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(Stroke. 2006;37:404.)
© 2006 American Heart Association, Inc.

Original Contributions

Comparison of ABC/2 Estimation Technique to Computer-Assisted Planimetric Analysis in Warfarin-Related Intracerebral Parenchymal Hemorrhage

Hagen B. Huttner, MD; Thorsten Steiner, MD; Marius Hartmann, MD; Martin Köhrmann, MD; Eric Juettler, MD; Stephan Mueller, MD; Johannes Wikner, MD; Uta Meyding-Lamade, MD; Peter Schramm, MD; Stefan Schwab, MD Peter D. Schellinger, MD, PhD

From the Departments of Neurology (H.B.H., T.S., M.K., E.J., S.M., J.W., U.M.-L., S.S., P.D.S.), and Neuroradiology (H.B.H., M.H., P.S.), University of Heidelberg, Germany.

Correspondence to Hagen B. Huttner, Departments of Neurology and Neuroradiology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany. E-mail hagen.huttner{at}med.uni-heidelberg.de

Background and Purpose— The ABC/2 formula is a reliable estimation technique of intracerebral hematoma volume. However, oral anticoagulant therapy (OAT)–related intracerebral hemorrhage (ICH) compared with primary ICH is based on a different pathophysiological mechanism, and various shapes of hematomas are more likely to occur. Our objective was to validate the ABC/2 technique based on analyses of the hematoma shapes in OAT-related ICH.

Methods— We reviewed the computed tomography scans of 83 patients with OAT-associated intraparenchymal ICH. Location was divided into deep, lobar, cerebellar, and brain stem hemorrhage. Shape of the ICH was divided into (A) round-to-ellipsoid, (B) irregular with frayed margins, and (C) multinodular to separated. The ABC/2 technique was compared with computer-assisted planimetric analyses with regard to hematoma site and shape.

Results— The mean hematoma volume was 40.83±3.9 cm³ (ABC/2) versus 36.6±3.5 cm³ (planimetric analysis). Bland–Altman plots suggested equivalence of both estimation techniques, especially for smaller ICH volumes. The most frequent location was a deep hemorrhage (54%), followed by lobar (21%), cerebellar (14%) and brain stem hemorrhage (11%). The most common shape was round-to-ellipsoid (44%), followed by irregular ICH (31%) and separated and multinodular shapes (25%). In the latter, ABC/2 formula significantly overestimated volume by +32.1% (round shapes by +6.7%; irregular shapes by +14.9%; P ANOVA <0.01). Variation of the denominator toward ABC/3 in cases of irregularly and separately shaped hematomas revealed more a precise volume estimation with a deviation of –10.3% in irregular and +5.6% in separately shaped hematomas.

Conclusions— In patients with OAT-related ICH, >50% of bleedings are irregularly shaped. In these cases, hematoma volume is significantly overestimated by the ABC/2 formula. Modification of the denominator to 3 (ie, ABC/3) measured ICH volume more accurately in these patients potentially facilitating treatment decisions.

Key Words: stroke • warfarin

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