The MACRO score, a magnetic resonance imaging–based tool, demonstrated robust accuracy in predicting macrovascular causes of intracerebral hemorrhage in a recent study.

In the study, published in Neurology, researchers analyzed data from 1,043 patients across two cohorts. Participants had a mean age of 66 years, with 42% female representation. Intracerebral hemorrhage (ICH) locations included lobar (44.2%), supratentorial deep (43.5%), and infratentorial (12.3%). Hypertension was present in 71.4% of cases. Among the cohort, 7.5% had macrovascular causes, including arteriovenous malformations, dural arteriovenous fistulas, cavernomas, and cerebral venous thromboses.

Magnetic resonance imaging (MRI) protocols incorporated T2, SWI, and DWI sequences. Imaging assessments focused on SVD markers, including white matter hyperintensities (graded 0 to 3), microbleeds, lacunes, and cortical superficial siderosis. The median time from symptom onset to MRI was 3 days. Follow-up data were available for at least 6 months in 79.1% of cases, totaling 4,819 patient-years.

The researchers demonstrated that the score outperformed existing computed tomography (CT)-based models. Internal validation yielded a c-statistic of 0.90, whereas external validation achieved 0.87. Scores of ≥ 6 indicated a 0.2% risk for macrovascular causes, while scores ≤ 2 indicated a 48.9% risk.

The MACRO score significantly outperformed CT-based models such as DIAGRAM (c-statistic = 0.83) and the Secondary Intracerebral Hemorrhage Score (c-statistic = 0.75). A MACRO score of ≥ 6 applied to 59.5% of patients and correlated with a low likelihood (0.2%) of macrovascular causes. In contrast, 9% of patients had scores ≤ 2, corresponding to a high risk (48.9%).

The findings indicated that low MACRO scores might reduce the need for invasive digital subtraction angiography (DSA), sparing patients associated risks. DSA was performed in only 10.5% of cases, with MRI alone providing sufficient diagnostic information in most instances.

Further investigations are needed to confirm its utility in broader populations. The MACRO score may offer a practical solution for guiding diagnostic decisions, potentially reducing unnecessary procedures and optimizing resource allocation.

The authors reported no relevant disclosures.