| Objective:To assess the absorption and expansion of intracerebral hemorrhage after treatment with hemotoma volume measurement software,in order to give help to the clinical treatment and prognosis. Method:1 Clinical data1.1 Data collection147 cases diagnosed as intracerebral hemorrhage were selected in the Second Hospital of Hebei Medical University, from February 2007 to July 2008, including 80 male cases and 67 female cases, and the mean age was 57.08±12.37 years old with a range of 39 ~ 92 years old. The first CT examination was performed in 6 hours after onset. All patients underwent two or more CT examinations.Traumatic brain injury, aneurysm, arteriovenous malformation, tumor, anticoagulant therapy and other causes of bleeding were excluded.1.2 The conservative treatment groupContinued bleeding: 29 cases;hematoma absorption: 83 cases; There were 112 cases in the conservative treatment group: thalamic, 26 cases; basal ganglia, 59 cases; lobar, 19 cases; cerebellar, 8 cases; round or kidney-shape hematoma, 64 cases, irregular shape, 48 cases; long-term alcohol consumption, (the average daily liquor> 250g more than six months) and history of chronic liver disease were respectively 23 and 18 cases.1.3 The surgery groupAfter operation, the hematoma rebleeded in 4 cases, the hematoma was absorbed in 31 cases. The volume of hematoma was from 38 to 102ml. After admission, the drilling skull drainage treatment was performed in 6 ~ 48 hours after onset. In6 hours, 5 cases, 6 ~ 24 hours, 22 cases, 25 ~ 48 hours, 8 cases.2 Scanning MethodCT scanning was performed with GE Light speed 16, and axial scan was parallel to the OM line routinely. Spiral scan,rotational speed: 0.8s,detector: 16X1.25,slice thickness:10mm,voltage: 120kV, current flow: 250mA,pitch: 0.938:1,the speed of the movement of bed: 18.75mm,collimating apparatus width: 20mm.3 Methods of hematoma volume measurement3.1 The introduction of hematoma volume measurement softwareThis software was independently developed by the GE company and for the first time applied for research. The foundation was that CT threshold value determined the scope of hematoma and then pseudo-color stained. There were three methods to measure the hematoma: Auto / Bi-Threshold/Manual which were easy to operate and its measurement was accurate, so it was suitable for imaging professionals and clinicians to measure the volume of hematoma.3.2 Hematoma volume measurementAfter scanning, the images were sent to GE workstation and copied in the format of DICOM on CD-ROM, and then opened hematoma volume measurement software, identified the pathient's images, and finally hematoma was pseudo-color stained and measured. In the conservatively treated group, the volume of hematoma was measured after the first scan, at the first day, the third day and the seventh day, while in the surgery group, after the first scan, at the first time after operation, at the first day ,the third day and the seventh day after operation.3.3 The diagnostic criteria of Hematoma volume expansion According to the Brott criteria, if the volume of hematoma was expanded by more than 33%, it could be diagnosed as expansion.4 The measurement of CT value and diameter4.1 The measurements of CT valueThe size of the region of interest was 20 mm2.The CT value was measured at three points: at the central, the edge of the hematoma and the middle zone between them, and then listed the measured data and accquired the CT threshold values and the mean (95% confidence interval) from the first day to the seventh day after intracerebral hemorrhage.The differences of the CT values between the central and edge zone at the first day ,the third day and the seventh day were analyzed.4.2 Diameter measurements The definition of diameter of the intracerebral hemorrhage: On axial CT images longitudinal diameter was defined that the angle between the midline and longitudinal diameter was less than 45 degrees, and the transversal diameter was vertical to it. Respectively both of them were measured at the first day, the third day and the seventh day after intracerebral hemorrhage, and the data of the first day and the seventh day were compared in order to find out the dynamic regulations of morphology after the treatment of intracerebral hemorrhage.5 Treatment methods5.1 The surgery groupBased on CT location scan, avoiding the essential vessels, the nearest distance between the central of hematoma and the saclp was selected. According to the distance between central of hematoma and puncture point, the appropriate needle length was choosed. A plastic drainage tube was put into the central of hematoma for aspiration and flushing. Finally, urokinase (10000 U) was put into the hematoma, and the tube was opened after being clipped for 4 hours. According to different situations, washing and application of urokinase were done 1 or 2 times each day until the hematoma was completely or generally removed. The tube was remained for 2 ~ 5 days. The other treatments in the surgery group were the same as in the conservative treatment group.5.2 The conservative treatment groupAll in this group were treated as intracerebral hemorrhage, and being in bed, general supportion, monitoring blood pressure, controlling cerebral edema, nutriment nerve, prevention of complications (infection, stress ulcer, etc.)and so on.6 Statistical methodsChi-square test was used for numeration data. The mixed effect model analysis for duplicate design data