Abstract TP369: Comparison of Hematoma Volume Estimates in Intracerebral Hemorrhage

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Muhib A Khan ◽  
Joshua Rodriguez-Srednicki ◽  
Grayson Baird ◽  
Roderick Elias ◽  
Sandra Yan ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Intracerebral Hemorrhage ◽  
Linear Trend ◽  
Final Analysis ◽  
Volume Estimation ◽  
Hematoma Volume ◽  
Academic Center ◽  
Lower Volume ◽  
Volume Estimates ◽  
Better Than

Background: Intracerebral hemorrhage (ICH) volumes are frequently used for prognostication and inclusion of patients in clinical trials. There are three commonly used methods for volume estimation: the original ABC/2 method a simplified version (sABC/2), and the planimetric method. We sought to compare the ABC/2 and sABC/2 methods with the planimetric method. Methods: We retrospectively reviewed admission CT scans of consecutive ICH patients admitted to a single academic center from July 2012 to April 2013. Only patients with spontaneous ICH were included. We assessed ICH volume on the admission CT. In the ABC/2 method, C is the number of approximate cuts the hemorrhage is seen on (weighted by area as 75%), while in the sABC/2 method, C is the total number of cuts in which the ICH is seen. Planimetric analysis was performed with the Analyze software. Band-Altman plots were generated for both the ABC/2 and sABC/2 methods in comparison to the planimetric method; all units were log transformed. Results: 135 patients with spontaneous ICH were included in the final analysis. Band-Altman analysis illustrated that both ABC/2 and sABC/2 were concordant with the planimetric method. ABC/2 had more bias than sABC/2 (47% vs 5%, respectively) with no evidence of a linear trend. At a lower volume threshold of 30 mL, ABC/2 was less sensitive but more specific than sABC/2 (sensitivity 77.9% and specificity 98.9% vs sensitivity 93.3% and specificity 91.1%, respectively, p<.0001). Overall, sABC/2 performed better than ABC/2 (c-stat 0.92 vs 0.88, respectively). Conclusion: Simplified ABC/2 (sABC/2) method performs better than ABC/2 in differentiating volumes greater than 30 ml. Both ABC/2 and sABC/2 methods accurately measure hematoma volumes in spontaneous ICH patients, in comparison with the planimetric method. These findings may have implications for outcomes prediction and clinical trials inclusion.

Abstract W MP86: Improving the Accuracy of the ABC/2 Estimation Technique in Spontaneous Supratentorial Intracerebral Hemorrhage

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Wendy Ziai ◽  
Saman Nekoovaght-Tak ◽  
Joshua F Betz ◽  
John Muschelli ◽  
Ryan N Fisico ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Regression Models ◽  
Volume Estimation ◽  
Central Laboratory ◽  
Hematoma Volume ◽  
Optimal Value ◽  
Study Population ◽  
Optimal Adjustment ◽  
Linear And Nonlinear ◽  
Linear And Nonlinear Regressions

Introduction: The ABC/2 formula is the most common, rapid, and effective method to estimate intracerebral hemorrhage (ICH) volumes. However, ABC/2 overestimates clot volume with increasing error for larger hematomas. We used linear and nonlinear regressions to find if adjusting C, adjusting the denominator, or adjusting both would improve ICH volume estimation. Materials and methods: We assessed the diagnostic computed tomography (CT) scans of 373 patients enrolled in the MISTIE II (N=100) and CLEAR III (N=273) clinical trials using a standard central laboratory ABC/2 technique compared with planimetry volumetric calculations. Linear and nonlinear regressions were used to find optimal adjustments for C and the denominator, both individually and jointly. Results were stratified by study population to determine generality. Results: In MISTIE II (M2) patients, mean hematoma volume was 45.72 ± 27.1 (SD) cm 3 using ABC/2 vs. 39.48 ± 19.58 cm 3 using planimetry. In CLEAR III (C3) patients, mean hematoma volume was 11.11±8.30 (ABC/2) vs. 9.58±7.10 cm 3 (planimetry). The optimal denominator for the ABC approximation without adjusting C was 2.39 in M2 patients (95% CI 2.33, 2.46) and 2.37 in C3 patients (95% CI 2.31, 2.42). When these samples are combined, the optimal denominator was 2.39 (95% CI 2.35, 2.42). Without any correction to the denominator, the optimal adjustment for C was a decrease of 0.8352 in M2 patients (95% CI -0.976, -0.694) and a decrease of 0.5277 in C3 patients (95% CI -0.595, -0.46). In regression models adjusting C and the denominator, the optimal adjustment for C was an increase of 0.5707 in M2 patients (95% CI -0.215, 1.635), and an increase of 0.0485 in C3 patients (95% CI -0.383, 0.235). The optimal value of the denominator in these models was 2.64 in M2 patients (95% CI 2.29, 3.13) and 2.39 in C3 patients (95% CI 2.21, 2.62). Conclusion: Empirical evidence from a large international population of ICH patients suggests that ABC/2 consistently over-estimates ICH volumes. Shrinking the C-axis of the ellipse improves fit, but the optimal adjustment depends on ICH size. Using a denominator of 2.4 is a simple, objective way to improve rapid ICH assessment with the existing measurement paradigm, which is consistent in both large and small hematomas.

