Comparison of the Ellipsoid Methods and the Cavalieri Method, for Calculating Hematoma Volume in Computed Tomography by non-Specialist

Year 2021, Volume: 7 Issue: 2, 115 - 119, 29.05.2021

Ahmet Tolgay Akıncı , Gizem Özdemir

https://doi.org/10.30934/kusbed.732215

Abstract

Objective: Intracerebral haemorrhages account for approximately 20% of all strokes and have higher morbidity and mortality, nearly 60% of patients die within a year, and 20% of the survivors live disabled. The volume of intracerebral haemorrhage has a strong association with the unfavourable outcome; therefore, fast and accurate measurement of the volume is crucial for clinical decision making. This study aimed to compare the ellipsoid methods and the Cavalieri method for calculating intracerebral hematoma volumes by physicians without special education on computed tomography assessment.
Methods: The hematoma volumes in the computed tomography images of 30 consecutive patients were measured via ellipsoid methods and the Cavalieri method. The calculated volumes of hematoma by the four methods were compared statistically.
Results: The median haematoma volumes (interquartile ranges) for ‘Cavalieri’, ‘prolate ellipse (abc)’, ‘prolate sphere (aac)’ and ‘sphere (aaa)’ methods were 23.2 (27.4), 37.2 (45.8), 22.1 (30.75), and 14.4 (31.87) respectively. A Friedman repeated measures ANOVA test determined that the results of the four methods to evaluate the haematoma volume differ significantly (p<0.001). A Durbin-Conover test demonstrated that the abc method was significantly different from other methods and that no significant difference among other methods was present. A week agreement was found between methods (Kendall’s W = 0.3).
Conclusion: Apart from the ‘prolate ellipse (abc)’ method, which tends to over-calculate the volume, three methods out of four seem feasible to use for physicians without special education on computed tomography assessment.

Keywords

Computed tomography, intracerebral haemorrhage calculation, volume

Bilgisayarlı Tomografide Hematom Hacminin Uzman Olmayanlar Tarafından Hesaplanması için Elipsoid Yöntemler ile Cavalieri Yönteminin Karşılaştırılması

Abstract

Amaç: İntraserebral kanamalar tüm inmelerin yaklaşık %20'sini oluşturur ve yüksek morbidite ile mortaliteye sahiptir, hastaların yaklaşık %60'ı bir yıl içinde ölür ve hayatta kalanların ise %20'si engelli yaşar. İntraserebral kanama hacminin olumsuz sonuç ile güçlü bir ilişkisi vardır; bu nedenle, hacmin hızlı ve doğru bir şekilde ölçülmesi klinik karar verme için çok önemlidir. Bu çalışmada bilgisayarlı tomografi değerlendirmesinde özel eğitim almamış hekimler tarafından intraserebral hematom hacimlerini hesaplamak için elipsoid yöntemlerle Cavalieri yönteminin karşılaştırılması amaçlanmıştır.
Yöntem: Ardışık 30 hastanın bilgisayarlı tomografi görüntülerindeki hematom hacimleri elipsoid yöntemleri ve Cavalieri yöntemi ile ölçüldü. Dört yöntemle hesaplanan hematom hacimleri istatistiksel olarak karşılaştırıldı.
Bulgular: 'Cavalieri', 'yayvan elips (abc)', 'yayvan küre (aac)' ve 'küre (aaa)' yöntemleri için medyan hematom hacimleri (çeyrekler arası aralık) sırasıyla 23,2 (27,4), 37,2 (45,8), 22,1 (30,75) ve 14,4 (31,87) idi. Friedman tekrarlanan ölçümler ANOVA testi, hematom hacmini değerlendirmek için dört yöntemin sonuçlarının önemli ölçüde farklı olduğunu belirledi (p<0.001). Durbin-Conover testi, abc yönteminin diğer yöntemlerden önemli ölçüde farklı olduğunu ve diğer yöntemler arasında anlamlı bir fark olmadığını gösterdi. Yöntemler arasında bir zayıf bir uzlaşma saptandı (Kendall’ın W = 0.3).
Sonuç: Hacmi fazla hesaplama eğiliminde olan 'yayvan elips (abc)' yöntemi hariç tutulursa; bilgisayarlı tomografi değerlendirmesinde özel eğitim almamış doktorlar için dört yöntemden üçü kullanılabilir.

