Diagnostic imaging strategies of acute intracerebral hemorrhage in European academic hospitals—a decision-making analysis
(2023) In Neuroradiology 65(4). p.729-736- 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.... (More)
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.
(Less)
- author
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Analysis, Decision-making, Deep, Hemorrhage, Intracerebral, Lobar
- in
- Neuroradiology
- volume
- 65
- issue
- 4
- pages
- 729 - 736
- publisher
- Springer
- external identifiers
-
- pmid:36633612
- scopus:85146184851
- ISSN
- 0028-3940
- DOI
- 10.1007/s00234-022-03110-9
- language
- English
- LU publication?
- yes
- id
- 51e28700-8b9d-46ec-ac5e-92bd7aaceab1
- date added to LUP
- 2023-02-16 12:20:38
- date last changed
- 2024-07-21 14:20:57
@article{51e28700-8b9d-46ec-ac5e-92bd7aaceab1,
abstract = {{<p>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.</p>}},
author = {{Putora, Paul Martin and Almeida, Gonçalo G. and Wildermuth, Simon and Weber, Johannes and Dietrich, Tobias and Vernooij, Meike W. and van Doormaal, Pieter Jan and Smagge, Lucas and Zeleňák, Kamil and Krainik, Alexandre and Bonneville, Fabrice and van Den Hauwe, Luc and Möhlenbruch, Markus and Bruno, Federico and Ramgren, Birgitta and Ramos-González, Ana and Schellhorn, Till and Waelti, Stephan and Fischer, Tim}},
issn = {{0028-3940}},
keywords = {{Analysis; Decision-making; Deep; Hemorrhage; Intracerebral; Lobar}},
language = {{eng}},
number = {{4}},
pages = {{729--736}},
publisher = {{Springer}},
series = {{Neuroradiology}},
title = {{Diagnostic imaging strategies of acute intracerebral hemorrhage in European academic hospitals—a decision-making analysis}},
url = {{http://dx.doi.org/10.1007/s00234-022-03110-9}},
doi = {{10.1007/s00234-022-03110-9}},
volume = {{65}},
year = {{2023}},
}