/12) intermodal agreement. Subarachnoid hemorrhage was detected in 24% (21/87) of patients on CT and/or MRI with 29% (6/21) intermodal agreement. Conclusion With the exception of subarachnoid hemorrhage and minor petechial hemorrhagic transformation, we found that MRI and CT are overall interchangeable for detecting and classifying hemorrhage after EVT. These findings are reassuring for both clinical decision‐making and research application. Given the complexity of hemorrhage subtypes post‐EVT, work to further refine a post‐EVT hemorrhage classification scale with clinical correlation would be beneficial.https://www.ahajournals.org/doi/10.1161/SVIN.124.001441acute ischemic strokeCTendovascular therapyhemorrhagic transformationMRI |
| spellingShingle | Amie W. Hsia Lawrence L. Latour Sana Somani Carolyn A. Lomahan Yongwoo Kim John K. Lynch Marie Luby Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE Study Stroke: Vascular and Interventional Neurology acute ischemic stroke CT endovascular therapy hemorrhagic transformation MRI |
| title | Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE Study |
| title_full | Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE Study |
| title_fullStr | Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE Study |
| title_full_unstemmed | Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE Study |
| title_short | Comparison of Hemorrhage on CT Versus MRI After Thrombectomy: The HECATE Study |
| title_sort | comparison of hemorrhage on ct versus mri after thrombectomy the hecate study |
| topic | acute ischemic stroke CT endovascular therapy hemorrhagic transformation MRI |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.124.001441 |
| work_keys_str_mv | AT amiewhsia comparisonofhemorrhageonctversusmriafterthrombectomythehecatestudy AT lawrencellatour comparisonofhemorrhageonctversusmriafterthrombectomythehecatestudy AT sanasomani comparisonofhemorrhageonctversusmriafterthrombectomythehecatestudy AT carolynalomahan comparisonofhemorrhageonctversusmriafterthrombectomythehecatestudy AT yongwookim comparisonofhemorrhageonctversusmriafterthrombectomythehecatestudy AT johnklynch comparisonofhemorrhageonctversusmriafterthrombectomythehecatestudy AT marieluby comparisonofhemorrhageonctversusmriafterthrombectomythehecatestudy |