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ABC/2: estimating intracerebral haemorrhage volume and total brain volume, and predicting outcome in children
Jonathan T Kleinman1, Argye E Hillis, Lori C Jordan
1Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
The ABC/2 method accurately estimates paediatric intracerebral haemorrhage (ICH) volume as a percentage of total brain volume (TBV). This bedside tool aids clinicians in predicting outcomes for children with ICH.
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Prognosis after paediatric intracerebral haemorrhage (ICH) lacks sufficient clinical data.
- ICH volume as a percentage of total brain volume (TBV) shows promise in predicting pediatric outcomes.
- Accurate and efficient methods for estimating ICH and TBV are needed for clinical decision-making.
Purpose of the Study:
- To develop a bedside method for estimating TBV using standard hospital imaging software.
- To validate the ABC/2 method for calculating ICH volume and TBV in pediatric patients.
- To determine ICH volume as a percentage of TBV to aid in pediatric ICH prognosis.
Main Methods:
- Utilized the ABC/2 method with slice thickness to calculate ICH and TBV in 23 pediatric patients with acute ICH.
- Excluded preterm infants and infants with isolated intraventricular hemorrhages.
- Compared ABC/2 method results against manual segmentation (criterion standard) for accuracy and reliability.
Main Results:
- High accuracy was observed for estimated ICH volume (combined R²=0.96) and TBV (combined R²=0.89) compared to the criterion standard.
- Excellent interrater reliability was demonstrated for both ICH volume (ICC=0.94) and TBV (ICC=0.80).
- The ABC/2 method accurately measured ICH volume as a percentage of TBV without specialized software.
Conclusions:
- The ABC/2 × slice thickness method is a validated, accurate bedside tool for estimating ICH volume in pediatric patients.
- This method provides a reliable means to report ICH volume as a percentage of TBV, aiding clinical prognosis.
- The ABC/2 method offers a practical approach for clinicians to assess and manage pediatric intracerebral haemorrhages.
Aim:
Few data exist to aid the clinician in prognosis after paediatric intracerebral haemorrhages (ICHs). Recently, ICH volume as a per cent of total brain volume (TBV) was shown to help predict outcomes in children. Thus, we sought to develop a bedside method of TBV estimation using typical hospital imaging software, and to validate the ABC/2 method for children in order to determine ICH volume and aid prognosis.
Method:
The study group comprised 23 children and adolescents with non-traumatic, acute ICH who had undergone head computed tomography and who were available for analysis. The median age of participants, 14 males (61%) and nine females (39%), was 6 years (range 0-16 y; mean 7.8 y; SD 5.3 y). Preterm infants born at less than 37 weeks' gestation and term infants with pure intraventricular haemorrhages were excluded. Manual segmentation, which is the criterion standard for measurement of ICH volume and TBV, requires specialized software and is time-consuming. We therefore used the well-known 'ABC/2 × slice thickness' method to calculate ICH volume and TBV, thus allowing ICH size to be reported as a percentage of TBV regardless of the absolute size of ICH.
Results:
The estimated ICH volume was highly accurate compared with the criterion standard (R(2) =0.97 and R(2) =0.93; combined R(2) =0.96), as was the estimated TBV (R(2) =0.89 and R(2) =0.77; combined R(2) =0.89). The interrater reliability was high for both ICH volume and TBV, with an intraclass correlation coefficient of 0.94 and 0.80 respectively. Therefore, using no specialized software, we accurately measured ICH volume as a percentage of TBV.
Interpretation:
The ABC/2 × slice thickness method is a possible bedside tool for the clinician that can aid prognosis after paediatric ICH.
