Niloufar Valizadeh, Hediyeh Baradaran, Ajay Malhotra, Javier M Romero, Shahram Majidi, David Roh, Santosh B Murthy, Guido J Falcone, Kevin N Sheth, Seyedmehdi Payabvash
Contemporary neuroradiology practice demonstrates several readily addressable gaps in ICH imaging and reporting, including hematoma volume quantification, routine vascular imaging, standardized assessment of hematoma expansion imaging markers, and etiologic assessment. Standardizing these practices can improved image guided risk-stratification and facilitate implementation of emerging time-sensitive ICH therapies.
BACKGROUND AND PURPOSE: Recent advances in spontaneous intracerebral hemorrhage (ICH) management increasingly expand the role of neuroimaging beyond diagnosis to potentially guide time-sensitive therapies and targeted clinical trial enrollment. We surveyed neuroradiologists to characterize current ICH imaging and reporting practices and identify opportunities for quality improvement.
MATERIALS AND METHODS: An anonymous 52-item electronic survey was distributed through the American Journal of Neuroradiology Survey Corner and REDCap between April and May 2026. Survey domains included imaging acquisition, reporting practices, hematoma volume quantification, assessment of hematoma expansion predictors, ICH localization, etiologic assessment, and follow-up imaging. Responses were summarized using descriptive statistics.
RESULTS: A total of 267 neuroradiologists completed the survey. Nearly all respondents (97.3%) reported 24/7 emergency head CT interpretation coverage. However, 41.5% did not routinely quantify hematoma volume, only 45% reported routine CTA acquisition for patients with ICH, and 30% rarely or only occasionally recommended CTA when it was not performed. While 91.3% routinely reported a positive CTA spot-sign, only 43.0% almost always assessed non-contrast CT predictors of hematoma expansion. Confidence in hemorrhage localization when crossing anatomical boundaries and etiologic classification was modest, and 45.8% routinely used the Boston Criteria version 2.0 for MRI-based assessment of cerebral amyloid angiopathy.
CONCLUSIONS: Contemporary neuroradiology practice demonstrates several readily addressable gaps in ICH imaging and reporting, including hematoma volume quantification, routine vascular imaging, standardized assessment of hematoma expansion imaging markers, and etiologic assessment. Standardizing these practices can improved image guided risk-stratification and facilitate implementation of emerging time-sensitive ICH therapies.