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Diagnostic yield and accuracy of CT angiography, MR angiography, and digital subtraction angiography for detection of macrovascular causes of intracerebral haemorrhage: prospective, multicentre…

Overview of attention for article published in British Medical Journal, November 2015
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About this Attention Score

  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (91st percentile)
  • Good Attention Score compared to outputs of the same age and source (73rd percentile)

Mentioned by

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1 blog
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24 X users
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2 Facebook pages

Citations

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82 Dimensions

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163 Mendeley
Title
Diagnostic yield and accuracy of CT angiography, MR angiography, and digital subtraction angiography for detection of macrovascular causes of intracerebral haemorrhage: prospective, multicentre cohort study
Published in
British Medical Journal, November 2015
DOI 10.1136/bmj.h5762
Pubmed ID
Authors

Charlotte J J van Asch, Birgitta K Velthuis, Gabriël J E Rinkel, Ale Algra, Gérard A P de Kort, Theo D Witkamp, Johanna C M de Ridder, Koen M van Nieuwenhuizen, Frank-Erik de Leeuw, Wouter J Schonewille, Paul L M de Kort, Diederik W Dippel, Theodora W M Raaymakers, Jeannette Hofmeijer, Marieke J H Wermer, Henk Kerkhoff, Korné Jellema, Irene M Bronner, Michel J M Remmers, Henri Paul Bienfait, Ron J G M Witjes, Jacoba P Greving, Catharina J M Klijn

Abstract

What are the diagnostic yield and accuracy of early computed tomography (CT) angiography followed by magnetic resonance imaging/angiography (MRI/MRA) and digital subtraction angiography (DSA) in patients with non-traumatic intracerebral haemorrhage? This prospective diagnostic study enrolled 298 adults (18-70 years) treated in 22 hospitals in the Netherlands over six years. CT angiography was performed within seven days of haemorrhage. If the result was negative, MRI/MRA was performed four to eight weeks later. DSA was performed when the CT angiography or MRI/MRA results were inconclusive or negative. The main outcome was a macrovascular cause, including arteriovenous malformation, aneurysm, dural arteriovenous fistula, and cavernoma. Three blinded neuroradiologists independently evaluated the images for macrovascular causes of haemorrhage. The reference standard was the best available evidence from all findings during one year's follow-up. A macrovascular cause was identified in 69 patients (23%). 291 patients (98%) underwent CT angiography; 214 with a negative result underwent additional MRI/MRA and 97 with a negative result for both CT angiography and MRI/MRA underwent DSA. Early CT angiography detected 51 macrovascular causes (yield 17%, 95% confidence interval 13% to 22%). CT angiography with MRI/MRA identified two additional macrovascular causes (18%, 14% to 23%) and these modalities combined with DSA another 15 (23%, 18% to 28%). This last extensive strategy failed to detect a cavernoma, which was identified on MRI during follow-up (reference strategy). The positive predictive value of CT angiography was 72% (60% to 82%), of additional MRI/MRA was 35% (14% to 62%), and of additional DSA was 100% (75% to 100%). None of the patients experienced complications with CT angiography or MRI/MRA; 0.6% of patients who underwent DSA experienced permanent sequelae. Not all patients with negative CT angiography and MRI/MRA results underwent DSA. Although the previous probability of finding a macrovascular cause was lower in patients who did not undergo DSA, some small arteriovenous malformations or dural arteriovenous fistulas may have been missed. CT angiography is an appropriate initial investigation to detect macrovascular causes of non-traumatic intracerebral haemorrhage, but accuracy is modest. Additional MRI/MRA may find cavernomas or alternative diagnoses, but DSA is needed to diagnose macrovascular causes undetected by CT angiography or MRI/MRA. Dutch Heart Foundation and The Netherlands Organisation for Health Research and Development, ZonMw. The authors have no competing interests. Direct requests for additional data to the corresponding author.

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X Demographics

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Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 163 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Japan 1 <1%
Netherlands 1 <1%
Unknown 160 98%

Demographic breakdown

Readers by professional status Count As %
Other 26 16%
Researcher 24 15%
Student > Ph. D. Student 17 10%
Student > Bachelor 13 8%
Student > Postgraduate 12 7%
Other 37 23%
Unknown 34 21%
Readers by discipline Count As %
Medicine and Dentistry 79 48%
Neuroscience 15 9%
Nursing and Health Professions 5 3%
Agricultural and Biological Sciences 3 2%
Biochemistry, Genetics and Molecular Biology 3 2%
Other 12 7%
Unknown 46 28%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 22. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 November 2023.
All research outputs
#1,779,549
of 26,150,873 outputs
Outputs from British Medical Journal
#16,648
of 65,518 outputs
Outputs of similar age
#24,915
of 298,837 outputs
Outputs of similar age from British Medical Journal
#243
of 912 outputs
Altmetric has tracked 26,150,873 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 93rd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 65,518 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 45.2. This one has gotten more attention than average, scoring higher than 74% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 298,837 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 91% of its contemporaries.
We're also able to compare this research output to 912 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 73% of its contemporaries.