Webb Alastair J S, Ullman Natalie L, Morgan Tim C, Muschelli John, Kornbluth Joshua, Awad Issam A, Mayo Stephen, Rosenblum Michael, Ziai Wendy, Zuccarrello Mario, Aldrich Francois, John Sayona, Harnof Sagi, Lopez George, Broaddus William C, Wijman Christine, Vespa Paul, Bullock Ross, Haines Stephen J, Cruz-Flores Salvador, Tuhrim Stan, Hill Michael D, Narayan Raj, Hanley Daniel F
From the Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom (A.J.S.W.); Division of Brain Injury Outcomes, Johns Hopkins Medical Institutions, Baltimore, MD (N.L.U., T.C.M., J.K., W.Z., D.F.H.); Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.M., M.R.); Department of Neurosurgery, University of Chicago, IL (I.A.A.); Emissary International, LLC, Austin, TX (S.M.); Department of Neurosurgery, University of Cincinnati, OH (M.Z.); Department of Neurosurgery, University of Maryland, Baltimore (F.A.); Department of Neurology, Rush University Medical Center, Chicago, IL (S.J., G.L.); Department of Neurosurgery, Sheba Medical Center, Ramat Gan, Israel (S.H.); Department of Neurosurgery, Medical College of Virginia, Richmond (W.C.B., R.B.); Department of Neurology and Neurological Sciences, Stanford Medicine, CA (C.W.); Department of Neurosurgery, University of California, Los Angeles (P.V.); Department of Neurological Surgery, Medical University of South Carolina, Charleston (S.J.H.); St. Louis University, MO (S.C.-F.); Department of Neurology, Mount Sinai School of Medicine, New York, NY (S.T.); Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (M.D.H.); and Department of Neurosurgery, Wayne State University, Detroit, MI (R.N.).
Stroke. 2015 Sep;46(9):2470-6. doi: 10.1161/STROKEAHA.114.007343. Epub 2015 Aug 4.
The ABC/2 score estimates intracerebral hemorrhage (ICH) volume, yet validations have been limited by small samples and inappropriate outcome measures. We determined accuracy of the ABC/2 score calculated at a specialized reading center (RC-ABC) or local site (site-ABC) versus the reference-standard computed tomography-based planimetry (CTP).
In Minimally Invasive Surgery Plus Recombinant Tissue-Type Plasminogen Activator for Intracerebral Hemorrhage Evacuation-II (MISTIE-II), Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage (CLEAR-IVH) and CLEAR-III trials. ICH volume was prospectively calculated by CTP, RC-ABC, and site-ABC. Agreement between CTP and ABC/2 was defined as an absolute difference up to 5 mL and relative difference within 20%. Determinants of ABC/2 accuracy were assessed by logistic regression.
In 4369 scans from 507 patients, CTP was more strongly correlated with RC-ABC (r(2)=0.93) than with site-ABC (r(2)=0.87). Although RC-ABC overestimated CTP-based volume on average (RC-ABC, 15.2 cm(3); CTP, 12.7 cm3), agreement was reasonable when categorized into mild, moderate, and severe ICH (κ=0.75; P<0.001). This was consistent with overestimation of ICH volume in 6 of 8 previous studies. Agreement with CTP was greater for RC-ABC (84% within 5 mL; 48% of scans within 20%) than for site-ABC (81% within 5 mL; 41% within 20%). RC-ABC had moderate accuracy for detecting ≥5 mL change in CTP volume between consecutive scans (sensitivity, 0.76; specificity, 0.86) and was more accurate with smaller ICH, thalamic hemorrhage, and homogeneous clots.
ABC/2 scores at local or central sites are sufficiently accurate to categorize ICH volume and assess eligibility for the CLEAR-III and MISTIE III studies and moderately accurate for change in ICH volume. However, accuracy decreases with large, irregular, or lobar clots.
URL: http://www.clinicaltrials.gov. Unique identifier: MISTIE-II NCT00224770; CLEAR-III NCT00784134.
ABC/2评分用于估计脑出血（ICH）体积，但此前的验证因样本量小和结局指标不当而受到限制。我们比较了在专业阅片中心计算的ABC/2评分（RC-ABC）和在当地计算的ABC/2评分（site-ABC）与基于计算机断层扫描的参考标准平面测量法（CTP）的准确性。
在脑出血微创清除术联合重组组织型纤溶酶原激活剂治疗-II（MISTIE-II）、脑室内出血加速溶解的血栓溶解评估（CLEAR-IVH）和CLEAR-III试验中，前瞻性地通过CTP、RC-ABC和site-ABC计算ICH体积。CTP与ABC/2评分之间的一致性定义为绝对差异达5 mL以内和相对差异在20%以内。通过逻辑回归评估ABC/2评分准确性的决定因素。
在507例患者的4369次扫描中，CTP与RC-ABC的相关性更强（r(2)=0.93），而与site-ABC的相关性较弱（r(2)=0.87）。虽然RC-ABC平均高估了基于CTP的体积（RC-ABC为15.2 cm(3)；CTP为12.7 cm(3)），但在分为轻度、中度和重度ICH时一致性尚可（κ=0.75；P<0.001）。这与之前8项研究中的6项对ICH体积的高估一致。RC-ABC与CTP的一致性高于site-ABC（84%在5 mL以内；48%的扫描在20%以内）（site-ABC为81%在5 mL以内；41%在20%以内）。RC-ABC在检测连续扫描间CTP体积变化≥5 mL时具有中等准确性（敏感性为0.76；特异性为0.86），对较小的ICH、丘脑出血和均匀血凝块更为准确。
当地或中心部位计算的ABC/2评分在对ICH体积进行分类以及评估CLEAR-III和MISTIE III研究的入选资格方面足够准确，在评估ICH体积变化方面具有中等准确性。然而，对于大的、不规则的或脑叶性血凝块，准确性会降低。
网址：http://www.clinicaltrials.gov。唯一标识符：MISTIE-II NCT00224770；CLEAR-III NCT00784134。
