Abstract Number ‐ 246: Quantification of Hemorrhage Volume for Prediction of Complications of Aneurysmal Subarachnoid Hemorrhage

Abstract

Introduction Aneurysmal subarachnoid hemorrhage (aSAH) can lead to life‐threatening complications such as vasospasm and hydrocephalus. The incidence of these events is influenced by the volume of intracranial hemorrhage. The Fisher score is a subjective adjudication of SAH volume. We developed an objective semi‐automated method to quantify the volume of intracranial hemorrhage. Moreover, we evaluated the association of aSAH volume with vasospasm and hydrocephalus. Methods A custom semi‐automated image segmentation algorithm quantifying aSAH volume was implemented in MATLAB. The volume of hemorrhage was retrospectively measured from non‐contrast brain CT scans with Fisher grade ≥ 2. The algorithm utilized region‐growing and 3D k‐means clustering. Performance was validated against the average of two sets of hemorrhage volumes manually measured. These measurements were obtained from two independent raters who selected regions of interest spanning areas of hemorrhage. The association between blood volume and clinical outcome (hydrocephalus or vasospasm) was evaluated using ROC analysis. Results Fifty‐seven patients were included in this study and 10 patients were used for validation of our method. The ICC between raters for manual measurements of hemorrhage in the validation group was 0.988 (CI: (0.911, 0.997), p < 0.001). Validation of semi‐automated versus manual methods resulted in an ICC of 0.961 (CI: (0.756, 0.991), p < 0.001). Bland‐Altman analysis revealed that the algorithm slightly underestimated blood volume (mean difference = ‐4.11 mL). Hemorrhage volume discriminated for the development of vasospasm (AUC = 0.781) and hydrocephalus (AUC = 0.776). Conclusions Volume of hemorrhage is a key factor that influences the incidence of complications in aSAH. We developed and validated a semi‐automated algorithm for quantifying the volume of aSAH. Vasospasm and hydrocephalus were associated with greater amounts of intracranial blood. Objective measurements of aSAH volume can aid in adjudicating risk of complications among patients with aSAH.