A retrospective validation of cone-beam CT for assessing size of intraparenchymal hemorrhage Sabrina
1 Begley ,
Timothy White
1Donald
2 MD ,
Sex male 6 female 11 Hemorrhage etiology AVM 10 aneurysm 3 hypertensive 2 unknown 2
Hemorrhage location left side right unspecified deep cerebellar region of brain lobar unspecified
6 6 5 3 2 9 3
ABC/2 Volume Correlation 120
R² = 0.9638
CONE BEAM CT VOLUME
100
Left: IPH on conventional CT
80
40
0 0
20
40 60 80 CONVENTIONAL CT VOLUME
100
120
Segmentation Volume Correlation 100
R² = 0.9985
90 80 CONE BEAM CT VOLUME
Right: IPH on cone-beam CT
Conclusions
60
20
The aim of the study is to validate the accuracy of a 6s Dyna cone-beam CT to assess the size of intraparenchymal hemorrhage, for both supra- and infratentorial hemorrhage, as compared to conventional multi-slice CT.
A retrospective chart review was conducted of patients diagnosed with a stable IPH based on conventional CT. Inclusion criteria • Age 18-85 • Diagnosis of non-traumatic IPH based on conventional CT • Received rotational cone-beam CT during work up Image analysis • CT evaluation by 2 separate reviewers • Hemorrhage volume – as calculated by Grabb formula and segmentation method • Correlation analysis of hemorrhage volume between CT modalities
2 MD
Results
Hypothesis
Methods
Henry Woo
and Barbara Zucker School of Medicine at Hofstra/Northwell 2Department of Neurosurgery, North Shore University Hospital
Background Although only associated with 10-20% of stroke cases, intraparenchymal hemorrhage (IPH) is associated with the highest mortality rate. Rapid diagnosis of hemorrhagic vs ischemic stroke in patients presenting with neurologic symptoms is vital for determining appropriate management. Urgent treatment of IPH is vital given the rapid deterioration of patients and subsequent complications. Non-contrast CT is the gold-standard for IPH diagnosis since it can quickly define many characteristic of an acute ICH, including hematoma volume and expansion, both of which are relevant for patient outcomes. Cone-beam CT has become a popular diagnostic tool available within angiography suites that does not require patient transport to and from another CT scanner. However, the diagnostic accuracy of cone-beam CT has yet to be validated for detection and measurement of either IPH or SAH.
Kevin Shah
2 MD ,
70 60 50 40 30 20
CBCT successfully identified IPH in all cases (N=17) and therefore had 100% diagnostic sensitivity for IPH. Importantly, hemorrhage sizes on CBCT and convention CT also correlated strongly when the volume was calculated by segmentation as well as by the ABC/2 method. This data preliminarily demonstrates that CBCT is both accurate and sufficient for the diagnosis of IPH, albeit in this small dataset. This is critically important for multiple reasons. As sites begin to bypass conventional CT in patients with stroke symptoms, in order to achieve mechanical reperfusion faster, they will rely on CBCT to assess for IPH and early ischemic stroke. However, the efficacy of CBCT to assess for both hemorrhage (including IPH and SAH) and early ischemic stroke has not been demonstrated. This study provides early evidence that CBCT may be accurate in assessing and characterizing IPH.
References
10 0 0
10
20
30
40 50 60 CONVENTIONAL CT VOLUME
70
80
90
100
Fig. 1: Correlation of cone-beam CT vs conventional CT hemorrhage volume measurement, as calculated by the ABC/2 (Grabb) method. R2 = 0.9638 Fig 2: Correlation of cone-beam CT vs conventional CT hemorrhage volume measurement, as calculated by the segmentation method. R2 = 0.9985
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