ICH Volume Calculator

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Round or ellipsoid bleeds use the divider 2; irregular, separated, or multinodular bleeds use the more conservative divider 3, as the ABC/2 method overestimates volume for non-ellipsoid shapes.
CT measurements are typically reported in mm on the PACS workstation.
The longest diameter of the hemorrhage on the axial CT slice that shows the largest area of bleeding.
mm
The diameter perpendicular to A, measured on the same CT slice as A.
mm
You can measure the craniocaudal height directly on the scan, or calculate it from the number of axial slices containing hemorrhage multiplied by the slice thickness.
The craniocaudal (head-to-foot) height of the hemorrhage in the same units as A and B.
mm
ICH VolumeModerate
18mL

Estimated hematoma volume using the ABC/2 or ABC/3 method

Volume (cm³)18cm³
C dimension used30mm
Volume categoryModerate
Formula divider2
18 mL
Small<10Moderate10-30Large30-60Very Large60+

Moderate ICH: 18.0 mL estimated volume.

  • A volume of 18.0 mL is below the 30 mL threshold used in the ICH Score. Smaller bleeds still require close monitoring for hematoma expansion.
  • The ABC/2 divider was applied for an ellipsoid or round hemorrhage. If the bleed is irregular or multinodular, switch to ABC/3 for a more accurate estimate.
  • Hematoma volume is a powerful independent predictor of 30-day mortality and functional outcome. Up to 40% of patients expand their hematoma within 24 hours, so serial imaging is recommended.

Next stepMonitor for hematoma expansion with repeat CT at 6-24 hours if neurological deterioration occurs. Strict blood pressure control (target SBP <140 mmHg) reduces expansion risk.

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