{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T02:52:51Z","timestamp":1790823171068,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,12,7]],"date-time":"2018-12-07T00:00:00Z","timestamp":1544140800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Hemorrhagic transformation (HT) is a complication of stroke that can occur spontaneously or after treatment. We aimed to assess the inter\u2010 and intrarater reliability of HT diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Studies assessing the reliability of the European Cooperative Acute Stroke Study (ECASS) classification of HT or of the presence (yes\/no) of HT were systematically reviewed. A total of 18 raters independently examined 30 post\u2010thrombectomy computed tomography scans selected from the Aspiration versus STEnt\u2010Retriever (ASTER) trial. They were asked whether there was HT (yes\/no), what the ECASS classification of the particular scan (0\/HI1\/HI2\/PH1\/PH2) (HI indicates hemorrhagic infarctions and PH indicates parenchymal hematomas) was and whether they would prescribe an antiplatelet agent if it was otherwise indicated. Agreement was measured with Fleiss\u2019 and Cohen's \u03ba statistics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The systematic review yielded four studies involving few (\u22643) raters with heterogeneous results. In our 18\u2010rater study, agreement for the presence of HT was moderate [<jats:italic>\u03ba<\/jats:italic> = 0.55; 95% confidence interval (CI), 0.41\u20130.68]. Agreement for ECASS classification was only fair for all five categories, but agreement improved to substantial (<jats:italic>\u03ba<\/jats:italic> = 0.72; 95% CI, 0.69\u20130.75) after dichotomizing the ECASS classification into 0\/HI1\/HI2\/PH1 versus PH2. The inter\u2010rater agreement for the decision to reintroduce antiplatelet therapy was moderate for all raters, but substantial among vascular neurologists (<jats:italic>\u03ba<\/jats:italic> = 0.70; 95% CI, 0.57\u20130.84).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The ECASS classification may involve too many categories and the diagnosis of HT may not be easily replicable, except in the presence of a large parenchymal hematoma.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.13859","type":"journal-article","created":{"date-parts":[[2018,11,10]],"date-time":"2018-11-10T11:01:40Z","timestamp":1541847700000},"page":"476-482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Hemorrhagic transformation after stroke: inter\u2010 and intrarater agreement"],"prefix":"10.1111","volume":"26","author":[{"given":"A.","family":"Guenego","sequence":"first","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"},{"name":"Interventional Neuroradiology Department Toulouse University Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Lecler","sequence":"additional","affiliation":[{"name":"Diagnostic Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Raymond","sequence":"additional","affiliation":[{"name":"Radiology Department Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Sabben","sequence":"additional","affiliation":[{"name":"Neurology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Khoury","sequence":"additional","affiliation":[{"name":"HSHS Neuroscience Center HSHS St John's Hospital Springfield IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Premat","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Botta","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Boisseau","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Ma\u00efer","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Ciccio","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Redjem","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Smajda","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Ducroux","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department Fondation Ophtalmologique Adolphe de Rothschild Hospital Paris"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Di Meglio","sequence":"additional","affiliation":[{"name":"Radiology Department Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Davy","sequence":"additional","affiliation":[{"name":"Radiology Department Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al Montreal Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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