Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage

• Published in: Stroke (1970) Vol. 37; no. 2; pp. 404 - 408
• Main Authors: HUTTNER, Hagen B, STEINER, Thorsten, SCHELLINGER, Peter D, HARTMANN, Marius, KÖHRMANN, Martin, JUETTLER, Eric, MUELLER, Stephan, WIKNER, Johannes, MEYDING-LAMADE, Uta, SCHRAMM, Peter, SCHWAB, Stefan
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.02.2006
• Subjects: Algorithms; Biological and medical sciences; Brain - pathology; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - pathology; Drug toxicity and drugs side effects treatment; Hematoma, Subdural - diagnosis; Hematoma, Subdural - pathology; Humans; Image Processing, Computer-Assisted; Medical sciences; Miscellaneous; Models, Statistical; Neurology; Neuropharmacology; Pharmacology. Drug treatments; Prognosis; Prospective Studies; Software; Stroke - chemically induced; Stroke - diagnosis; Thrombolytic Therapy - adverse effects; Tomography, X-Ray Computed; Toxicity: nervous system and muscle; Vascular diseases and vascular malformations of the nervous system; Warfarin - pharmacology; Stroke; Nervous system diseases; Warfarin; Coumarine derivatives; Estimation; Cardiovascular disease; Anticoagulant; Cerebral disorder; Vascular disease; Antivitamin K; Cerebral hemorrhage; Central nervous system disease; Cerebrovascular disease; Comparative study
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.str.0000198806.67472.5c

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. 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. 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. 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.