Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.
School of Pathology and Laboratory Medicine, The University of Western Australia, Nedlands, Australia.
J Neurol Neurosurg Psychiatry. 2015 Nov;86(11):1258-66. doi: 10.1136/jnnp-2014-309845. Epub 2015 Jan 9.
Poor prognosis after intracerebral haemorrhage (ICH) is related to haemorrhage characteristics. Along with developing therapeutic interventions, we sought to understand the performance of haemorrhage descriptors in large clinical trials.
Clinical and neuroimaging data were obtained for 548 participants with ICH from the Efficacy of Nitric Oxide in Stroke (ENOS) trial. Independent observers performed visual categorisation of the largest diameter, measured volume using ABC/2, modified ABC/2, semiautomated segmentation (SAS), fully automatic measurement methods; shape, density and intraventricular haemorrhage were also assessed. Intraobserver and interobserver reliability were determined for these measures.
ICH volume was significantly different among standard ABC/2, modified ABC/2 and SAS: (mean) 12.8 (SD 16.3), 8.9 (9.2), 12.8 (13.1) cm(3), respectively (p<0.0001). There was excellent agreement for haemorrhage volume (n=193): ABC/2 intraobserver intraclass correlation coefficient (ICC) 0.96-0.97, interobserver ICC 0.88; modified ABC/2 intraobserver ICC 0.95-0.97, interobserver ICC 0.91; SAS intraobserver ICC 0.95-0.99, interobserver ICC 0.93; largest diameter: (visual) interadjudicator ICC 0.82, (visual vs measured) adjudicator vs observer ICC 0.71; shape intraobserver ICC 0.88 interobserver ICC 0.75; density intraobserver ICC 0.86, interobserver ICC 0.73. Graeb score (mean 3.53) and modified Graeb (5.22) scores were highly correlated. Using modified ABC/2, ICH volume was underestimated in regular (by 2.2-2.5 cm(3), p<0.0001) and irregular-shaped haemorrhages (by 4.8-4.9 cm(3), p<0.0001). Fully automated measurement of haemorrhage volume was possible in only 5% of cases.
Formal measurement of haemorrhage characteristics and visual estimates are reproducible. The standard ABC/2 method is superior to the modified ABC/2 method for quantifying ICH volume.
ISRCTN9941422.
脑出血（ICH）后预后不良与出血特征有关。随着治疗干预措施的发展，我们试图了解出血描述符在大型临床试验中的表现。
从 Efficacy of Nitric Oxide in Stroke（ENOS）试验中获得了 548 名 ICH 患者的临床和神经影像学数据。独立观察者对最大直径进行视觉分类，使用 ABC/2、改良 ABC/2、半自动分割（SAS）、全自动测量方法测量体积；还评估了形状、密度和脑室内出血。确定了这些措施的观察者内和观察者间可靠性。
标准 ABC/2、改良 ABC/2 和 SAS 之间的 ICH 体积有显著差异：（平均值）分别为 12.8（16.3）、8.9（9.2）和 12.8（13.1）cm3（p<0.0001）。对于出血体积（n=193），具有极好的一致性：ABC/2 观察者内组内相关系数（ICC）0.96-0.97，观察者间 ICC 0.88；改良 ABC/2 观察者内 ICC 0.95-0.97，观察者间 ICC 0.91；SAS 观察者内 ICC 0.95-0.99，观察者间 ICC 0.93；最大直径：（视觉）不同评判者 ICC 0.82，（视觉与测量）评判者与观察者 ICC 0.71；形状观察者内 ICC 0.88 观察者间 ICC 0.75；密度观察者内 ICC 0.86，观察者间 ICC 0.73。Graeb 评分（平均值 3.53）和改良 Graeb 评分（5.22）高度相关。使用改良 ABC/2，规则形状（减少 2.2-2.5 cm3，p<0.0001）和不规则形状（减少 4.8-4.9 cm3，p<0.0001）的 ICH 体积被低估。仅 5%的情况下可以全自动测量血肿体积。
出血特征的正式测量和视觉估计是可重复的。标准 ABC/2 方法优于改良 ABC/2 方法，可用于量化 ICH 体积。
ISRCTN9941422。
