Planimetric Hematoma Measurement in Patients With Intraventricular Hemorrhage

Abstract

on behalf of the PREDICT/Sunnybrook ICH-CTA study group Background and Purpose-Reliable quantification of both intracerebral hemorrhage and intraventricular hemorrhage (IVH) volume is important for hemostatic trials. We evaluated the reliability of computer-assisted planimetric volume measurements of IVH. Methods-Computer-assisted planimetry was used to quantify IVH volume. Five raters measured IVH volumes, total (intracerebral hemorrhageϩIVH) volumes, and Graeb scores from 20 randomly selected computed tomography scans twice. Estimates of interrater and intrarater reliability were calculated and expressed as an intrarater correlation coefficient and an absolute minimum detectable difference. Results-Planimetric IVH volume analysis had excellent intra-and interrater agreement (intrarater correlation coefficient, 0.96 and 0.92, respectively), which was superior to the Graeb score (intrarater correlation coefficient, 0.88 and 0.83). Minimum detectable differences for intra-and interrater volumes were 12.1 mL and 17.3 mL, and were dependent on the total size of the hematoma; hematomas smaller than the median 43.8 mL had lower minimum detectable differences, whereas those larger than the median had higher minimum detectable differences. Planimetric total hemorrhage volume analysis had the best intra-and interrater agreement (intrarater correlation coefficient, 0.99 and 0.97, respectively). Key Words: intracerebral hemorrhage Ⅲ intraventricular hemorrhage Ⅲ planimetry H ematoma volume and intraventricular hemorrhage (IVH) are independent predictors of outcome following intracerebral hemorrhage (ICH). 1-2 Early ventricular rupture and subsequent autodecompression of parenchymal hematoma is common in ICH. 3 Ventricular decompression of ICH results in IVH expansion, which is also associated with poor outcome. 2 Given that hematoma expansion is a common surrogate outcome for ICH studies, 4 easy and accurate measurement of IVH and volume dynamics following ventricular rupture is relevant to hemostatic trials. In this study, we sought to evaluate the reliability of computer-assisted planimetric measurements for quantifying IVH volumes. Conclusions-Computer-assisted MethodsThe computer-assisted volume measurement software Quantomo (Cybertrial) 5 was used to quantify IVH volumes. Quantomo provides an interface that enables raters to guide segmentation algorithms with manual planimetric intervention to quantify volumes on computed tomography (CT) and magnetic resonance scans. Raters measured ICH and IVH volumes by selecting a hematoma and adjusting intensity thresholds, adding or removing regions to the computerselected region at their discretion, and manually drawing boundaries to separate IVH from ICH. CT scans of patients with both ICH and IVH were blindly and randomly selected from the ongoing PREDICT study. 6 Five raters (2 neurologists, 1 radiologist, 1 neuroradiologist, and 1 radiology trainee) measured IVH volumes, total (ICHϩIVH) volumes, and Graeb scores from 20 randomly selected CT scans twice, presented in a blind...

Evolution of Computed Tomography Angiography Spot Sign Is Consistent With a Site of Active Hemorrhage in Acute Intracerebral Hemorrhage

“…We measured baseline hematoma volumes and spot volumes, including maximal spot volumes (the largest spot sign volume measured for a given patient), for each acquisition time using computerized planimetry. 10 We used Fisher exact tests, t tests, and Mann-Whitney U tests as appropriate to compare baseline demographics, hematoma volumes, and medication/medical history between spot-positive and spotnegative patients. We used 1-way repeated-measures ANOVA to assess spot volume change over time in spot-positive patients.…”

Magnitude of Hematoma Volume Measurement Error in Intracerebral Hemorrhage

“…4,5 Raters measured total hematoma volumes using Quantomo by (1) selecting ≥1 segments of a hematoma with the mouse cursor, (2) adjusting an intensity threshold in Hounsfield units, which may be adjusted independently for each segment selected in step 1, and (3) manually adding or removing regions from the computer-selected region at their discretion. Volumes were quantified (in mL) using the spatial dimensions and positions of the voxels.…”

“…Therefore, baseline ICH volume should be taken into account in ICH expansion definitions. Larger hematomas are more likely to distort anatomic landmarks, 5 which may increase the imprecision of volume measurements and therefore the MDD. 7 Further, there is a mathematical proportional relationship between the MDD and the standard error of the mean volume, meaning that there will always be larger MDD for larger hemorrhage volume categories.…”

“…Further, this error may increase with the hematoma volume size. 4,5 The knowledge of what amount of the hematoma volume difference between CT scans can be considered as measurement error becomes critical when choosing a dichotomous expansion definition for a given ICH study. In this study, we aimed to investigate the minimum detectable difference (MDD) for total hematoma (ICH+IVH) volume in a cohort of ICH patients from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study.…”

Restarting oral anticoagulants after intracerebral hemorrhage: cons

“…Up to 76 % of patients with VKA-associated ICH may have severe disability or may die in the short term [13]. Mortality rates remain high and clinical outcomes generally remain poor despite reversal of anticoagulation [14]. Although NOACs have been associated with a reduced risk of ICH in clinical trials, we do not yet know if this reduced risk also applies to subjects with a previous ICH since they were excluded from those studies.…”