TY - JOUR
T1 - Interobserver Agreement on Intracranial Hemorrhage on Magnetic Resonance Imaging in Patients With Ischemic Stroke
AU - van der Ende, Nadinda A. M.
AU - Luijten, Sven P. R.
AU - Kluijtmans, Leo
AU - Postma, Alida A.
AU - Cornelissen, Sandra A.
AU - van Hattem, Antonius M. G.
AU - Nijeholt, Geert J.
AU - Bokkers, Reinoud P. H.
AU - Thomassen, Lars
AU - Waje-Andreassen, Ulrike
AU - Logallo, Nicola
AU - Bracard, Serge
AU - Gory, Benjamin
AU - Roozenbeek, Bob
AU - Dippel, Diederik W. J.
AU - van der Lugt, Aad
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Background:The Heidelberg Bleeding Classification, developed for computed tomography, is also frequently used to classify intracranial hemorrhage (ICH) on magnetic resonance imaging. Additionally, the presence of any ICH is frequently used as (safety) outcome measure in clinical stroke trials that evaluate acute interventions. We assessed the interobserver agreement on the presence of any ICH and the type of ICH according to the Heidelberg Bleeding Classification on magnetic resonance imaging in patients treated with reperfusion therapy. Methods:We used 300 magnetic resonance imaging scans including susceptibility-weighted imaging or T2*-weighted gradient echo imaging of ischemic stroke patients within 1 week after reperfusion therapy. Six observers, blinded to clinical characteristics except for suspected location of the infarction, independently rated ICH according to the Heidelberg Bleeding Classification in random pairs. Percent agreement and Cohen's kappa (kappa) were estimated for the presence of any ICH (yes/no), and for agreement on the Heidelberg Bleeding Classification class 1 and 2. For the Heidelberg Bleeding Classification class 1 and 2, weighted kappa was estimated to take the degree of disagreement into account. Results:In 297 of 300 scans, the quality of scans was sufficient to score ICH. Observers agreed on the presence or absence of any ICH in 264 of 297 scans (88.9%; kappa 0.78 [95% CI, 0.71-0.85]). There was agreement on the Heidelberg Bleeding Classification class 1 and 2 and no ICH in class 1 and 2 in 226 of 297 scans (76.1%; kappa 0.63 [95% CI, 0.56-0.69]; weighted kappa 0.90 [95% CI, 0.87-0.93]). Conclusions:The presence of any ICH can be reliably scored on magnetic resonance imaging and can, therefore, be used as (safety) outcome measure in clinical stroke trials that evaluate acute interventions. Agreement of ICH types according to the Heidelberg Bleeding Classification is substantial and disagreements are small.
AB - Background:The Heidelberg Bleeding Classification, developed for computed tomography, is also frequently used to classify intracranial hemorrhage (ICH) on magnetic resonance imaging. Additionally, the presence of any ICH is frequently used as (safety) outcome measure in clinical stroke trials that evaluate acute interventions. We assessed the interobserver agreement on the presence of any ICH and the type of ICH according to the Heidelberg Bleeding Classification on magnetic resonance imaging in patients treated with reperfusion therapy. Methods:We used 300 magnetic resonance imaging scans including susceptibility-weighted imaging or T2*-weighted gradient echo imaging of ischemic stroke patients within 1 week after reperfusion therapy. Six observers, blinded to clinical characteristics except for suspected location of the infarction, independently rated ICH according to the Heidelberg Bleeding Classification in random pairs. Percent agreement and Cohen's kappa (kappa) were estimated for the presence of any ICH (yes/no), and for agreement on the Heidelberg Bleeding Classification class 1 and 2. For the Heidelberg Bleeding Classification class 1 and 2, weighted kappa was estimated to take the degree of disagreement into account. Results:In 297 of 300 scans, the quality of scans was sufficient to score ICH. Observers agreed on the presence or absence of any ICH in 264 of 297 scans (88.9%; kappa 0.78 [95% CI, 0.71-0.85]). There was agreement on the Heidelberg Bleeding Classification class 1 and 2 and no ICH in class 1 and 2 in 226 of 297 scans (76.1%; kappa 0.63 [95% CI, 0.56-0.69]; weighted kappa 0.90 [95% CI, 0.87-0.93]). Conclusions:The presence of any ICH can be reliably scored on magnetic resonance imaging and can, therefore, be used as (safety) outcome measure in clinical stroke trials that evaluate acute interventions. Agreement of ICH types according to the Heidelberg Bleeding Classification is substantial and disagreements are small.
KW - interobserver agreement
KW - intracranial hemorrhage
KW - ischemic stroke
KW - magnetic resonance imaging
KW - INTRAVENOUS ALTEPLASE
KW - RELIABILITY
KW - CLASSIFICATION
KW - TRANSFORMATION
KW - THROMBOLYSIS
KW - DIAGNOSIS
KW - MRI
KW - CT
U2 - 10.1161/STROKEAHA.122.042145
DO - 10.1161/STROKEAHA.122.042145
M3 - Article
C2 - 37154054
SN - 0039-2499
VL - 54
SP - 1587
EP - 1592
JO - Stroke
JF - Stroke
IS - 6
ER -