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Diagnostic imaging strategies of acute intracerebral hemorrhage in European academic hospitals—a decision-making analysis

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate and compare which factors are relevant to the diagnostic decision-making and imaging workup of intracerebral hemorrhages in large, specialized European centers.

Methods

Expert neuroradiologists from ten large, specialized centers (where endovascular stroke treatment is routinely performed) in nine European countries were selected in cooperation with the European Society of Neuroradiology (ESNR). The experts were asked to describe how and when they would investigate specific causes in a patient who presented with an acute, atraumatic, intracerebral hemorrhage for two given locations: (1) basal ganglia, thalamus, pons or cerebellum; (2) lobar hemorrhage. Answers were collected, and decision trees were compared.

Results

Criteria that were considered relevant for decision-making reflect recommendations from current guidelines and were similar in all participating centers. CT Angiography or MR angiography was considered essential by the majority of centers regardless of other factors. Imaging in clinical practice tended to surpass guideline recommendations and was heterogeneous among different centers, e.g., in a scenario suggestive of typical hypertensive hemorrhage, recommendations ranged from no further follow-up imaging to CT angiography and MR angiography. In no case was a consensus above 60% achieved.

Conclusion

In European clinical practices, existing guidelines for diagnostic imaging strategies in ICH evaluation are followed as a basis but in most cases, additional imaging investigation is undertaken. Significant differences in imaging workup were observed among the centers. Results suggest a high level of awareness and caution regarding potentially underlying pathology other than hypertensive disease.

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Funding

This study did not receive external funding.

Author information

Authors and Affiliations

  1. Department of Radio-Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Paul Martin Putora

  2. Department of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Gonçalo G. Almeida, Simon Wildermuth, Johannes Weber, Tobias Dietrich, Stephan Waelti & Tim Fischer

  3. Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands

    Meike W. Vernooij, Pieter Jan van Doormaal & Lucas Smagge

  4. Department of Radiology, Comenius University’s Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia

    Kamil Zeleňák

  5. Department of Neuroradiology, University Hospital of Grenoble, Grenoble, France

    Alexandre Krainik

  6. Department of Neuroradiology, Toulouse University Hospital, University Toulouse 3-Paul Sabatier, Toulouse, France

    Fabrice Bonneville

  7. Department of Radiology, Antwerp University Hospital, Antwerp, Belgium

    Luc van Den Hauwe

  8. Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany

    Markus Möhlenbruch

  9. Department of Biotechnology and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy

    Federico Bruno

  10. Diagnostic Radiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden

    Birgitta Ramgren

  11. Department of Neuroradiology, University Hospital, 12 de Octubre, Madrid, Spain

    Ana Ramos-González

  12. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

    Till Schellhorn

Authors
  1. Paul Martin Putora
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  2. Gonçalo G. Almeida
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  3. Simon Wildermuth
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  4. Johannes Weber
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  7. Pieter Jan van Doormaal
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  8. Lucas Smagge
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  14. Federico Bruno
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  15. Birgitta Ramgren
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  16. Ana Ramos-González
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  17. Till Schellhorn
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  18. Stephan Waelti
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  19. Tim Fischer
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Contributions

PMP, TF, GGA and TJD contributed to the study conceptation and design. Material preparation was performed by TF and GGA. Data collection and analysis were performed by all authors. First draft of the manuscript was written by TF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. The authors have no competing interests to declare that are relevant to the content of this article. No funding was received for conducting this study.

Corresponding author

Correspondence to Tim Fischer.

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Conflict of interest

The authors declare no conflict of interest.

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Not applicable, since no patient data was used. All data used in this study was provided by the authors.

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Putora, P.M., Almeida, G.G., Wildermuth, S. et al. Diagnostic imaging strategies of acute intracerebral hemorrhage in European academic hospitals—a decision-making analysis. Neuroradiology 65, 729–736 (2023). https://doi.org/10.1007/s00234-022-03110-9

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  • DOI: https://doi.org/10.1007/s00234-022-03110-9

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