Abstract TP345: A Systematic Review of Statins in Animal Models of Intracerebral Hemorrhage and Proposal of a Modified STAIR Criteria for Evaluation of Preclinical Studies in ICH

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Dominic A Nistal ◽  
Christopher P Kellner ◽  
Daniel Wei ◽  
Diana Herrera ◽  
J D Mocco
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Intracerebral Hemorrhage ◽  
Randomized Clinical Trials ◽  
Behavioral Outcomes ◽  
Severe Form ◽  
P Value ◽  
Preclinical Studies ◽  
Hematoma Volume ◽  
Preclinical Trials

Background and Purpose: Intracerebral hemorrhage (ICH) is a severe form of stroke with limited medical and surgical treatment. Similarly to clinical trials in acute stroke, none of the medications that appeared promising in preclinical testing have panned out in human clinical trials. HMG-CoA reductase inhibitors (e.g. statins) show promise as a therapy for ICH in both animal and human studies. Our aim is to review and assess the quality of preclinical studies on the role of statins in ICH recovery. Methods: We identified preclinical trials assessing the efficacy of statins in ICH via a systematic review of the literature according to PRISMA guidelines. In total, 16 studies were identified that described the use of statins in an animal model of ICH and assessed changes in histological outcomes, behavioral scores, or both. Design characteristics were analyzed using Stroke Therapy Academic Industry Roundtable (STAIR) criteria modified for ICH. Results: Behavioral outcomes were assessed in 12 of the studies with 100% (n=12) reporting statins significantly improved ICH recovery. Histological hematoma volume and histological Brain Water Content (BWC) outcomes were analyzed in 10 of the studies with 50% (n=5) reporting significant improvement. There was no correlation between STAIR Quality Score and behavioral, histological hematoma volume, and histological BWC outcomes across all studies (n=16), (p=0.75, p-value=0.49, p=0.44). Conclusions: Behavioral outcomes in ICH were found to consistently improve with administration of statins suggesting that this medication may be suitable for randomized clinical trials in humans. In addition, the STAIR criteria can be modified to effectively evaluate preclinical studies in ICH. Key words: Intracerebral hemorrhage, Intraparenchymal hemorrhage, ICH, stroke, statins, neuroprotection, animal, preclinical trials, review, systematic review

Comparison of log volume estimates using formulae for log center of gravity and center of volume

1994 ◽  
Vol 24 (1) ◽  
pp. 133-138 ◽  
Author(s):  
Thomas B. Lynch ◽  
Harry V. Wiant Jr. ◽  
David W. Patterson
Keyword(s):  
Center Of Gravity ◽  
Volume Estimation ◽  
Uniform Density ◽  
Engineering Applications ◽  
Volume Estimates ◽  
Better Than ◽  
Solids Of Revolution

Formulae for estimating log center of gravity for logs of uniform density are presented that are based on frusta of simple solids of revolution. The center of gravity position for logs shaped as cones, paraboloids, paracones, neiloids, and logs having intermediate shapes can be estimated by using these formulae. A comparison of log volume estimates was made using the center of gravity and the center of volume locations as interlog positions for diameter measurements. The center of volume was found to be better than the center of gravity for log volume estimation. However, formulae for log center of gravity should be useful for engineering applications with logs of uniform density.

