Hilkens et al reported scores for identifying macrovascular causes of non-traumatic intracerebral hemorrhage (ICH). The authors are from Radboud University in the Netherlands.
DIAGRAM is from the DIagnostic AngioGRAphy to find vascular Malformations Study.
Macrovascular causes for ICH: arteriovenous malformations, dural arteriovenous fistula, cavernoma, central venous thrombosis, aneurysm, developmental venous anomaly, carotid cavernous fistula.
Patient selection: nontraumatic intracerebral hemorrhage
Parameters:
(1) age in years
(2) small vessel disease
(3) ICH location
(4) CT angiography (for DIAGRAM PLUS)
|
Parameter |
Finding |
Points |
|
age |
<= 50 years |
1 |
|
|
> 50 years |
0 |
|
small vessel disease |
no |
2 |
|
|
yes |
0 |
|
ICH location |
deep |
0 |
|
|
lobar |
2 |
|
|
posterior fossa |
3 |
DIAGRAM score =
= SUM(points for the 3 parameters)
|
Parameter |
Finding |
Points |
|
age |
<= 50 years |
1 |
|
|
> 50 years |
0 |
|
small vessel disease |
no |
2 |
|
|
yes |
0 |
|
ICH location |
deep |
0 |
|
|
lobar |
1 |
|
|
posterior fossa |
2 |
|
CT angiography |
negative |
0 |
|
|
positive |
3 |
DIAGRAM Plus =
= SUM(points for all 4 parameters)
Interpretation:
• minimum scores: 0
• maximum DIAGRAM score: 6
• maximum DIAGRAM Plus score: 8
• The higher the score the greater the risk of a macrovascular source (MVS).
|
Score |
MVS by DIAGRAM |
MVS by DIAGRAM PLUS |
|
0 |
0.7% |
0.4% |
|
1 |
2.3% |
1.6% |
|
2 |
4.6% |
3.8% |
|
3 |
14.3% |
10.6% |
|
4 |
27.5% |
26.5% |
|
5 |
54% |
40% |
|
6 |
76% |
60% |
|
7 |
NA |
83% |
|
8 |
NA |
93% |
Performance:
• The are under the ROC was 0.83 in the derivative and 0.66 in external validation cohorts.
• Addition of CT angiography increased the area under the ROC curve to 0.91.
Specialty: Neurology, Emergency Medicine
