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

Paul Martin Putora, Gonçalo G. Almeida, Simon Wildermuth, Johannes Weber, Tobias Dietrich, Meike W. Vernooij, Pieter Jan van Doormaal, Lucas Smagge, Kamil Zeleňák, Alexandre Krainik, Fabrice Bonneville, Luc van Den Hauwe, Markus Möhlenbruch, Federico Bruno, Birgitta Ramgren, Ana Ramos-González, Till Schellhorn, Stephan Waelti, Tim Fischer*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)729-736
Number of pages8
Issue number4
Publication statusPublished - Apr 2023

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© 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.


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