Intracerebral Hematoma, Perihemorrhagic Edema and Urinary Excreted Cysteinyl Leukotrienes Correlation Study

2014 ◽  
Vol 68 (2) ◽  
pp. 85-88
Author(s):  
Natalija Dolnenec-Baneva ◽  
Dijana Nikodijevic ◽  
Gordana Kiteva-Trenchevska ◽  
Igor Petrov ◽  
Dragana Petrovska-Cvetkovska ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Edema ◽  
Correlation Study ◽  
Intracerebral Hematoma ◽  
Moderate Correlation ◽  
Hematoma Volume ◽  
Cysteinyl Leukotrienes ◽  
Edema Volume ◽  
Perihemorrhagic Edema

AbstractIntroduction.Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage.Methods.An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2).Results.CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rdday (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5thday (R=0.3).Conclusion.In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rdday, a moderate correlation on admission and on the 5thday, which means that high cysLT and hematoma values were associated with high/moderate edema values.

scholarly journals Anti-inflammatory genes in PBMCs post-spontaneous intracerebral hemorrhage

2021 ◽  
Vol 12 (1) ◽  
pp. 58-66
Author(s):  
Doan Nguyen ◽  
Vi Tran ◽  
Alireza Shirazian ◽  
Cruz Velasco-Gonzalez ◽  
Ifeanyi Iwuchukwu
Keyword(s):  
Intracerebral Hemorrhage ◽  
Negative Correlation ◽  
Mononuclear Cells ◽  
Inflammatory Cells ◽  
Favorable Outcome ◽  
Hospital Length Of Stay ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Peripheral Blood Mononuclear ◽  
Anti Inflammatory

Abstract Background Neuroinflammation is important in the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and peripheral inflammatory cells play a role in the clinical evolution and outcome. Methodology Blood samples from ICH patients (n = 20) were collected at admission for 5 consecutive days for peripheral blood mononuclear cells (PBMCs). Frozen PBMCs were used for real-time PCR using Taqman probes (NFKB1, SOD1, PPARG, IL10, NFE2L2, and REL) and normalized to GAPDH. Data on hospital length of stay and modified Rankin score (MRS) were collected with 90-day MRS ≤ 3 as favorable outcome. Statistical analysis of clinical characteristics to temporal gene expression from early to delayed timepoints was compared for MRS groups (favorable vs unfavorable) and hematoma volume. Principle findings and results IL10, SOD1, and REL expression were significantly higher at delayed timepoints in PBMCs of ICH patients with favorable outcome. PPARG and REL increased between timepoints in patients with favorable outcome. NFKB1 expression was not sustained, but significantly decreased from higher levels at early onset in patients with unfavorable outcome. IL10 expression showed a negative correlation in patients with high hematoma volume (>30 mL). Conclusions and significance Anti-inflammatory, pro-survival regulators were highly expressed at delayed time points in ICH patients with a favorable outcome, and IL10 expression showed a negative correlation to high hematoma volume.

Late Neurological Deterioration after Acute Intracerebral Hemorrhage: A post hoc Analysis of the ATACH-2 Trial

2020 ◽  
Vol 49 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Shuhei Okazaki ◽  
Haruko Yamamoto ◽  
Lydia D. Foster ◽  
Mayumi Fukuda-Doi ◽  
Masatoshi Koga ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Significant Risk ◽  
Blood Pressure Level ◽  
Neurological Deterioration ◽  
Major Influence ◽  
Case Report Form ◽  
Hematoma Volume ◽  
Systolic Blood Pressure Level ◽  
Significant Difference

Background: Neurological deterioration (ND) has a major influence on the prognosis of intracerebral hemorrhage (ICH); however, factors associated with ND occurring after 24 h of ICH onset are unknown. Methods: We performed exploratory analyses of data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial, which compared intensive and standard blood pressure lowering treatment in ICH. NDs were captured on the adverse event case report form. Logistic regression analysis was performed to examine the independent predictors of late ND. Results: Among 1,000 participants with acute ICH, 82 patients (8.2%) developed early ND (≤24 h), and 64 (6.4%) had late ND. Baseline hematoma volume (adjusted OR [aOR] per 1-cm3 increase 1.04, 95% CI 1.02–1.06, p < 0.0001), hematoma volume increase in 24 h (aOR 2.24, 95% CI 1.23–4.07, p = 0.008), and the presence of intraventricular hemorrhage (IVH; aOR 2.38, 95% CI 1.32–4.29, p = 0.004) were independent predictors of late ND (vs. no late ND). Late ND was a significant risk factor for poor 90-day outcome (OR 3.46, 95% CI 1.82–6.56). No statistically significant difference in the incidence of late ND was noted between the 2 treatment groups. Conclusions: Initial hematoma volume, early hematoma volume expansion, and IVH are independent predictors of late ND after ICH. Intensive reduction in the systolic blood pressure level does not prevent the development of late ND.