was selected in the hematoma absorption measurement. SAS 9.1 statistical software was used.Result:1 The results of conservative treatment group1.1 Hematoma absorption1.1.1 The result of the measured CT values:The threshold values and mean of intracerebral hemorrhage respectively were: at the first day, 53.75~71.29HU, 62.53HU; the second day, 50.33 ~ 70.67HU, 60.50HU; the third day, 48.53~70.75HU, 59.64HU; the fourth day, 45.48~70.73HU, 59.44HU; the fifth day, 44.74~71.00HU, 59.34HU; the sixth day, 43.6~68.93HU, 56.26HU; the seventh day, 43.19~68.83HU, 56.21HU. The change of CT value in the central area and edge area were compared and the statistical analysis result found that CT value in the edge of hematoma changed more quickly than that in the central area, in other words the rate of hematoma absorption in the central area was faster than in the edge area.1.1.2 The result of diameter measurements:The absolute value of the change of longitudinal diameter from the first day to the seventh day was larger than the transversal diameter, but there was no significant statistical difference.1.1.3 The rate of hematoma absorption:The average rates of hematoma absorption separately were: 9.31%, 16.04%, 28.05%.The rates decreased according to the original amount of bleeding, and at the first day, the third day and the seventh day after intracerebral hemorrhage the rates were respectively: 15.07%, 11.44%, 8.51%; 20.82%, 18.07%, 15.34%; 49.01%, 45.22%, 41.88%.1.2 Hematoma expansionThe rate and time: hematoma expansion, 29 cases(25.9%), and 23 cases of them(79.31%) happened at the first 24 hours, the left 6 cases happened in the following 7days (including the seventh day). The shape of hematoma: subrotund and nephroid, 15.62% (10/64), while unregularity, 39.58% (19/48). The position of hematoma: thalamus, 12 cases(46%), basal ganglia, 14 cases(23.72%), brain lobe 2 cases(10.52%), cerebellum, 1 cases(12.5%). The rate of hematoma expansion in thalamus+basal ganglia was 30.59% (26/85), which was higher than that in other positions(brain lobe+ cerebellum) with 11.11% (3/27). Long-term alcohol consumption, (the average daily liquor> 250g, more than six months) and history of chronic liver disease: hematoma enlargement group: 34.48% (10/29), 27.58% (8/29).2 The results of drilling skull drainage group The amout of bleeding was 38~102ml, the hematoma reduced by 30.19% at the first day after operation. The absorption rates of residual hematoma after operation were 34.11% at the third day and 58.38% at the seventh day. 2.2 The rebleeding after operation:11.42%,including 3 cases in 6-12h, 1 cases in 12-24h.3 Statistical resultsTwo sample t test was applied in the analysis of the changes of the CT values and diameter of hematoma. The results showed that the differences of CT values at different parts had statistical significance while the changes between the longitudinal diameter and the transversal diameter of hematoma had no statistical significance.Chi-square test was used in the analysis of relevant factors of hematoma expansion in conservative treatment group, and the results showed that the shape and position of hematoma, long-term alcohol consumption and history of chronic liver disease had significant differences between the hematoma expansion group and non- expansion group(P<0.05). The mixed effect model analysis for duplicate design data was used in the analysis of the hematoma absorption rate. Statistical software was SAS9.1. Statistical analysis showed that at different time points, different groups, the hematoma absorption rates were significantly different. There were interactions in the treatment groups and time points, that was, the hematoma absorption rates were different between conservative treatment and drilling skull drainage treatment, and the hematoma absorption rates of different treatment groups at different time points were different.Conclusion:1 The remarkable character of this hematoma volume measurement software is conformity. Besides it is fast, convenient and practical, and is helpful for the assessment of hematoma in clinical, so it is suitable for extensive popularization.2 The mean CT values of intracerebral hemorrhage is gradually decreased from the first day to the seventh day, while the scope of the threshold CT values is gradually increased.3. The hematoma absorption in the edge is faster than that in the central.4. The absolute value of the change of longitudinal diameter of hematoma from the first day to the seventh day was larger than the transversal diameter, but there was no significant statistical difference.5 The hematoma absorption rate is associated with the first amount of bleeding, and it is quickly absorbed if the amount of bleeding is small, otherwise, opposite.6 The hematoma absorption rate with conservative treatment is gradually increasing at the first, third and seventh day.7 The hematoma absorption rate with the drilling skull drainage treatment is gradually increasing at the first, third and seventh day.8 When the volume of hemotoma is more than 30ml, the residual hematoma cured after the drilling skull drainage treatment would be absorbed quicklier than conservative treatment if the patient could tolerate the operation.9 The incidence of the expansion of hematoma is related to bleeding time, bleeding site, the irregular shapes of hematomas,long-term alcohol consumption and chronic hepatic disease.
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