A number of techniques have been developed to measure intracerebral hemorrhage volume.
Unfortunately, these methods often involve complicated formulas, require specialized equipment, or cannot be performed rapidly at the patient's bedside.
The formula ABC/2 was used, where A is the greatest hemorrhage diameter by CT, B is the diameter 90 degrees to A, and C is the approximate number of CT slices with hemorrhage multiplied by the slice thickness.
The ICH volumes for 118 patients were evaluated in a mean of 38 seconds and correlated with planimetric measurements (R2 = 9.6). Interrater and intrarater reliability were excellent, with an intraclass correlation of .99 for both.
Kothari et al., conclude that ICH volume can be accurately estimated in less than 1 minute with the simple formula ABC/2 1).
Rapid calculation of ICH volume at the time of initial patient presentation has clinical utility. For prognosis, a model of 30-day mortality that used the Glasgow Coma Scale and hemorrhage volume in patients with ICH correctly predicted outcome with a sensitivity and specificity of 97%.
The ABC/2 technique may also be used to identify appropriate patients with ICH suitable for randomization into therapeutic trials.
For example, the technique is the measurement method used for patient eligibility assessment in the multicenter Surgical Trial of Intracerebral Hemorrhage (J. Grotta, unpublished data, 1996). In this trial, patients with ICH and anticipated good outcome are not eligible for surgery. Thus, patients with hemorrhage volumes of less than 10 cm3 and patients with lobar hemorrhage volumes of 10 to 20 cm3 with minimal or no neurological deficits are excluded.
Lisk and colleagues demonstrated the ease and power of the ABC/2 method of volume measurement in a model of outcome after ICH but did not correlate this technique with other methods of volume measurement. The ABC/2 formula can be adjusted for CT slices of varying thickness by multiplying the number of slices of the different thicknesses on which the hematoma is seen (C of ABC/2) by the slice thickness in centimeters. Other authors have estimated hematoma volume by assuming it to approximate the volume of a sphere, an ellipsoid, or a rectangulopiped.
Only estimates of volume that use the formula for an ellipsoid have been shown to correlate with planimetric techniques.
This rapid method of measuring hemorrhage volume may allow physicians to quickly select and stratify patients in future treatment trials 2).
The ABC/2 method could be used for epidural hematoma volume EDHV measurement, which would contribute to treatment decision making as well as clinical outcome prediction. However, clinicians should be aware that the ABC/2 method results in a general volume overestimation. Future studies focusing on justification of the technique to improve its accuracy would be of practical value 3).