Rodriguez-Luna David, Boyko Matthew, Subramaniam Suresh, Klourfeld Evgenia, Jo Patricia, Diederichs Brendan J, Kosior Jayme C, Dowlatshahi Dar, Aviv Richard I, Molina Carlos A, Hill Michael D, Demchuk Andrew M
From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, University of Calgary, Calgary, AB, Canada (D.R.-L., M.B., S.S., E.K., P.J., B.J.D., M.D.H., A.M.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); and Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.).
Stroke. 2016 Apr;47(4):1124-6. doi: 10.1161/STROKEAHA.115.012170. Epub 2016 Feb 18.
Limiting intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) expansion is 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.
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).
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.
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.
限制脑出血（ICH）和脑室内出血（IVH）的扩大是急性脑出血研究的常见目标，因此，需要准确测量血肿体积。我们研究了计算机断层扫描之间血肿体积差异的量，该差异可被视为测量误差。
五名评估者对来自使用对比剂团注CT预测脑出血血肿生长及预后（PREDICT）研究队列的40例选定脑出血患者进行了基线（<6小时）和24小时总血肿（ICH + IVH）的计算机辅助体积分析，共进行两次。评估者内和评估者间可靠性估计值以组内相关系数和最小可检测差异（MDD）表示。
总血肿体积分析具有出色的评估者内和评估者间一致性（组内相关系数分别为0.994和0.992）。评估者内和评估者间体积的MDD分别为6.68和7.72 mL，并且总血肿体积越大以及蛛网膜下腔出血或IVH患者的MDD越高。血肿体积最大的患者中，总血肿体积测量的MDD为10.4 mL。在蛛网膜下腔出血或IVH患者中，总血肿体积的MDD分别为10.3和10.4 mL。在无IVH的患者中，评估者内和评估者间单纯ICH体积的MDD分别为3.82和5.83 mL。
高于10.4 mL的阈值似乎对于避免广泛患者群体中总血肿体积测量的误差是可靠的。ICH研究中常用的ICH体积绝对增加>6 mL似乎远高于MDD，因此可用于可靠地检测ICH扩大。
