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Software output from semi-automated planimetry can underestimate intracerebral haemorrhage and peri-haematomal oedema volumes by up to 41 %

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Introduction

Haematoma and oedema size determines outcome after intracerebral haemorrhage (ICH), with each added 10 % volume increasing mortality by 5 %. We assessed the reliability of semi-automated computed tomography planimetry using Analyze and Osirix softwares.

Methods

We randomly selected 100 scans from 1329 ICH patients from two centres. We used Hounsfield Unit thresholds of 5–33 for oedema and 44–100 for ICH. Three raters segmented all scans using both softwares and 20 scans repeated for intra-rater reliability and segmentation timing. Volumes reported by Analyze and Osirix were compared to volume estimates calculated using the best practice method, taking effective individual slice thickness, i.e. voxel depth, into account.

Results

There was excellent overall inter-rater, intra-rater and inter-software reliability, all intraclass correlation coefficients >0.918. Analyze and Osirix produced similar haematoma (mean difference: Analyze − Osirix = 1.5 ± 5.2 mL, 6 %, p ≤ 0.001) and oedema volumes (−0.6 ± 12.6 mL, −3 %, p = 0.377). Compared to a best practice approach to volume calculation, the automated haematoma volume output was 2.6 mL (−11 %) too small with Analyze and 4.0 mL (−18 %) too small with Osirix, whilst the oedema volumes were 2.5 mL (−12 %) and 5.5 mL (−25 %) too small, correspondingly. In scans with variable slice thickness, the volume underestimations were larger, −29%/−36 % for ICH and −29 %/−41 % for oedema. Mean segmentation times were 6:53 ± 4:02 min with Analyze and 9:06 ± 5:24 min with Osirix (p < 0.001).

Conclusion

Our results demonstrate that the method used to determine voxel depth can influence the final volume output markedly. Results of clinical and collaborative studies need to be considered in the context of these methodological differences.

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Acknowledgments

TYW is supported by grants from the Neurological Foundation of New Zealand and the Royal Melbourne Hospital Neuroscience Foundation. AP-J is supported by a National Institute for Health Research Clinician Scientist Award. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health. AM is supported by grants from National Health and Medical Research Council (Australia), the Academy of Finland and the Finnish Medical Foundation.

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Authors and Affiliations

  1. Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia

    Teddy Y. Wu, Nawaf Yassi, Bruce C. V. Campbell, Stephen M Davis & Atte Meretoja

  2. Centre for Vascular and Stroke Research, Manchester Academic Health Sciences Centre, Salford Royal Hospital Trust, University of Manchester, Manchester, UK

    Oluwaseun Sobowale, Robert Hurford & Adrian R Parry-Jones

  3. Department of Radiology, the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia

    Gagan Sharma & Patricia M Desmond

  4. Stanford Stroke Center, Stanford University, Palo Alto, CA, USA

    Søren Christensen

  5. Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden

    Turgut Tatlisumak

  6. Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Turgut Tatlisumak

  7. Department of Neurology, Helsinki University Hospital, PK Admin, Haartmaninkatu 4E, P.O. Box 220, 00029 HUS, Helsinki, Finland

    Atte Meretoja

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  1. Teddy Y. Wu
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Corresponding author

Correspondence to Atte Meretoja.

Ethics declarations

We declare that all human and animal studies have been approved by the Helsinki University Hospital and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that given no identifiable patient data is presented, Helsinki University Hospital waived informed consent for this observational registry study.

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We declare that we have no conflict of interest.

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Supplementary Table

Technical code of the workflow for volume calculation (DOCX 71 kb)

Supplementary Fig. 1

Effect of gantry tilt on voxel depth calculation. Two representative image slices of 7.5 mm thickness with a gantry tilt of 16.5°. Slice thickness is derived from midpoint to midpoint distance. a) Gantry tilt was not adjusted when image position patient (DICOM header, 0020, 0032) coordinates were used resulting in an inter-slice distance of 7.82 mm, solid line. B) Gantry tilt was adjusted using our in-house method and the inter-slice distance was 7.5 mm, dotted line (PDF 729 kb)

Supplementary Fig. 2

Bland–Altman plots for oedema segmentation. Inter-rater Bland–Altman plots with intraclass correlation coefficients (ICC) for semi-automated planimetry of oedema segmentation on Analyze and Osirix. The solid line represents mean volume difference between raters and the dotted lines are the limits of 95 % agreement. The outliers all had significant white matter changes. (PDF 320 kb)

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Wu, T.Y., Sobowale, O., Hurford, R. et al. Software output from semi-automated planimetry can underestimate intracerebral haemorrhage and peri-haematomal oedema volumes by up to 41 %. Neuroradiology 58, 867–876 (2016). https://doi.org/10.1007/s00234-016-1720-z

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  • DOI: https://doi.org/10.1007/s00234-016-1720-z

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