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(Stroke. 1996;27:1304-1305.)
© 1996 American Heart Association, Inc.
Articles |
the Departments of Emergency Medicine (R.U.K.), Neurology (T.B., J.P.B., L.R.S.), Neurosurgery (M.Z.), and Environmental Health (J.K.), University of Cincinnati (Ohio), and the Section of Emergency Medicine, Department of Surgery, University of Michigan, Ann Arbor (W.G.B.).
| Abstract |
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Methods The formula ABC/2 was used, where A is the greatest hemorrhage diameter by CT, B is the diameter 90° to A, and C is the approximate number of CT slices with hemorrhage multiplied by the slice thickness.
Results The ICH volumes for 118 patients were evaluated in a mean of 38 seconds and correlated with planimetric measurements (R2=.96). Interrater and intrarater reliability were excellent, with an intraclass correlation of .99 for both.
Conclusions We conclude that ICH volume can be accurately estimated in less than 1 minute with the simple formula ABC/2.
Key Words: blood volume computed tomography intracerebral hemorrhage
| Introduction |
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| Subjects and Methods |
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For the bedside ABC/2 method, the CT slice with the largest area of hemorrhage was identified. The largest diameter (A) of the hemorrhage on this slice was measured. The largest diameter 90° to A on the same slice was measured next (B). Finally, the approximate number of 10-mm slices on which the ICH was seen was calculated (C). C was calculated by a comparison of each CT slice with hemorrhage to the CT slice with the largest hemorrhage on that scan. If the hemorrhage area for a particular slice was greater than 75% of the area seen on the slice where the hemorrhage was largest, the slice was considered 1 hemorrhage slice for determining C. If the area was approximately 25% to 75% of the area, the slice was considered half a hemorrhage slice; and if the area was less than 25% of the largest hemorrhage, the slice was not considered a hemorrhage slice. These CT hemorrhage slice values were then added to determine the value for C. All measurements for A and B were made with the use of the centimeter scale on the CT scan to the nearest 0.5 cm. A, B, and C were then multiplied and the product divided by 2, which yielded the volume of hemorrhage in cubic centimeters. The time required for the measurements and calculations was recorded. Hemorrhage volumes determined by the two techniques were then compared by regression analysis.
Twenty CT scans were randomly selected from the study population of 118, and hemorrhage volumes were measured by four individuals (a neurosurgery faculty member [M.Z.], a third-year neurosurgery resident, an emergency medicine faculty member [R.U.K], and a registered nurse [L.R.S.]) with the ABC/2 technique.
We evaluated intrarater reliability for a single reader by comparing initial measurements of these 20 CT scans using the ABC/2 method with repeated measurements by the same investigator using the same technique.
| Results |
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| Discussion |
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Rapid calculation of ICH volume at the time of initial patient presentation has clinical utility. For prognosis, a model of 30-day mortality that used the Glasgow Coma Scale and hemorrhage volume in patients with ICH correctly predicted outcome with a sensitivity and specificity of 97%.2 The ABC/2 technique may also be used to identify appropriate patients with ICH suitable for randomization into therapeutic trials.3 For example, the technique is the measurement method used for patient eligibility assessment in the multicenter Surgical Trial of Intracerebral Hemorrhage (J. Grotta, unpublished data, 1996). In this trial, patients with ICH and anticipated good outcome are not eligible for surgery. Thus, patients with hemorrhage volumes of less than 10 cm3 and patients with lobar hemorrhage volumes of 10 to 20 cm3 with minimal or no neurological deficits are excluded.
The ABC/2 and other bedside techniques of calculating hemorrhage volumes have been described previously.3 5 6 Lisk and colleagues3 demonstrated the ease and power of the ABC/2 method of volume measurement in a model of outcome after ICH but did not correlate this technique with other methods of volume measurement. The ABC/2 formula can be adjusted for CT slices of varying thickness by multiplying the number of slices of the different thicknesses on which the hematoma is seen (C of ABC/2) by the slice thickness in centimeters. Other authors have estimated hematoma volume by assuming it to approximate the volume of a sphere, an ellipsoid, or a rectangulopiped.2 7 8 Only estimates of volume that use the formula for an ellipsoid have been shown to correlate with planimetric techniques.5
In conclusion, intraparenchymal hemorrhage volume can be accurately estimated in less than 1 minute with the simple formula ABC/2. This rapid method of measuring hemorrhage volume may allow physicians to quickly select and stratify patients in future treatment trials.
| Footnotes |
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| Appendix |
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(A/2)(B/2)(C/2), where A, B, and C are the three diameters. If
is estimated to be 3, then the volume of an ellipsoid becomes ABC/2. Received December 28, 1995; revision received April 17, 1996; accepted April 17, 1996.
