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BMC Nurs
BMC Nurs
BMC Nursing
1472-6955
BioMed Central London

39256738
2323
10.1186/s12912-024-02323-y
Research
Assessment of nurse practitioners’ capacity of using the ABC/2 formula for intracranial lesion volume measurement
Hu Tingting 12
Yan Qiong 3
Wang Xianke 12
Yue Gefen 12
Yu Peng 12
Cheng Xiangwei xwcheng@hust.edu.cn

2
Yan Pengfei yanpfei@hust.edu.cn

1
1 grid.33199.31 0000 0004 0368 7223 Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
2 grid.33199.31 0000 0004 0368 7223 Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022 Hubei China
3 https://ror.org/02mh8wx89 grid.265021.2 0000 0000 9792 1228 Department of Surgery Center, NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134 China
11 9 2024
11 9 2024
2024
23 64123 1 2024
3 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

This study investigates the precision of nurse practitioners (NPs) in measuring intracranial lesion volumes using the ABC/2 method, a simple yet widely used technique in neurosurgical practices. Amidst physician workforce shortages, the role of NPs in clinical practice, including specialized tasks like lesion volume estimation, is gaining importance.

Methods

We conducted a retrospective study involving patients treated for intracranial meningiomas. NPs estimated tumor volumes using the ABC/2 method, which was then compared with automated ABC/2 estimations considered as the gold standard. Statistical analyses, including paired sample t-tests, Bland-Altman analysis, and Intraclass Correlation Coefficient (ICC) analysis, were employed to assess measurement accuracy and consistency.

Results

Among the 265 meningioma patients included, NPs measured the average tumor volume as 36.95 ml, generally underestimating it compared to the 39.57 ml average obtained by the automated ABC/2 method. This underestimation, however, was clinically modest, indicated by an average percentage difference of 6.59% and a Cohen’s d value of 0.08. Consistency in measurements, assessed using Bland-Altman and ICC analyses, demonstrated a high level of agreement between NPs measurements and the automated method. Additionally, no significant differences in measurement accuracy were observed either among different NPs or across NPs with varying levels of work experience.

Conclusions

Nurse practitioners can effectively employ the ABC/2 method for estimating intracranial lesion volumes with reasonable accuracy and consistency, irrespective of their work experience. This finding is pivotal in enhancing the role of NPs in neurosurgical practices and could be significant in alleviating the strain caused by the global shortage of physicians. Future research may explore extending NPs’ roles in other clinical diagnostic and therapeutic tasks.

Keywords

Intracranial lesion
Volume measurement
Nurse training
Competence assessment
Neurosurgical patient care
http://dx.doi.org/10.13039/501100010580 Department of Science and Technology, Hubei Provincial People’s Government 2021CFB593 issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcBackground

The ABC/2 formula, a streamlined tool for lesion volume estimation, has been widely accepted in neurosurgical practices. Despite being theoretically less precise than the planimetry method, it continues to be favored clinically due to its ease of use and reasonable accuracy. This method was initially utilized for measuring the volume of cerebral hematomas [1]. However, its utility has gradually expanded to encompass a variety of intracerebral lesions, including tumors, infarcts, and some other cerebrovascular conditions [2–6]. For example, a recent study by Boisseau et al. demonstrates its strong accuracy and reliability in measuring infarct volumes [3]. The simplicity and reliability of the ABC/2 method not only make it valuable in neurosurgical assessments but also facilitate its potential use by a broad range of healthcare professionals, including nurse practitioners (NPs).

In the face of physician workforce shortages, the potential role of NPs in clinical practice is increasingly valued. As frontline healthcare providers, NPs are fundamental in patient observation, diagnosis, and treatment [7]. Often the first to notice changes in patient conditions, they play a crucial role in early detection and diagnosis, which is vital for timely medical interventions and effective patient management [8]. Moreover, NPs’ deeper understanding of diseases aids significantly in enhancing communication within the medical team, and hence in the development and execution of treatment strategies [9]. Additionally, NPs also play a crucial role in communicating medical status to patients and their families, ensuring a comprehensive understanding that is vital for informed decision-making [10].

