Association of Automatically Quantified Total Blood Volume after Aneurysmal Subarachnoid Hemorrhage with Delayed Cerebral Ischemia.
The total amount of extravasated blood after aneurysmal subarachnoid hemorrhage, assessed with semiquantitative methods such as the modified Fisher and Hijdra scales, is known to be a predictor of delayed cerebral ischemia. However, prediction rates of delayed cerebral ischemia are moderate, which may be caused by the rough and observer-dependent blood volume estimation used in the prediction models. We therefore assessed the association between automatically quantified total blood volume on NCCT and delayed cerebral ischemia.



We retrospectively studied clinical and radiologic data of consecutive patients with aneurysmal SAH admitted to 2 academic hospitals between January 2009 and December 2011. Adjusted ORs with associated 95% confidence intervals were calculated for the association between automatically quantified total blood volume on NCCT and delayed cerebral ischemia (clinical, radiologic, and both). The calculations were also performed for the presence of an intraparenchymal hematoma and/or an intraventricular hematoma and clinical delayed cerebral ischemia.



We included 333 patients. The adjusted OR of total blood volume for delayed cerebral ischemia (clinical, radiologic, and both) was 1.02 (95% CI, 1.01-1.03) per milliliter of blood. The adjusted OR for the presence of an intraparenchymal hematoma for clinical delayed cerebral ischemia was 0.47 (95% CI, 0.24-0.95) and of the presence of an intraventricular hematoma, 2.66 (95% CI, 1.37-5.17).



A higher total blood volume measured with our automated quantification method is significantly associated with delayed cerebral ischemia. The results of this study encourage the use of rater-independent quantification methods in future multicenter studies on delayed cerebral ischemia prevention and prediction.
From the Departments of Radiology (I.A.Z, A.M.B., H.A.M, R.v.d.B., C.B.M.) ij.a.zijlstra@amc.uva.nl.
I A
0000-0002-2089-1918
IA
Zijlstra
Neurology (C.S.G., G.J.R.), University Medical Center Utrecht, Utrecht, the Netherlands.
C S
0000-0002-4756-9216
CS
Gathier
From the Departments of Radiology (I.A.Z, A.M.B., H.A.M, R.v.d.B., C.B.M.) Biomedical Engineering and Physics (A.M.B., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands Department of Robotics and Mechatronics (A.M.B.), University of Twente, Enschede, the Netherlands.
A M
0000-0002-3950-1561
AM
Boers
From the Departments of Radiology (I.A.Z, A.M.B., H.A.M, R.v.d.B., C.B.M.) Biomedical Engineering and Physics (A.M.B., H.A.M.), Academic Medical Center, Amsterdam, the Netherlands.
H A
0000-0002-1414-6313
HA
Marquering
Intensive Care (A.J.S.).
A J
0000-0003-0804-8378
AJ
Slooter
Departments of Radiology (B.-K.V.).
B K
0000-0002-2542-9474
BK
Velthuis
Neurosurgery (B.A.C., D.V.).
B A
0000-0003-3277-031X
BA
Coert
Neurosurgery (B.A.C., D.V.).
D
0000-0002-9212-5470
D
Verbaan
From the Departments of Radiology (I.A.Z, A.M.B., H.A.M, R.v.d.B., C.B.M.).
R
0000-0002-8791-8791
R
van den Berg
Neurology (C.S.G., G.J.R.), University Medical Center Utrecht, Utrecht, the Netherlands.
G J
0000-0001-8930-3953
GJ
Rinkel
From the Departments of Radiology (I.A.Z, A.M.B., H.A.M, R.v.d.B., C.B.M.).
C B
0000-0002-7600-9568
CB
Majoie
D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging*; D001810:Blood Volume; D002545:Brain Ischemia / Q000209:etiology*; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology