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Background: Stroke guidelines recommend that thrombolytic therapy should be carried out within 60 minutes from the arrival at the hospital. CT may decrease door-to-treatment interval compared to MRI. However, MRI may provide more information on brain pathology to select the treatment than CT. Thus, it remains controversial which is informative for selecting thrombolysis and endovascular treatment in acute ischemic stroke between CT and MRI.Purpose: Purpose of this study is to evaluate which clinical risk score using CT or MRI presents the best predictive performance for symptomatic intracranial hemorrhage (SICH).Methods: Consecutive stroke patients suffering anterior circulation were analyzed, who were received IV rt-PA therapy between October 2005 and March 2016. We calculated nine scores for each patient: DRAGON, MRI-DRAGON, HAT, SEDAN, SITS-ICH, SPAN-100, ASTRAL, PRS, and GRASPS. The area under the receiver operating characteristic curve was calculated to determine the predictive performance of each SICH predictive score according to two criteria: NINDS and ECASS-II. Logistic regression determined the odds ratio for two SICH criteria.Results: A total of 166 acute ischemic stroke patients were analyzed (113 men, 72±12 years old). SICH defined following NINDS criteria occurred in 14 patients, SICH defined following ECASS criteria occurred in 11 patients. 144 patients were performed both CT and MRI [median time between CT and MRI, 11; IQR 8-16]. Only 2 scores predicted SICH (NINDS criteria) with good accuracy (ROC area> 0.7, Figure1). Only one score predicted SICH (NINDS criteria) with good accuracy (Figure2).Conclusion: We concluded that MRI-DRAGON presented the best predictive performance for SICH, and MRI may be more useful for selecting thrombolysis and endovascular treatment in acute ischemic stroke than CT.