Magnitude of Hematoma Volume Measurement Error in Intracerebral Hemorrhage

Abstract

Background and Purpose-Limiting intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) expansionis a common target for acute ICH studies and, therefore, accurate measurement of hematoma volumes is required. We investigated the amount of hematoma volume difference between computed tomography scans that can be considered as measurement error. Methods-Five raters performed baseline (<6 hours) and 24-hour total hematoma (ICH+IVH) computer-assisted volumetric analysis from 40 selected ICH patients from the Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study cohort twice. Estimates of intrarater and interrater reliability are expressed as intraclass correlation coefficients and minimum detectable difference (MDD). Results-Total hematoma volumetric analyses had excellent intra-and interrater agreements (intraclass correlation coefficients 0.994 and 0.992, respectively). MDD for intra-and interrater volumes was 6.68 and 7.72 mL, respectively, and were higher the larger total hematoma volume was and in patients with subarachnoid hemorrhage or IVH. MDD for total hematoma volume measurement of 10.4 mL was found in patients with largest hematoma volumes. In patients with subarachnoid hemorrhage or IVH, MDD for total hematoma volume was 10.3 and 10.4 mL, respectively. In patients without IVH, MDD for intra-and interrater pure ICH volumes were 3.82 and 5.83 mL, respectively. Conclusions-A threshold higher than 10.4 mL seems to be reliable to avoid error of total hematoma volume measurement in a broad range of patients. An absolute ICH volume increase of >6 mL, commonly used as outcome in ICH studies, seems well above MDD and, therefore, could be used to reliably detect ICH expansion.

Software output from semi-automated planimetry can underestimate intracerebral haemorrhage and peri-haematomal oedema volumes by up to 41 %

“…We demonstrated excellent inter-rater and intra-rater ICCs in both Analyze and Osirix using a validated semi-automated planimetry approach [10]. The reliability of the ICH measurement in our study is consistent with that reported in the literature (inter-rater and intra-rater ICCs >0.900) [12,14,18]. Divani et al demonstrated in a simulated cadaveric ICH model that Analyze software and Medical Imaging Processing, Analysis and Visualization (Center for Information Technology, National Institutes of Health, Bethesda, MD) software produced less error than the ABC/2 method when compared to the actual volume of simulated blood injected, but the authors did not directly compare the volumes produced by the different softwares [19].…”

Meta-analysis of haematoma volume, haematoma expansion and mortality in intracerebral haemorrhage associated with oral anticoagulant use

“…However, these methodological limitations applies to both, OAC-ICH and non-OAC-ICH. (5) Even with sophisticated measuring techniques, for large haematomas, the magnitude of haematoma volume measurement error may exceed the threshold used to dichotomize HE in the respective study [43]. In our analysis of aggregate data, we were not able to correct for this incertitude.…”

Location of intracerebral haemorrhage predicts haematoma expansion

“…However, as previous studies have indicated, an absolute definition of >6 ml falls within the MDD for total haematoma volume. 24 Furthermore, the requirement for follow-up imaging to assess for haematoma expansion likely excluded patients at highest risk of early mortality, which precluded our ability to fully determine the effect of haemorrhage location on clinical outcome. Our choice to exclude patients who received a ventricular drain prior to repeat imaging may have biased our sample towards better outcomes.…”