Background and Purpose-Both initial hematoma volume and hematoma growth are independent predictors of clinical outcomes and mortality among intracerebral hemorrhage patients. The purpose of this study was to evaluate the accuracy of different computed tomography image acquisition protocols and hematoma volume measurement techniques. Methods-We used plastic and cadaveric phantoms to determine the accuracy of different volumetric measurement techniques. We performed both axial and spiral computed tomography scans with 0.75-, 1.5-, 3.0-, and 4.5-mm-thick transverse sections (with no gap). Different measurement techniques (planimetry, ABC/2, and 3D rendering) and different window width/level settings (I, 150/50 versus II, 587/Ϫ321) were used to assess generated errors in volumetric calculations. 4 Later on, a simplified version of the ellipsoid equation, known as ABC/2 or XYZ/2, has been used. 2,5,6 Even though other methods for hematoma volume calculations have been proposed after the ABC/2 method, published studies have been limited regarding the role of image acquisition protocols, such as slice thickness, in the accuracy of volumetric measurements of hematoma. The purpose of this study was to evaluate the accuracy of different computed tomography (CT) protocols and hematoma volume measurement techniques. We used silicone and cadaveric phantoms to determine the accuracy of commonly used imaging techniques in measuring predetermined volumes. Results-Both Materials and Methods Silicone PhantomWe scanned 6 arbitrarily shaped solid-silicone phantoms of different volumes (ranging from 9.47 to 68.42 mL) by using a multichannel/ multidetector CT scanner (Sensation 64, Siemens Healthcare, Erlangen, Germany). The volumes of silicone objects were determined by measuring the volume of water displaced by the phantoms in a filter flask.Image acquisition was performed for axial and spiral CT protocols with a 0.75-mm (with no gap) slice thickness. The scanned objects were also reconstructed in 1.5-, 3.0-, and 4.5-mm-thick transverse sections. For volume estimation, we used different methods, including planimetry, 3D volume rendering, ABC/2, and ABC/2 with adjusted C values. The ABC/2 method is based on the volume of an ellipsoid that is approximately equal to ABC/2 (when the value of is approximated to 3). In this formula, A represents maximum length measured on the slice with the largest area, B represents maximum width perpendicular to A on the same slice, and C represents the number of slices in which the hematoma is visualized multiplied by the slice thickness. In the ABC/2 adjusted method, C values were calculated as described previously by Kothari et al. 7 We used Medical Image Processing, Analysis, and Visualization (Center for Information Technology, National Institutes of Health, Bethesda, MD) software for performing planimetry measurements. Image segmentation and volume rendering were performed by using 2 commercially available packages (Analyze 10; Analyze Direct, Inc, Overland Park, KS, and Voxar 3D, Barco NV,...
Independent predictors of NP included early hospital admission, in-hospital aspiration, intubation, and tracheostomy. NP was associated with prolonged hospital LOS.
Limited clinical and angiographic data exists for patients with spontaneous or traumatic cervico-cranial dissections treated with stent placement. We reviewed clinical and angiographic data on consecutive patients admitted to our hospital with spontaneous, traumatic, and iatrogenic cervico-cranial dissections treated with stent placement to study immediate and long-term clinical and angiographic outcomes. Additional patients were identified using pertinent studies published between 1980 and 2009, using a search of the PubMed, Cochrane, and Ovid libraries. Post-procedure complications and clinical outcomes were documented. Angiographic abnormalities collected at follow-up included presence of in-stent restenosis or pseudoaneurysm. After applying our strict search criteria, four studies including our series were used in the meta-analysis, representing 46 patients (mean age [standard deviation] 47 ± 14 years; 24 [52%] male) treated with stent placement for dissection. Overall, 72 stents were placed to treat 28 spontaneous, 11 traumatic, and 7 iatrogenic dissection patients with 51 dissections, involving 51 vessels; with a mean pre-stent stenosis of 71 ± 26% and mean post-stent stenosis of 6 ± 15%. The immediate and follow-up post-procedure complication rates per stent placed was 8 (11%) and 8 (11%), respectively. Among the 36 patients who underwent follow-up angiography, in-stent restenosis or pseudoaneurysms were present in 3 (8%) and 2 (6%) patients, respectively. A high rate of sustained resolution of angiographic abnormalities during long-term follow-up was noted, with a low rate of new transient ischemic attack, ischemic stroke, or death, supporting the feasibility, safety, and effectiveness of endovascular stent reconstruction.
No clear difference was observed between compliant and noncompliant balloons for therapeutic angioplasty in preventing angiographic recurrence or the need for repeat angioplasty in patients with subarachnoid hemorrhage-related cerebral vasospasm. An immediate normal or supranormal vessel diameter after the first-time angioplasty resulted in a significant reduction in the need for repeat angioplasty.
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