Background and purpose
Intracerebral hemorrhage volume (ICHV) as a percentage of total brain volume (TBV) is a strong predictor of outcome in childhood intracerebral hemorrhage (ICH) with ICHV/TBV>2% associated with functional impairment. We aimed to determine whether easily performed approximations of ICH and brain volume can accurately and reliably stratify ICH by size.
CT scans of 18 children with spontaneous ICH were independently reviewed by 4 neurologists. ICHV as a proportion of TBV was estimated as ABC/XYZ, expressed as a percentage. A = largest axial hemorrhage diameter; B = largest axial diameter perpendicular to A on the same slice; and C = hemorrhage vertical diameter. Similarly, X = largest midline axial diameter of supratentorial brain; Y = largest axial diameter perpendicular to X; and Z = brain vertical diameter. Inter-rater reliability was measured with intraclass correlation coefficients (ICC). ICHV and TBV were measured using computer-assisted manual segmentation tracings to establish criterion validity. Each ICH was classified as small (≤2%TBV) or large (>2%TBV).
Estimates of ICHV, TBV, and ICHV/TBV using the ABC/XYZ method had outstanding inter-rater reliability (ICC 0.95–0.99). These estimates were highly correlated with volumetric measures (R2 0.77–0.96). Sensitivity of the ABC/XYZ method for identifying an ICHV >2% TBV was 100% (95%CI: 89–100%). Specificity was 95% (95%CI: 83–99%).
The ABC/XYZ method accurately and reliably estimates ICHV and TBV in children. These values can be used to quickly and easily approximate ICHV as a percentage of TBV, which has important prognostic implications.
Keywords: intracerebral hemorrhage, hemorrhage volume, pediatric