• Nina A Hilkens, van Asch Charlotte J J CJJ Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Nethe, David J Werring, Duncan Wilson, Rinkel Gabriël J E GJE 0000-0001-8930-3953 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Ut, Ale Algra, Birgitta K Velthuis, de Kort Gérard A P GAP Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Theo D Witkamp, Koen M van Nieuwenhuizen, Frank-Erik de Leeuw, Wouter J Schonewille, de Kort Paul L M PLM Department of Neurology, St Elisabeth Hospital, Tilburg, The Netherlands., Dippel Diederik W J DWJ Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands., Raaymakers Theodora W M TWM Department of Neurology, Meander Medical Center, Amersfoort, The Netherlands., Jeannette Hofmeijer, Wermer Marieke J H MJH Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands., Henk Kerkhoff, Korné Jellema, Irene M Bronner, Remmers Michel J M MJM Department of Neurology, Amphia Hospital, Breda, The Netherlands., Henri Paul Bienfait, Witjes Ron J G M RJGM Department of Neurology, Tergooi Hospitals, Blaricum, The Netherlands., H Rolf Jäger, Jacoba P Greving, Klijn Catharina J M CJM Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherla, and DIAGRAM study group.
• Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
• J. Neurol. Neurosurg. Psychiatr. 2018 Jul 1; 89 (7): 674-679.

ObjectiveA 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.MethodsThe 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%).ResultsIndependent 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.ConclusionThe 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.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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