How useful are simple clinical features and non-invasive imaging at predicting an underlying structural cause of acute intracerebral haemorrhage?

Imaging approaches to the diagnosis of intracerebral haemorrhage

The role of imaging in the detection of an underlying structural or macrovascular cause of acute intracerebral haemorrhage (ICH) is poorly defined, yet this issue has significant resource and investigative risk implications for patients and healthcare providers. In this issue, Hilkens et al1 (see pp XXXX) introduce a simple individualised decision-making tool (age <50 vs ≥50–70 years, lobar/posterior fossa vs deep location, presence vs absence of small vessel disease (SVD) on CT, and with/without a positive (or uncertain) vs negative findings on CT angiography (CTA)) that shows high predictive ability for an underlying macrovascular cause of acute ICH.

Conventionally, clinicians make decisions about whether, how and when to use vascular imaging—usually through sequential use of CTA, MRI alone and with angiography, and intra-arterial digital subtraction angiography (IADSA)—after the initial diagnostic CT on the basis of three key factors: patient age, ICH location...

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