Hematoma volume calculation in ICH textbook based
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AHA spontaneous intracerebral hemorrhage guideline hematoma volume ABC/2 CT
For intracerebral hemorrhage (ICH) on non-contrast CT, hematoma volume is usually estimated by the ABC/2 method:
[
\text{Hematoma volume (mL or cm}^3\text{)}=\frac{A \times B \times C}{2}
]
- A: greatest hematoma diameter on the axial CT slice with the largest bleed, in cm
- B: greatest diameter perpendicular to A on that same slice, in cm
- C: total craniocaudal depth, calculated as:
[ \text{number of CT slices containing hematoma} \times \text{slice thickness (cm)} ] If slice thickness varies, add the thicknesses of all involved slices.
Example:
A = 5 cm, B = 3 cm, and the hematoma spans 4 slices of 0.5 cm thickness:
A = 5 cm, B = 3 cm, and the hematoma spans 4 slices of 0.5 cm thickness:
[
C=4 \times 0.5=2\text{ cm}
]
[
\text{Volume}=\frac{5 \times 3 \times 2}{2}=15\text{ mL}
]
This approximates the hematoma as an ellipsoid. It is fast and widely used clinically, but can be less accurate for irregular, multilobulated, or very large hematomas. The 2022 AHA/ASA ICH guideline states that ICH volume is often estimated in practice using ABC/2.
A common prognostic cutoff is ICH volume ≥30 mL, which scores 1 point in the ICH Score. Goldman-Cecil Medicine describes this cutoff in its ICH score table.
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