Risk Assessment of Hemorrhagic Transformation of Acute Middle Cerebral Artery Stroke Using Multimodal CT

Journal of Neuroimaging, 04/25/2012

For acute middle cerebral artery (MCA) infarcts ≤9 hours, the strongest predictor of symptomatic intracerebral hemorrhage (SICH) on multimodal CT was ASPECTS on CTP maps for ischemic severity and CT angiography source images (CTA–SI).


  • This retrospective study included patients evaluated by baseline multimodal CT ≤ 9 hours from ictus with acute nonlacunar middle cerebral artery (MCA) territory infarction.
  • Two readers independently evaluated CTP maps for ischemic severity and CTA source images (CTA-SI) for infarct extent (as measured by ASPECTS).
  • Presence of proximal occlusion (ICA or M1) and degree of collateralization (collateral score) were also assessed on CTA.
  • HT was defined as SICH if associated with deterioration ≥ 4-points on NIHSS.
  • Multivariate logistic regression analysis identified independent predictors of SICH.
  • ROC curves selected optimal thresholds.


  • Of 84 patients reviewed, HT occurred in 22 (26.2%) and SICH in 8 (9.5%).
  • Univariate predictors for SICH were proximal occlusion (OR=8.65, P=.049), collateral score (OR=.34, P=.017), ASPECTS (OR=.46, P= .001), and CBV (OR=.001, P=.005).
  • Multivariate analysis revealed ASPECTS as the only independent predictor with optimal threshold ≤ 5 and sensitivity and specificity of 75.0% and 85.5%, respectively.

Print Article Summary Cat 2 CME Report