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Computer-Assisted Measurement of Traumatic Brain Hemorrhage Volume Is More Predictive of Functional Outcome and Mortality than Standard ABC/2 Method: An Analysis of Computed Tomography Imaging Data from the Progesterone for Traumatic Brain Injury Experimental Clinical Treatment Phase-III Trial
Journal of Neurotrauma ( IF 4.2 ) Pub Date : 2021-02-19 , DOI: 10.1089/neu.2020.7209
Owen P Leary 1, 2 , Lisa H Merck 1, 2, 3, 4 , Sharon D Yeatts 5 , Ian Pan 2 , David D Liu 1 , Tyler J Harder 2, 3 , Stefan Jung 2, 3 , Scott Collins 2 , Maria Braileanu 6 , Ziya L Gokaslan 1 , Jason W Allen 6 , David W Wright 7 , Derek Merck 2, 4
Affiliation  

Hemorrhage volume is an important variable in emergently assessing traumatic brain injury (TBI). The most widely used method for rapid volume estimation is ABC/2, a simple algorithm that approximates lesion geometry as perfectly ellipsoid. The relative prognostic value of volume measurement based on more precise hematoma topology remains unknown. In this study, we compare volume measurements obtained using ABC/2 versus computer-assisted volumetry (CAV) for both intra- and extra-axial traumatic hemorrhages, and then quantify the association of measurements using both methods with patient outcome following moderate to severe TBI. A total of 517 computer tomography (CT) scans acquired during the Progesterone for Traumatic Brain Injury Experimental Clinical Treatment Phase-III (ProTECTIII) multi-center trial were retrospectively reviewed. Lesion volumes were measured using ABC/2 and CAV. Agreement between methods was tested using Bland–Altman analysis. Relationship of volume measurements with 6-month mortality, Extended Glasgow Outcome Scale (GOS-E), and Disability Rating Scale (DRS) were assessed using linear regression and area under the curve (AUC) analysis. In subdural hematoma (SDH) >50cm3, ABC/2 and CAV produce significantly different volume measurements (p < 0.0001), although the difference was not significant for smaller SDH or intra-axial lesions. The disparity between ABC/2 and CAV measurements varied significantly with hematoma size for both intra- and extra-axial lesions (p < 0.0001). Across all lesions, volume was significantly associated with outcome using either method (p < 0.001), but CAV measurement was a significantly better predictor of outcome than ABC/2 estimation for SDH. Among large traumatic SDH, ABC/2 significantly overestimates lesion volume compared with measurement based on precise bleed topology. CAV also offers significantly better prediction of patient functional outcofme and mortality.

中文翻译:

计算机辅助测量创伤性脑出血量比标准 ABC/2 方法更能预测功能结果和死亡率:对创伤性脑损伤实验性临床治疗 III 期试验中黄体酮的计算机断层扫描成像数据进行分析

出血量是紧急评估创伤性脑损伤(TBI)的重要变量。最广泛使用的快速体积估计方法是 ABC/2,这是一种将病变几何形状近似为完美椭球体的简单算法。基于更精确的血肿拓扑的体积测量的相对预后价值仍然未知。在这项研究中,我们比较了使用 ABC/2 与计算机辅助容量法 (CAV) 获得的轴内和轴外创伤性出血的体积测量值,然后量化使用这两种方法获得的测量值与中度至重度 TBI 后患者结果的关联。回顾性审查了黄体酮用于创伤性脑损伤实验性临床治疗 III 期 (ProTECTIII) 多中心试验期间获得的总共 517 幅计算机断层扫描 (CT) 扫描结果。使用 ABC/2 和 CAV 测量病变体积。使用 Bland-Altman 分析测试方法之间的一致性。使用线性回归和曲线下面积 (AUC) 分析评估体积测量值与 6 个月死亡率、扩展格拉斯哥结果量表 (GOS-E) 和残疾评定量表 (DRS) 的关系。在硬膜下血肿 (SDH) >50cm 3中,ABC/2 和 CAV 产生显着不同的体积测量值 ( p  < 0.0001),尽管对于较小的 SDH 或轴内病变,差异并不显着。ABC/2 和 CAV 测量值之间的差异随着轴内和轴外病变的血肿大小而显着变化 ( p  < 0.0001)。在所有病变中,体积与使用任一方法的结果显着相关 ( p  < 0.001),但 CAV 测量是比 SDH 的 ABC/2 估计更好的结果预测因子。在大型创伤性 SDH 中,与基于精确出血拓扑的测量相比,ABC/2 显着高估了病变体积。CAV 还可以更好地预测患者的功能结果和死亡率。
更新日期:2021-03-02
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