Keywords

Bilgisayarlı tomografi, intraserebral kanama hesaplama, hacim

References

• Rennert RC, Tringale K, Steinberg JA, et al. Surgical management of spontaneous intracerebral hemorrhage: insights from randomized controlled trials. Neurosurg Rev. 2019:1-8. doi:10.1007/s10143-019-01115-2.
• Smith EE, Shobha N, Dai D, et al. A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke. J Am Heart Assoc. 2013;2(1):e005207. doi:10.1161/JAHA.112.005207.
• Keep RF, Hua Y, Xi G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol. 2012;11(8):720-731.
• Oliveira Manoel AL de, Goffi A, Zampieri FG, et al. The critical care management of spontaneous intracranial hemorrhage: a contemporary review. Crit Care. 2016;20(1):272. doi:10.1186/s13054-016-1432-0.
• Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24(7):987-993. doi:10.1161/01.str.24.7.987.
• Ericson K, Håkansson S. Computed tomography of epidural hematomas. Association with intracranial lesions and clinical correlation. Acta Radiol Diagn (Stockh). 1981;22(5):513-519. doi:10.1177/028418518102200501.
• Petersen OF, Espersen JO. Extradural hematomas: measurement of size by volume summation on CT scanning. Neuroradiology. 1984;26(5):363-367. doi:10.1007/bf00327488.
• Kwak R, Kadoya S, Suzuki T. Factors affecting the prognosis in thalamic hemorrhage. Stroke. 1983;14(4):493-500. doi:10.1161/01.str.14.4.493.
• Clatterbuck RE, Sipos EP. The Efficient Calculation of Neurosurgically Relevant Volumes from Computed Tomographic Scans Using Cavalieri's Direct Estimator. Neurosurgery. 1997;40(2):339-343. doi:10.1097/0006123-199702000-00019.
• Cuce F, Tulum G, Dandin Ö, Ergin T, Karadas Ö, Osman O. A New Practical Method for Intracerebral Hematoma Volume Calculation and its Comparison to the simple ABC/2 method. Turk Neurosurg. 2019. doi:10.5137/1019-5149.JTN.25996-19.2.
• Divani AA, Majidi S, Luo X, et al. The ABCs of accurate volumetric measurement of cerebral hematoma. Stroke. 2011;42(6):1569-1574. doi:10.1161/STROKEAHA.110.607861.
• Stocchetti N, Croci M, Spagnoli D, Gilardoni F, Resta F, Colombo A. Mass volume measurement in severe head injury: accuracy and feasibility of two pragmatic methods. J Neurol Neurosurg Psychiatry. 2000;68(1):14-17. doi:10.1136/jnnp.68.1.14.
• ImageJ. https://imagej.nih.gov/ij/. Updated September 14, 2019. Accessed February 4, 2020.
• Jamovi - Stats. Open. Now. https://www.jamovi.org/. Updated February 4, 2020. Accessed February 4, 2020.
• Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods. 2007;39(2):175-191. doi:10.3758/BF03193146.
• Wang G, Wang L, Sun X-G, Tang J. Haematoma scavenging in intracerebral haemorrhage: from mechanisms to the clinic. J Cell Mol Med. 2018;22(2):768-777. doi:10.1111/jcmm.13441.
• Thabet AM, Kottapally M, Hemphill JC. Management of intracerebral hemorrhage. Handb Clin Neurol. 2017;140:177-194. doi:10.1016/B978-0-444-63600-3.00011-8.
• Mendelow AD, Gregson BA, Fernandes HM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365(9457):387-397. doi:10.1016/S0140-6736(05)17826-X.
• Scaggiante J, Zhang X, Mocco J, Kellner CP. Minimally Invasive Surgery for Intracerebral Hemorrhage. Stroke. 2018;49(11):2612-2620. doi:10.1161/STROKEAHA.118.020688.
• Andrews CM, Jauch EC, Hemphill JC, Smith WS, Weingart SD. Emergency neurological life support: intracerebral hemorrhage. Neurocrit Care. 2012;17 Suppl 1:S37-46. doi:10.1007/s12028-012-9757-2.
• Faigle R. Location, Location, Location: The Rural-Urban Divide in Intracerebral Hemorrhage Mortality. Neurocrit Care. 2020. doi:10.1007/s12028-020-00952-0.
• Doğan NÖ. Bland-Altman analysis: A paradigm to understand correlation and agreement. Turk J Emerg Med. 2018;18(4):139-141. doi:10.1016/j.tjem.2018.09.001.