From the Cleveland Clinic Foundation (J.M.G., C.A.S.), Cleveland, Ohio;
the University of Maryland Medical Center (M.A.S.), Baltimore, Md; and the
Duke University Medical Center (K.W.M., C.B.G., C.L.G.), Durham, NC.
Correspondence to Cathy A. Sila, MD, Cerebrovascular Center, Department of Neurology (S91), Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail silac{at}cesmtp.ccf.org
Methods—Computed tomographic (CT) brain scans of 244 patients
suffering from intracranial hemorrhage in the GUSTO-1 trial
were systematically reviewed. The volumes of 298 intraparenchymal
hematomas were measured by the ABC/2 technique, and the volumes of 44
subdural hematomas were measured by an adaptation of this technique and
compared to computer-assisted volumetric analysis.
Results—Excellent correlation between the techniques were
achieved for both subdural (r=0.842; slope, 0.982) and
intraparenchymal hematoma volume measurements (r=0.929;
slope, 1.11).
Conclusions—The ABC/2 method is a simple and accurate technique
for the measurement of intraparenchymal hematoma volume, and a simple
adaptation allows for a similarly accurate measurement of subdural
hematoma volume as well.
For intraparenchymal hematomas, the ABC/2 technique (as
previously described) was applied. Specifically, a
representative slice at the center of the hematoma was
selected. The maximum linear length (A) in cm was multiplied by the
maximum width (B) in cm and the maximum depth (C) in cm. The depth (C)
was determined by multiplying the number of slices on which hematoma
was visible by the slice thickness listed on the CT scan. To obtain the
volume in cm3, the final product was divided
by 2.
For subdural hematoma, the ABC/2 technique was adapted; again, a
representative slice near the center of the hematoma
was selected. The linear distance in cm between each corner of the
subdural crescent was used to determine the length (A). The width (B)
was measured as the maximum thickness in cm of hematoma (B) from the
inner table of the skull perpendicular to the length. The depth (C) was
determined by multiplying the number of slices on which hematoma was
visible by the slice thickness listed on the CT scan. To obtain the
volume in cm3, the final product was divided
by 2 (Figure 1
Computer-assisted volumetric analysis (propriety software,
Center for Computer-Assisted Neurosurgery, Cleveland Clinic Foundation,
run on Sun Microsystems Sparkstation I) was performed on all hematomas,
with each slice containing hematoma traced by the same technician
(J.P.W.), modeled after the technique of Hier et
al.11
Subdural hemorrhage after systemic thrombolytic
therapy, like intraparenchymal hemorrhage, carries a
significant mortality risk but may be more amenable to surgical
evacuation. However, because higher volume intracranial
hemorrhages have a poorer outcome,4 the
adaptation of the relatively simple ABC/2 method to measure volumes may
be a useful adjunct to clinical and radiographic
information currently used in determining prognosis and management of
affected patients.
Conclusion
Received April 23, 1998;
revision received June 23, 1998;
accepted June 23, 1998.
2.
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© 1998 American Heart Association, Inc.
Original Contributions
Comparison of the ABC/2 Estimation Technique to Computer-Assisted Volumetric Analysis of Intraparenchymal and Subdural Hematomas Complicating the GUSTO-1 Trial
Abstract
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Background and Purpose—The
volume of an intracerebral hemorrhage has been
shown to be an important independent predictor of mortality in several
reports.1 2 3 4 5 A technique for estimating hematoma volume,
known as the ABC/2 method, has been proven a reliable, simple bedside
technique for the volume measurement of intraparenchymal
intracerebral hemorrhage.6 7 8
Subdural hematomas also carry a significant mortality risk but are more
amenable to surgical evacuation. A reliable, simple bedside measurement
of subdural hematoma volume may prove a valuable tool in
prognostication and management of patients with this entity.
