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J Neurol Neurosurg Psychiatry. 2018 Jul;89(7):674-679. doi: 10.1136/jnnp-2017-317262. Epub 2018 Jan 18.

Predicting the presence of macrovascular causes in non-traumatic intracerebral haemorrhage: the DIAGRAM prediction score.

Author information

1
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
2
Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
3
Kempenhaeghe, Academic Centre for Epileptology, Heeze, The Netherlands.
4
Department of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
5
Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
6
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
7
Department of Neurology, St Antonius Hospital, Nieuwegein, The Netherlands.
8
Department of Neurology, St Elisabeth Hospital, Tilburg, The Netherlands.
9
Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
10
Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands.
11
Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.
12
Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
13
Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
14
Department of Neurology, MCH Westeinde, The Hague, The Netherlands.
15
Department of Neurology, Flevo Hospital, Almere, The Netherlands.
16
Department of Neurology, Amphia Hospital, Breda, The Netherlands.
17
Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands.
18
Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands.
19
Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, UK.
#
Contributed equally

Abstract

OBJECTIVE:

A substantial part of non-traumatic intracerebral haemorrhages (ICH) arises from a macrovascular cause, but there is little guidance on selection of patients for additional diagnostic work-up. We aimed to develop and externally validate a model for predicting the probability of a macrovascular cause in patients with non-traumatic ICH.

METHODS:

The DIagnostic AngioGRAphy to find vascular Malformations (DIAGRAM) study (n=298; 69 macrovascular cause; 23%) is a prospective, multicentre study assessing yield and accuracy of CT angiography (CTA), MRI/ magnetic resonance angiography (MRA) and intra-arterial catheter angiography in diagnosing macrovascular causes in patients with non-traumatic ICH. We considered prespecified patient and ICH characteristics in multivariable logistic regression analyses as predictors for a macrovascular cause. We combined independent predictors in a model, which we validated in an external cohort of 173 patients with ICH (78 macrovascular cause, 45%).

RESULTS:

Independent predictors were younger age, lobar or posterior fossa (vs deep) location of ICH, and absence of small vessel disease (SVD). A model that combined these predictors showed good performance in the development data (c-statistic 0.83; 95% CI 0.78 to 0.88) and moderate performance in external validation (c-statistic 0.66; 95% CI 0.58 to 0.74). When CTA results were added, the c-statistic was excellent (0.91; 95% CI 0.88 to 0.94) and good after external validation (0.88; 95% CI 0.83 to 0.94). Predicted probabilities varied from 1% in patients aged 51-70 years with deep ICH and SVD, to more than 50% in patients aged 18-50 years with lobar or posterior fossa ICH without SVD.

CONCLUSION:

The DIAGRAM scores help to predict the probability of a macrovascular cause in patients with non-traumatic ICH based on age, ICH location, SVD and CTA.

KEYWORDS:

CT angiography; arteriovenous malformation; digital subtraction angiography; intracerebral haemorrhage

PMID:
29348301
DOI:
10.1136/jnnp-2017-317262

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