Patients
Our study represents a retrospective analysis of 205 patients (62.21% male and 37.79% female patients with an average 68.40±10.70 years of age) with clinical signs of ICH who underwent CT scan of endocranium on Multislice Computed Tomography (MSCT) at the Center of Radiology,
Clinical Center Nis.
Clinical and laboratory parameters were obtained by reviewing the medical histories of the patients. Patients with incorrect examination due to technical reasons,
which included non-cooperation of the patient or insufficient concentration of the contrast agent in the arteries were excluded from this study.
Methods
Head CT examination was performed on the MSCT with 64 rows of detectors.
Slice thickness was 0.625 mm.
MSCT angiography was performed by standard protocol with manual start and slice thickness of 0.625 mm.
Native standard CT protocol for brain examination includes scanning field from C2 vertebral body to vertex,
while MSCT angiography field includes scanning of the aortic arch to the vertex.
The patient is in the supine position with a cannula placed 18-20 G in the cubital artery.
Non-ionic contrast medium is applied in the amount of 50-80 ml with a flow rate of 4-5 ml/s with a double-headed automatic injector.
Scanning parameters include the 120 kv and 300 mA,
with a rotating X-ray tube of 0.33 seconds.
After the software reconstruction of native and angiography CT scans,
the analysis of multiplanar image reconstruction (MPR) was enabled in all three standard projections: coronal,
sagittal and axial.
MSCT angiography was analyzed in 2D and 3D projections on a workstation Advantage Workstation (AW).
The following postprocessing techniques were used:
1.
3D volume rendering (VR),
2.
maximum intensity projection (MIP),
3.
multi-planar reconstruction (MPR).
Volumetric measurement
Volumetric measurements were performed by ABC/2 method and computer semiautomatic method with the volumetric programme on workstation.
a) Method with elliptic equation
One method of intracerebral hematoma volume measuring that was used in this study is the method of applying the formula for the elliptic equation - ABC/2 (Fig.
1).
Measurement was conducted in the program within the Advantage Workstation.
Slices with the largest surface area of hematoma were chosen.
Parameter A is the largest diameter of the hematoma; parameter B is the largest perpendicular diameter in relation to the parameter A and third parameter C is a diameter perpendicular in relation to the parameters A and B in the multiplanar reconstruction.
The values of A,
B and C are multiplied and then divided by two:
V = A x B x C / 2
b) Semiautomated method
Another method for intracerebral hematoma volume measuring is a method with computer software,
where the volume of ICH is measured by a semiautomatic process (Fig.
2).
All images were processed with an image processing software on the AW workstation.
Firstly,
the region of interest (ROI) was chosen by manual marking and selecting,
which is then separated from the environment automatically (software) based on a fixed threshold in Hounsfield's units (HU).
The isolated regions were visually inspected and manually adjusted to ensure that the hemorrhage is shown in all three projections.
Threshold of hematoma is manually adjusted from 40 to 75 HU.
Using a threshold value for distinguishing hematoma and edema of the surrounding brain tissue,
adjacent voxels automatically summarize and thereby provide a volume of hematoma.
Statistical analysis
All values were processed in Microsoft Excel (version 2016) and the Statistical Package for Social Sciences (Windows 10,
IBM SPSS version 23.0).
The results were statistically analyzed using the Mann Whitney U test and Pearson's correlation test; p<0.05 was considered as statistically significant.