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L. Derex, T. A. Tomsick, T. G. Brott, C. A. Lewandowski, M. R. Frankel, W. Clark, S. Starkman, J. Spilker, G. J. Udsten, J. Khoury, et al. Outcome of Stroke Patients without Angiographically Revealed Arterial Occlusion within Four Hours of Symptom Onset AJNR Am. J. Neuroradiol., April 1, 2001; 22(4): 685 - 690. [Abstract] [Full Text] |
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J. C. Hemphill III, D. C. Bonovich, L. Besmertis, G. T. Manley, S. C. Johnston, and S. Tuhrim The ICH Score : A Simple, Reliable Grading Scale for Intracerebral Hemorrhage Editorial Comment: A Simple, Reliable Grading Scale for Intracerebral Hemorrhage Stroke, April 1, 2001; 32(4): 891 - 897. [Abstract] [Full Text] [PDF] |
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K.J. Becker, A.B. Baxter, W.A. Cohen, H.M. Bybee, D.L. Tirschwell, D.W. Newell, H.R. Winn, and W.T. Longstreth Jr. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies Neurology, March 27, 2001; 56(6): 766 - 772. [Abstract] [Full Text] [PDF] |
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K. P.N. Forbes, J. G. Pipe, and J. E. Heiserman Evidence for Cytotoxic Edema in the Pathogenesis of Cerebral Venous Infarction AJNR Am. J. Neuroradiol., March 1, 2001; 22(3): 450 - 455. [Abstract] [Full Text] |
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H. B. van der Worp, S. P. Claus, P. R. Bar, L. M. P. Ramos, A. Algra, J. van Gijn, and L. J. Kappelle Reproducibility of Measurements of Cerebral Infarct Volume on CT Scans Stroke, February 1, 2001; 32(2): 424 - 430. [Abstract] [Full Text] [PDF] |
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T. G. Phan, M. Koh, R. A. Vierkant, and E. F.M. Wijdicks Hydrocephalus Is a Determinant of Early Mortality in Putaminal Hemorrhage Stroke, September 1, 2000; 31(9): 2157 - 2162. [Abstract] [Full Text] [PDF] |
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H. M. Perry Jr, B. R. Davis, T. R. Price, W. B. Applegate, W. S. Fields, J. M. Guralnik, L. Kuller, S. Pressel, J. Stamler, J. L. Probstfield, et al. Effect of Treating Isolated Systolic Hypertension on the Risk of Developing Various Types and Subtypes of Stroke: The Systolic Hypertension in the Elderly Program (SHEP) JAMA, July 26, 2000; 284(4): 465 - 471. [Abstract] [Full Text] [PDF] |
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D. H. Rhoney, L. B. Tipps, K. R. Murry, M. C. Basham, D. B. Michael, and W. M. Coplin Anticonvulsant prophylaxis and timing of seizures after aneurysmal subarachnoid hemorrhage Neurology, July 25, 2000; 55(2): 258 - 265. [Abstract] [Full Text] [PDF] |
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L. Derex, N. Nighoghossian, F. Turjman, M. Hermier, J. Honnorat, P. Neuschwander, J. C. Froment, and P. Trouillas Intravenous tPA in acute ischemic stroke related to internal carotid artery dissection Neurology, June 13, 2000; 54(11): 2159 - 2161. [Abstract] [Full Text] [PDF] |
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J. M. Montes, J. H. Wong, P. B. Fayad, and I. A. Awad Stereotactic Computed Tomographic-Guided Aspiration and Thrombolysis of Intracerebral Hematoma : Protocol and Preliminary Experience Stroke, April 1, 2000; 31(4): 834 - 840. [Abstract] [Full Text] [PDF] |
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J. R. Carhuapoma, P. Y. Wang, N. J. Beauchamp, P. M. Keyl, D. F. Hanley, and P. B. Barker Diffusion-Weighted MRI and Proton MR Spectroscopic Imaging in the Study of Secondary Neuronal Injury After Intracerebral Hemorrhage Stroke, March 1, 2000; 31(3): 726 - 732. [Abstract] [Full Text] [PDF] |
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T. Hirano, S. J. Read, D. F. Abbott, J. I. Sachinidis, H. J. Tochon-Danguy, G. F. Egan, C. F. Bladin, A. M. Scott, W. J. McKay, and G. A. Donnan No evidence of hypoxic tissue on 18F-fluoromisonidazole PET after intracerebral hemorrhage Neurology, December 1, 1999; 53(9): 2179 - 2179. [Abstract] [Full Text] [PDF] |
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K. J. Becker, A. B. Baxter, H. M. Bybee, D. L. Tirschwell, T. Abouelsaad, and W. A. Cohen Extravasation of Radiographic Contrast Is an Independent Predictor of Death in Primary Intracerebral Hemorrhage Stroke, October 1, 1999; 30(10): 2025 - 2032. [Abstract] [Full Text] [PDF] |
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M. Zuccarello, T. Brott, L. Derex, R. Kothari, L. Sauerbeck, J. Tew, H. Van Loveren, H.-S. Yeh, T. Tomsick, A. Pancioli, et al. Early Surgical Treatment for Supratentorial Intracerebral Hemorrhage : A Randomized Feasibility Study Stroke, September 1, 1999; 30(9): 1833 - 1839. [Abstract] [Full Text] [PDF] |
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K. D Flemming, E. F M Wijdicks, E. K S. Louis, and H. Li Predicting deterioration in patients with lobar haemorrhages J. Neurol. Neurosurg. Psychiatry, May 1, 1999; 66(5): 600 - 605. [Abstract] [Full Text] |
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J. M. Gebel, C. A. Sila, M. A. Sloan, C. B. Granger, J. P. Weisenberger, C. L. Green, E. J. Topol, and K. W. Mahaffey Comparison of the ABC/2 Estimation Technique to Computer-Assisted Volumetric Analysis of Intraparenchymal and Subdural Hematomas Complicating the GUSTO-1 Trial Stroke, September 1, 1998; 29(9): 1799 - 1801. [Abstract] [Full Text] [PDF] |
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S. Kazui, K. Minematsu, H. Yamamoto, T. Sawada, and T. Yamaguchi Predisposing Factors to Enlargement of Spontaneous Intracerebral Hematoma Stroke, December 1, 1997; 28(12): 2370 - 2375. [Abstract] [Full Text] |
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