Abstract WP418: Characteristic of Intracerebral Hemorrhage Related to Direct Oral Anticoagulant versus Warfarin: Results From the PASTA Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Satoshi Suda ◽  
Yasuyuki Iguchi ◽  
Shigeru Fujimoto ◽  
Yoshiki Yagita ◽  
Takayuki Mizunari ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Oral Anticoagulant ◽  
Hematoma Expansion ◽  
Direct Oral Anticoagulant ◽  
Registry Study ◽  
Stroke Patients ◽  
Hematoma Volume ◽  
Imaging Characteristics ◽  
Warfarin Treatment ◽  
Patient Enrollment

Background and Purpose: The characteristics of direct oral anticoagulant (DOAC)-related intracerebral hemorrhage (ICH) have not been fully clarified. We planned to recruit patients prospectively and to investigate the characteristics and outcomes in patients with ICH receiving direct oral anticoagulant (DOAC) and warfarin treatment. Methods: The prospective analysis of stroke patients taking anticoagulants (PASTA) registry study is an observational, multicenter, prospective registry of stroke patients receiving OAC. Patient enrollment started in April 2016 at 25 tertiary centers across Japan. We compared imaging, clinical characteristics, and discharge modified Rankin Scale (mRS) between DOAC- and warfarin-related ICH patients with atrial fibrillation (AF). Results: A total of 154 patients (51 women; median age 77 [quartiles 69-87] years) were analyzed. Of these, 111 patients (72%) received prior DOAC treatment and the remaining 43 (28%) received prior warfarin treatment (Fig. A, B and C). There were no relevant differences in clinical and hematoma characteristics between DOAC- and warfarin-related ICH regarding baseline hematoma volume (median [quartiles]: DOAC, 11 [5-23] mL vs. warfarin, 12 [5-30] mL; P =0.95), rate of hematoma expansion (DOAC, 12/111 [11%] vs. warfarin, 4/43 [9%]; P =0.80), rate of subcortical hemorrhage (DOAC, 15/111 [11%] vs. warfarin, 10/43 [9%]; P =0.80) and the proportion of patients with unfavorable outcome (mRS, 4-6: DOAC 76/108 [70%] vs. warfarin 23/38 [61%]; P =0.26). Cerebral microbleeds (CMBs) were detected more frequently in DOAC group than in warfarin (47/76 [62%] vs. 11/32 [34%]; P <0.01). Subgroup analyses showed that type of DOAC agent did not result in relevant differences in imaging characteristics or outcome (Fig. D and E). Conclusions: Our results showed that there were no significant differences in hematoma characteristics and functional outcome among AF patients with DOAC- or warfarin-related ICH.

Abstract 3543: Imaging Correlates of Early Neurologic Deterioration among Patients with Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
Adrian M Burgos ◽  
David S Liebeskind ◽  
Sidney Starkman ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Hematoma Volume ◽  
Phase 3 ◽  
Neurologic Deterioration ◽  
Irregular Border ◽  
History Of ◽  
Initial Imaging ◽  
Fazekas Scale ◽  
Frequent Presence

