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Computer-Assisted Volumetric Analysis Compared With ABC/2 Method for Assessing Warfarin-Related Intracranial Hemorrhage Volumes

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Abstract

Introduction

Intraparenchymal hemorrhage (IPH) volume is a powerful predictor of 30-day mortality. Warfarin-related intracranial hemorrhage (ICH) has a higher mortality than ICH without anticoagulation, possibly due to continued growth after 24 h, larger average size, and extension to extraparenchymal compartments. We compared 2 methods of measuring ICH volume in patients with warfarin-related ICH.

Methods

ICH volume was estimated using the ABC/2 method and a computer-assisted method (Analyze 6.0 software) applied to the initial head computed tomographic scans in a consecutive series of 8 patients with warfarin-related ICH. The 2 methods were compared for relative and absolute differences in estimated hematoma volumes.

Results

The ABC/2 method underestimated hematoma volume in 4 of 5 patients with IPH, inaccurately calculated intraventricular hemorrhage volume in 2 patients (overestimated by 9%, underestimated by 23%), and underestimated a complex subdural hematoma in 1 patient by 24% despite use of the Gebel modification. The mean percentage difference between the Analyze and ABC/2 methods was 24% in ellipsoid hemorrhages and 28% in nonellipsoid hemorrhages (P = 0.77). The mean of the absolute difference between the 2 methods was 6.7 cm3 in ellipsoid hemorrhages and 38.0 cm3 in nonellipsoid hemorrhages (P = 0.18).

Conclusion

The ABC/2 method accurately and quickly estimates smaller, ellipsoid intraparenchymal hematomas but is inaccurate for larger, complex-shaped warfarin-related intraparenchymal, intraventricular, and subdural hematomas. Warfarin-related ICH mortality may be underestimated by the ABC/2 method because of larger, complex-shaped, and multicompartmental hematomas.

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Abbreviations

CT:

Computed tomographic, computed tomography

ICH:

Intracranial hemorrhage

IPH:

Intraparenchymal hemorrhage

IVH:

Intraventricular hemorrhage

SDH:

Subdural hematoma

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Acknowledgments

This article was supported in part by research funding from the Robert H. and Clarice Smith/M. L. Simpson Foundation Trust Research Fellowship. Editing, proofreading, and reference verification were provided by the Section of Scientific Publications, Mayo Clinic.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    William D. Freeman, James F. Meschia & Thomas G. Brott

  2. Department of Neurology, University of Virginia, Charlottesville, VA, USA

    Kevin M. Barrett

  3. Department of Radiology, Mayo Clinic, Jacksonville, FL, USA

    Joseph M. Bestic & Daniel F. Broderick

Authors
  1. William D. Freeman
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  2. Kevin M. Barrett
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  3. Joseph M. Bestic
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  4. James F. Meschia
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  5. Daniel F. Broderick
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  6. Thomas G. Brott
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Corresponding author

Correspondence to William D. Freeman.

Additional information

Presented in part as a poster at the annual meeting of the Neurocritical Care Society, Baltimore, Maryland, November 6, 2006.

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Freeman, W.D., Barrett, K.M., Bestic, J.M. et al. Computer-Assisted Volumetric Analysis Compared With ABC/2 Method for Assessing Warfarin-Related Intracranial Hemorrhage Volumes. Neurocrit Care 9, 307–312 (2008). https://doi.org/10.1007/s12028-008-9089-4

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  • DOI: https://doi.org/10.1007/s12028-008-9089-4

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