A Quantitative Subarachnoid Hemorrhage Grading System, Including Supratentorial and Infratentorial Cisterns, With...

Area of Science:

• Neuroradiology
• Neuroimaging
• Medical Diagnostics

Background:

• Existing subarachnoid hemorrhage (SAH) grading scales often focus on limited cisterns in a single plane.
• A comprehensive and quantitative grading system for SAH is needed to improve diagnostic accuracy.

Purpose of the Study:

• To develop and validate a simple, quantitative grading scale for SAH.
• To apply this scale to all major intracranial cisterns, including infratentorial ones, using multiplanar CT reformations.

Main Methods:

• Retrospective review of 94 spontaneous SAH cases within 72 hours of onset.
• SAH grading based on short-axis thickness in 20 cisterns across axial, coronal, and sagittal CT planes.
• Statistical analysis including kappa and correlation coefficients for inter-rater and inter-plane agreement.

Main Results:

• Inter-rater agreement varied across planes, with kappa coefficients ranging from 0.35 to 0.87.
• High correlation (Spearman's ≥0.70) observed for average cistern grades between imaging planes.
• Excellent concordance (PCC ≥0.91) for total SAH scores across all three CT planes.

Conclusions:

• A straightforward quantitative SAH grading scale can be effectively applied to both supratentorial and infratentorial cisterns.
• The proposed scale demonstrates reliability and consistency across multiple CT imaging planes.
• This comprehensive grading approach may enhance the assessment of subarachnoid hemorrhage.