Assessment of the accuracy of ABC/2 variations in traumatic epidural hematoma volume estimation: a retrospective study.

Background. The traumatic epidural hematoma (tEDH) volume is often used to assist in tEDH treatment planning and outcome prediction. ABC/2 is a well-accepted volume estimation method that can be used for tEDH volume estimation. Previous studies have proposed different variations of ABC/2; however, it is unclear which variation will provide a higher accuracy. Given the promising clinical contribution of accurate tEDH volume estimations, we sought to assess the accuracy of several ABC/2 variations in tEDH volume estimation. Methods. The study group comprised 53 patients with tEDH who had undergone non-contrast head computed tomography scans. For each patient, the tEDH volume was automatically estimated by eight ABC/2 variations (four traditional and four newly derived) with an in-house program, and results were compared to those from manual planimetry. Linear regression, the closest value, percentage deviation, and Bland-Altman plot were adopted to comprehensively assess accuracy. Results. Among all ABC/2 variations assessed, the traditional variations y = 0.5 × A 1 B 1 C 1 (or A 2 B 2 C 1) and the newly derived variations y = 0.65 × A 1 B 1 C 1 (or A 2 B 2 C 1) achieved higher accuracy than the other variations. No significant differences were observed between the estimated volume values generated by these variations and those of planimetry (p > 0.05). Comparatively, the former performed better than the latter in general, with smaller mean percentage deviations (7.28 ± 5.90% and 6.42 ± 5.74% versus 19.12 ± 6.33% and 21.28 ± 6.80%, respectively) and more values closest to planimetry (18/53 and 18/53 versus 2/53 and 0/53, respectively). Besides, deviations of most cases in the former fell within the range of <10% (71.70% and 84.91%, respectively), whereas deviations of most cases in the latter were in the range of 10-20% and >20% (90.57% and 96.23, respectively). Discussion. In the current study, we adopted an automatic approach to assess the accuracy of several ABC/2 variations for tEDH volume estimation. Our initial results showed that the variations y = 0.5 × A 1 B 1 C 1 (or A 2 B 2 C 1) performed better than the other traditional variations, suggesting that the adjusted depth is favorable. In addition, linear regression has been shown to be useful for improving the estimation accuracy of the ABC/2 method, and future studies are warranted to investigate the applicability of such linear regression-derived formulas for clinical application.