Background: Early neurologic deterioration (END) occurs commonly in intracerebral hemorrhage (ICH) patients being transported by EMS ambulances, but the imaging correlates of END have not been previously delineated. Methods: We analyzed consecutive ICH patients in the Field Administration of Stroke Therapy - Magnesium (FAST-MAG) Trial, a phase 3, multicenter of paramedic-initiated magnesium sulfate vs. placebo for stroke patients presenting within 2 hours of symptom onset. END was defined as a 2-point or greater decrease in the Glasgow Coma Scale (GCS) from paramedic evaluation to ED evaluation. Baseline imaging studies were independently analyzed by 2 neurologists for ICH location, volume, presence of intraventricular hemorrhage (IVH), heterogeneity (defined as >20 point difference in Hounsfield units), irregular hematoma borders, multilobulated appearance, and substantial edema (defined as >0.5cm thickness). Leukoaraiosis was graded using the Fazekas scale for periventricular and deep white matter changes (0-3 for each). Results: Among 127 patients, mean age was 66 (SD 14) years, 34% were women, 35% were Hispanic ethnicity, 83% white, and 84% had a history of HTN. Patients were evaluated by paramedics a median of 23 (IQR 16, 39) minutes after last known well time (LKWT). At that time, the median GCS was 15 (IQR 15-15) and mean SBP/DBP was 177/95 (SD 34/22). Initial post-arrival brain imaging was performed a median of 94 (IQR 77, 117) min after LKWT. Post-arrival study GCS scores were obtained at a median of 108 (IQR 70, 144) min after LWKT. Early neurologic deterioration occurred in 37 (29%) patients. Among these patients, median first ED GCS was 3 (IQR 3-10). On first imaging, compared with neurologically stable patients, END patients had larger hematoma volume (33 cc v 16 cc, p<0.0001), and more frequent presence of intraventricular extension (45% v 20%, p=0.003), midline shift (58% v 22%), substantial edema (54% v 26%, p=0.038), heterogeneous density (50% v 22%, p=0.006), multilobulated appearance (44% v 18%, p=0.002), and irregular border (39% v 14%, p=0.010). Leukoaraiosis and cortical v subcortical location did not affect rates of END. In multivariate analysis, hematoma volume and presence of IVH were imaging findings independently associated with early neurologic deterioration. Conclusions: About 3 in 10 patients with hyperacute ICH neurologically deteriorate during the prehospital and early emergency department course, often before neuroimaging is obtained. Patients with early neurologic deterioration have larger hematoma volume and occurrence of IVH on initial imaging. These findings suggest hematoma expansion prior to ED arrival drives early neurologic deterioration in ICH and emphasize the need for prehospital interventions.

Dexamethasone in Patients with Spontaneous Intracerebral Hemorrhage: An Updated Meta-Analysis

2020 ◽  
Vol 49 (5) ◽  
pp. 495-502
Author(s):  
Stephanie Wintzer ◽  
Josef Georg Heckmann ◽  
Hagen B. Huttner ◽  
Stefan Schwab
Keyword(s):  
Clinical Trials ◽  
High Risk ◽  
Intracerebral Hemorrhage ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Control Groups ◽  
Language Data ◽  
Negative Effect

<b><i>Background:</i></b> Spontaneous intracerebral hemorrhage (ICH) is a frequent cerebrovascular disorder and still associated with high mortality and poor clinical outcomes. The purpose of this review was to update a 15-year-old former meta-analysis on randomized clinical trials (RCTs) addressing the question of whether ICH patients treated with dexamethasone have better outcomes than controls. <b><i>Methods:</i></b> The electronic databases PubMed, SCOPUS, and Cochrane as well as web platforms on current clinical trials were searched for the years 1970–2020 without constriction on language. Data were extracted and outcomes were pooled for conventional and cumulative meta-analysis using a commercial software program (www.Meta-Analysis.com). <b><i>Results:</i></b> Finally, 7 RCTs were identified and analyzed including 248 participants in the dexamethasone groups and 242 in the control groups. Five studies showed a high risk of bias. The overall relative risk (RR) for death was 1.32 (95% confidence interval [CI] 0.99–1.76; <i>p</i> = 0.06) and did not differ significantly between the 2 groups. After exclusion of studies with high risk of bias, the RR for death was 1.37 (95% CI 0.54–3.42; <i>p</i> = 0.51). The RR for poor outcome did not differ significantly between the 2 groups analyzed for all included studies (RR = 0.69; 95% CI 0.47–1; <i>p</i> = 0.05) and after exclusion of studies with high risk of bias (RR = 0.7; 95% CI 0.45–1.08; <i>p</i> = 0.11). The RR for complications did not differ significantly including all studies (RR = 1.29; 95% CI 0.77–2.17; <i>p</i> = 0.34) and after exclusion of studies with high risk of bias (RR = 1.27; 95% CI 0.18–8.89; <i>p</i> = 0.81). The cumulative statistics delivered no other results; however, it pointed out fewer complications over time in the dexamethasone group. <b><i>Conclusion:</i></b> Clear evidence of a beneficial or negative effect of dexamethasone is still lacking. Modern RCTs or observational studies with propensity design are necessary to evaluate the efficacy and safety of treatment with dexamethasone in patients with ICH.

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