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2015 ; 46
(4
): 1116-9
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Measurement of perihematomal edema in intracerebral hemorrhage
#MMPMID25721012
Urday S
; Beslow LA
; Goldstein DW
; Vashkevich A
; Ayres AM
; Battey TW
; Selim MH
; Kimberly WT
; Rosand J
; Sheth KN
Stroke
2015[Apr]; 46
(4
): 1116-9
PMID25721012
show ga
BACKGROUND AND PURPOSE: Perihematomal edema (PHE) is a marker of secondary injury
in intracerebral hemorrhage (ICH). PHE measurement on computed tomography (CT) is
challenging, and the principles used to detect PHE have not been described fully.
We developed a systematic approach for CT-based measurement of PHE. METHODS: Two
independent raters measured PHE volumes on baseline and 24-hour post-ICH CT scans
of 20 primary supratentorial ICH subjects. Boundaries were outlined with an
edge-detection tool and adjusted after inspection of the 3 orthogonal planes. PHE
was delineated with the additional principle that it should be (a) more hypodense
than the corresponding area in the contralateral hemisphere and (b) most
hypodense immediately surrounding the hemorrhage. We examined intra- and
interrater reliability using intraclass correlation coefficients and Bland-Altman
plots for interrater consistency. CT-based PHE was also compared using magnetic
resonance imaging-based PHE detection for 18 subjects. RESULTS: Median PHE
volumes were 22.7 cc at baseline and 20.4 cc at 24 hours post-ICH. There were no
statistically significant differences in PHE measurements between raters.
Interrater and intrarater reliability for PHE were excellent. At baseline and 24
hours, interrater intraclass correlation coefficients were 0.98 (0.96-1.00) and
0.98 (0.97-1.00); intrarater intraclass correlation coefficients were 0.99
(0.99-1.00) and 0.99 (0.98-1.00). Bland-Altman analysis showed the bias for PHE
measurements at baseline and 24 hours, -0.5 cc (SD, 5.4) and -3.2 cc (SD, 5.0),
was acceptably small. PHE volumes determined by CT and magnetic resonance imaging
were similar (23.9±16.9 cc versus 23.9±16.0 cc, R(2) = 0.98, P<0.0001).
CONCLUSIONS: Our method measures PHE with excellent reliability at baseline and
24 hours post-ICH.
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