ICH Volume Calculator
Estimate intracerebral hemorrhage volume from CT dimensions using the ABC2 formula with ellipsoid or irregular shape correction.
Estimating ICH Volume on CT
Intracerebral hemorrhage (ICH) volume on non-contrast CT helps predict outcome and feeds into the ICH score. The ABC2 formula estimates volume from maximum length (A), perpendicular width (B), slice thickness (C), and the number of slices showing hemorrhage. Volume in milliliters equals cubic centimeters for blood. After calculating volume, apply the ICH Score Calculator for mortality risk stratification.
The ABC2 Formula
Volume (mL) = A × B × C × number of slices ÷ shape factor. Length and width are measured in centimeters on the largest hemorrhage cross-section. Slice thickness can be entered in cm or mm. For round or ellipsoid bleeds, divide by 2. For irregular, separated, or multinodular bleeds, divide by 3 per the original Kothari method.
Volume Thresholds and Prognosis
Volumes of 30 mL or more add 1 point on the ICH score. Hemorrhages of 50 mL or more are associated with poor prognosis in many series. Volumes of 60 mL or more carry particularly high mortality and may influence surgical candidacy discussions. Always interpret imaging findings in clinical context alongside GCS, age, and bleed location.
Frequently Asked Questions
What measurements does the ABC2 method need?
Maximum hemorrhage length (A) and width (B) in centimeters, CT slice thickness (C), the count of slices containing hemorrhage, and whether the shape is ellipsoid (÷ 2) or irregular (÷ 3).
When should I divide by 2 versus 3?
Use divide by 2 for round or ellipsoid hematomas. Use divide by 3 for irregular, separated, or multinodular hemorrhages that do not approximate an ellipse.
Why is 30 mL a important cutoff?
ICH volume of 30 mL or more contributes 1 point on the ICH score and correlates with higher mortality and worse functional outcomes in multiple outcome studies.
Are mL and cm³ the same for blood volume?
Yes. One milliliter of blood equals one cubic centimeter. CT volume estimates are reported interchangeably as mL or cm³.
How accurate is ABC2 compared to planimetry?
ABC2 is a fast bedside estimate validated against planimetric volume. It is less precise for highly irregular bleeds but widely used in emergency and research settings for consistent stratification.
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