Follow-up imaging after hospital discharge for acute intracerebral hemorrhage in European academic hospitals : a decision-making analysis
(2026) In Neuroradiology 68(4). p.901-909- Abstract
Purpose: To investigate factors guiding follow-up imaging after hospital discharge in atraumatic intracerebral hemorrhage (ICH) across large European academic centers and compare decision-making patterns using a standardized approach. Methods: Expert neuroradiologists from nine European centers in eight countries detailed their follow-up algorithms for deep and lobar ICH, specifying (1) patient-related decision criteria, (2) preferred imaging modalities, and (3) advised follow-up timing. Free-text and schematic inputs were harmonized into uniform decision trees, mapping recommended modalities (CT, MRI/MRA, DSA, CTA) to patient-factor constellations. The primary endpoint was the distribution of recommended strategies; the secondary... (More)
Purpose: To investigate factors guiding follow-up imaging after hospital discharge in atraumatic intracerebral hemorrhage (ICH) across large European academic centers and compare decision-making patterns using a standardized approach. Methods: Expert neuroradiologists from nine European centers in eight countries detailed their follow-up algorithms for deep and lobar ICH, specifying (1) patient-related decision criteria, (2) preferred imaging modalities, and (3) advised follow-up timing. Free-text and schematic inputs were harmonized into uniform decision trees, mapping recommended modalities (CT, MRI/MRA, DSA, CTA) to patient-factor constellations. The primary endpoint was the distribution of recommended strategies; the secondary endpoint was inter-center consensus (≥ 50% agreement). Results: Key decision criteria were hemorrhage location, suspected structural macrovascular pathology (SMVP), age, hypertension, and small-vessel disease. MRI/MRA was recommended by all centers and appeared in nearly all decision branches; “no further imaging” was rare. Additional strategies variably combined MRI/MRA with DSA and/or CTA, whereas stand-alone DSA as first follow-up test was uncommon. Formal consensus was achieved in a minority of clinical scenarios, most consistently for deep ICH, where MRI/MRA reached around 60% support. In young patients with lobar ICH and suspected SMVP, no single strategy reached consensus. The most frequently proposed timepoint for follow-up imaging was 6–12 weeks after discharge. Conclusion: In current European practice, MRI/MRA at 6–12 weeks represents the predominant follow-up strategy after ICH discharge, with CTA ± DSA added when SMVP is suspected. Despite this MRI-centered pattern, substantial inter-center heterogeneity persists, underscoring the need for standardized follow-up imaging with clearly defined timelines and protocols.
(Less)
- author
- organization
- publishing date
- 2026
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Consensus, CT-Angiography, Decision-making analysis, Digital subtraction angiography, European academic centers, Intracerebral hemorrhage, MR-Angiography, MRI, Small-vessel disease
- in
- Neuroradiology
- volume
- 68
- issue
- 4
- pages
- 901 - 909
- publisher
- Springer
- external identifiers
-
- pmid:41779161
- scopus:105032115913
- ISSN
- 0028-3940
- DOI
- 10.1007/s00234-026-03927-8
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.
- id
- 13cbb2f9-a2d3-4688-9516-a307ed6ac21a
- date added to LUP
- 2026-04-28 13:35:56
- date last changed
- 2026-09-03 05:34:20
@article{13cbb2f9-a2d3-4688-9516-a307ed6ac21a,
abstract = {{<p>Purpose: To investigate factors guiding follow-up imaging after hospital discharge in atraumatic intracerebral hemorrhage (ICH) across large European academic centers and compare decision-making patterns using a standardized approach. Methods: Expert neuroradiologists from nine European centers in eight countries detailed their follow-up algorithms for deep and lobar ICH, specifying (1) patient-related decision criteria, (2) preferred imaging modalities, and (3) advised follow-up timing. Free-text and schematic inputs were harmonized into uniform decision trees, mapping recommended modalities (CT, MRI/MRA, DSA, CTA) to patient-factor constellations. The primary endpoint was the distribution of recommended strategies; the secondary endpoint was inter-center consensus (≥ 50% agreement). Results: Key decision criteria were hemorrhage location, suspected structural macrovascular pathology (SMVP), age, hypertension, and small-vessel disease. MRI/MRA was recommended by all centers and appeared in nearly all decision branches; “no further imaging” was rare. Additional strategies variably combined MRI/MRA with DSA and/or CTA, whereas stand-alone DSA as first follow-up test was uncommon. Formal consensus was achieved in a minority of clinical scenarios, most consistently for deep ICH, where MRI/MRA reached around 60% support. In young patients with lobar ICH and suspected SMVP, no single strategy reached consensus. The most frequently proposed timepoint for follow-up imaging was 6–12 weeks after discharge. Conclusion: In current European practice, MRI/MRA at 6–12 weeks represents the predominant follow-up strategy after ICH discharge, with CTA ± DSA added when SMVP is suspected. Despite this MRI-centered pattern, substantial inter-center heterogeneity persists, underscoring the need for standardized follow-up imaging with clearly defined timelines and protocols.</p>}},
author = {{Almeida, Gonçalo G. and Liebelt, Jan and Putora, Paul Martin and Weber, Johannes and Wildermuth, Simon and Leschka, Sebastian and Dietrich, Tobias Johannes and Mordasini, Pasquale and Wagner, Franca and Vernooij, Meike W. and Zeleňák, Kamil and Krainik, Alexandre and Bonneville, Fabrice and Hauwe, Luc van Den and Möhlenbruch, Markus and Bruno, Federico and Ramgren, Birgitta and Ramos-González, Ana and Schellhorn, Till and Wälti, Stephan and Fischer, Tim Steffen}},
issn = {{0028-3940}},
keywords = {{Consensus; CT-Angiography; Decision-making analysis; Digital subtraction angiography; European academic centers; Intracerebral hemorrhage; MR-Angiography; MRI; Small-vessel disease}},
language = {{eng}},
number = {{4}},
pages = {{901--909}},
publisher = {{Springer}},
series = {{Neuroradiology}},
title = {{Follow-up imaging after hospital discharge for acute intracerebral hemorrhage in European academic hospitals : a decision-making analysis}},
url = {{http://dx.doi.org/10.1007/s00234-026-03927-8}},
doi = {{10.1007/s00234-026-03927-8}},
volume = {{68}},
year = {{2026}},
}