The ABCs of Subarachnoid Hemorrhage Blood Volume Measurement: A Simplified Quantitative Method Predicts Outcomes and Delayed Cerebral Ischemia

J Am Heart Assoc. 2024 Oct 15;13(20):e032195. doi: 10.1161/JAHA.123.032195. Epub 2024 Oct 11.

Abstract

Background: We developed a simplified ABC/2-derived method to estimate total subarachnoid hemorrhage volume (SAHV) on noncontrast computed tomography in patients with aneurysmal SAH and compared the clinical and radiographic outcomes.

Methods and results: In this retrospective observational cohort study, we analyzed 277 patients with SAH admitted to our Comprehensive Stroke Center between 2012 and 2022. We derived a mathematical model (model 1) by measuring SAH basal cisternal blood volume using an ABC/2-derived ellipsoid formula (A=width/thickness, B=length, C=vertical extension) on head noncontrast computed tomography in 5 major SAH cisternal compartments. We compared model 1 against a manual segmentation method (model 2) on noncontrast computed tomography. Data were analyzed using logistic regression analysis, t test, receiver operator characteristic curves, and area under the curve analysis. There was no significant difference in cisternal SAHV analysis between the 2 models (P=0.14). Mean SAHV by the simplified method was 7.0 mL (95% CI, 5.89-8.09) for good outcome and 16.6 mL (95% CI, 13.49-19.77) for poor outcome. Patients with delayed cerebral ischemia had higher SAHV, with a cutoff value of 10 mL.

Conclusions: Our simplified ABC/2-derived method to estimate SAHV is comparable to manual segmentation and can be performed in low-resource settings. Higher total SAHV was associated with worse outcomes and higher risk of delayed cerebral ischemia. A potential dose-response relationship was observed, with SAHV >10 mL predicting worse outcomes and higher risk of DCI.

Keywords: ABC/2‐derived volumetrics; aneurysmal subarachnoid hemorrhage; clinical outcomes; delayed cerebral ischemia; subarachnoid hemorrhage volume.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Blood Volume
  • Blood Volume Determination / methods
  • Brain Ischemia* / diagnostic imaging
  • Brain Ischemia* / etiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Subarachnoid Hemorrhage* / diagnosis
  • Subarachnoid Hemorrhage* / diagnostic imaging
  • Subarachnoid Hemorrhage* / etiology
  • Time Factors
  • Tomography, X-Ray Computed