Abilities of a densitometric analysis of computed tomography images and hemorrhagic parameters to predict outcome favorability in patients with intracerebral hemorrhage

Hakseung Kim, Xiaoke Yang, Young Hun Choi, Byung C. Yoon, Keewon Kim, Dong-Joo Kim

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


BACKGROUND: Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability. OBJECTIVE: To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes. METHODS: Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted. RESULTS: The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes. CONCLUSION: Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.

Original languageEnglish
Pages (from-to)226-236
Number of pages11
Issue number2
Publication statusPublished - 2018 Aug

Bibliographical note

Funding Information:
This research was supported by the MSIP (Ministry of Science, ICT and Future Planning), Korea, under the ITRC (Information Technology Research Center) support program (IITP-2017-2016-0-00464) supervised by the IITP (Institute for Information & communications Technology Promotion). The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.

Publisher Copyright:
Copyright © 2017 by the Congress of Neurological Surgeons


  • Computed tomography
  • Critical care
  • Intracerebral hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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