Key Words: cerebral hemorrhage • subdural hemorrhage • computer-assisted image processing
Introduction
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
The volume of an intracerebral hematoma
has been shown to be an independent predictor of mortality in
prediction models studying various populations of patients with
intracerebral
hemorrhage.1 2 3 4 A simple estimation
method of intracerebral hematoma volume, known as the
ABC/2 or XYZ/2 method, was first reported by Kwak et
al6 and later by Broderick et
al,7 and validated by Kothari et
al.8 To our knowledge, this technique has not yet
been adapted or validated for use in the measurement of subdural
hematoma volume. Because subdural hematomas are
potentially highly morbid and generally more amenable to
surgical evacuation, the availability of a simple, accurate bedside
technique for determination of their volume may be useful in patient
management and prognostication. This study compares the estimation
method of hematoma volume to a computer-assisted volumetric
analysis in a large series of intracranial hemorrhages,
both intraparenchymal and subdural, complicating systemic
thrombolytic therapy for acute myocardial infarction in
the GUSTO-1 trial.
Subjects and Methods
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
All available CT brain scans from patients suffering from
intracranial hemorrhage while enrolled in the GUSTO-1
trial9 were reviewed by at least 1 of the 3
principal investigators (J.M.G., C.A.S., or M.A.S.). In total, 244 CT
scans containing 298 intraparenchymal hematomas and 44 subdural
hematomas were reviewed. This CT scan population represents a
highly diverse variable quality collection of studies from all over
the world, ideally suited for testing the widespread applicability of
the ABC/2 technique. Details regarding the anatomic locations of the
intraparenchymal hematomas in this population have been published
elsewhere.10 Hematoma margins were handtraced and
2 methods of hematoma volume measurement were employed. 
).
View larger version (131K):
[in a new window]
Figure 1. CT scan demonstrating measurement technique for
subdural hematomas where length (L) represents measurement A
and width (W) represents measurement B.
Results
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
For 298 individual intraparenchymal hematomas occurring in 244
patients, mean volume was 68.7 cm3 by the
standard ABC/2 estimate technique, versus 63.3
cm3 by the computer-assisted volumetric
technique, with r= 0.929 and slope, 1.11. (Figure 2). The mean volume of the 44 subdural
hematomas was 91.0 cm3 by the modified ABC/2
estimate technique versus 82.4 cm3 by the
computer-assisted technique, with r =0.842 and slope, 0.982.
(Figure 3).
View larger version (17K):
[in a new window]
Figure 2. Comparison of intraparenchymal hematoma volumes
obtained by the computer-assisted volumetric technique vs the ABC/2
estimation method, r=0.929.
View larger version (14K):
[in a new window]
Figure 3. Comparison of subdural hematoma volumes obtained
by the computer-assisted volumetric technique versus the ABC/2
estimation method, r=0.982.
Discussion
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
Excellent correlation between the ABC/2 technique and the
computer-assisted volumetric technique for the measurement of
intraparenchymal hematoma volume was observed and is comparable to
previously reported results.5 8 There was also an
excellent correlation between the ABC/2 technique and the
computer-assisted technique for subdural hematomas. This relationship
was accurate particularly at the hematoma volumes typically associated
with acute clinical symptoms; it demonstrates the validity and
applicability to a rather diverse variable quality CT scan
population which included imaging studies from various hospitals around
the world.
We conclude that the ABC/2 technique, adapted as described in this
article, is a simple, accurate bedside method for the measurement of
subdural hematoma volume. We also confirm the precision and
applicability of the ABC/2 technique for intraparenchymal hematoma
volume measurement in a heterogeneous variable quality
group of brain CT scans.
Acknowledgments
This study was funded by Genentech (South San
Francisco, Calif), Bayer (New York, NY), CIBA-Corning (Medfield, Mass),
ICI Pharmaceuticals (Wilmington, Del), and Sanofi Pharmaceuticals
(Paris, France).
References
Top
Abstract
Introduction
Subjects and Methods
Results
Discussion
References
1.
Portenoy RK, Lipton RB, Berger AR, Lesser ML,
Lantos G. Intracerebral haemorrhage: a model
for the prediction of outcome. J Neurol Neurosurg
Psych. 1987;50:976–979.
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