Published Online
on December 22, 2005

A more recent version of this article appeared on February 1, 2006

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Submitted on July 28, 2005
Revised on November 8, 2005
Accepted on November 21, 2005

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; and 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.

^* To whom correspondence should be addressed. 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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