This article summarizes recent developments concerning MRI-based risk assessment of symptomatic intracerebral hemorrhage (sICH) associated with thrombolytic therapy for acute stroke. Special attention is paid to three imaging parameters: cerebral microangiopathy, lesion size on diffusion weighted imaging (DWI), and the role of cerebral microbleeds. Both severe cerebral microangiopathy and increasing lesion size on DWI are now established risk factors for sICH following thrombolysis, while the presence of a single or few microbleeds is not associated with a substantially elevated sICH risk.