Recent studies have begun to explore the expanded roles of NPs in neurosurgical contexts. For instance, a report by James et al. highlights the involvement of advanced registered NPs and physician assistants in pediatric neurosurgery, covering a range of responsibilities from outpatient and inpatient care to surgical activities, and extending to teaching and clinical research [11]. Similarly, a study by Ellens et al. examined the accuracy and safety of external ventricular drain (EVD) placements by so-called midlevel practitioners, demonstrating comparable accuracy and complication rates to those performed by neurosurgeons [12]. While existing studies have shown that NPs can perform comparably to physicians in various clinical settings, to the best of our knowledge, no research has yet assessed NPs’ abilities in measuring intracranial lesion volumes using the ABC/2 method. This study is designed to investigate this aspect, aiming to provide meaningful references for future clinical practice.

Methods

Patient population

Our study was approved by the institutional review board, with the requirement for written informed consent waived due to its retrospective nature and our commitment to maintaining patient confidentiality through the use of anonymized data. All patient medical data were de-identified to ensure anonymity prior to analysis. Our study concentrated on patients who received surgical treatment for suspected intracranial meningiomas in our department between January 2021 and June 2023, with subsequent histopathological confirmation. The inclusion criteria for patients were as follows: (1) receipt of MR imaging within four weeks prior to surgery; (2) presence of a single tumor in MR images; (3) more than four tumor-containing MRI slices; (4) absence of significant motion artifacts; (5) availability of MR images in DICOM format, including T1-weighted imaging (T1WI), T2 fluid-attenuated inversion recovery (FLAIR), and contrast-enhanced T1-weighted imaging (CE-T1WI) sequences. MR imaging was performed using either a 1.5T Siemens Avanto or a 3.0T Siemens Trio magnetic resonance scanner, equipped with a standard head coil. The imaging parameters included a field of view of 230 × 230 mm, a resolution matrix of 512 × 512, slice thicknesses ranging from 4 to 5 mm, and a flip angle of 90°. The specific repetition time (TR) and echo time (TE) values for T1WI, T2WI, and FLAIR sequences were 500/8.4 ms, 9000/89 ms, and 9000/105 ms, respectively. CE-T1WI sequences were acquired in axial planes following the intravenous administration of 0.2 mL/kg gadopentetate dimeglumine.

Volume estimation

The initial segmentation of each meningioma was conducted on CE-T1WI sequences using ITK-SNAP software (version 4.0.1, University of Pennsylvania) [13]. This task was undertaken by one of our researchers (TTH) and subsequently reviewed and refined by another researcher (PFY) to guarantee segmentation precision. Following this, we applied the ABC/2 formula method to estimate tumor volumes. The process involved selecting the axial MRI slice displaying the largest tumor area, identifying the longest tumor dimension as A, and the width perpendicular to A as B in the same slice. The tumor height, represented as C, was calculated by multiplying the slice thickness with the total number of axial slices containing the tumor. To automate the detection and measurement of these parameters (A, B, and C), we developed a custom script in Python (version 3.9.17) (Fig. 1). The computed value of ABC/2, derived from this script, was considered as the gold standard for tumor volume estimation in our study, owing to its automated and precise calculation.

Fig. 1 Schematic overview of the automated ABC/2 calculation process

Lesions are initially manually segmented by researchers across sequential slices, with the total number of lesion-containing slices multiplied by the slice thickness yielding the value ‘C’. Subsequently, a Python script automatically identifies the slice with the largest lesion area. It computes the lengths of all line segments spanning the lesion’s perimeter points, determining the longest segment as ‘A’. The script then iterates over each perimeter point again, drawing and measuring a line segment perpendicular to ‘A’ through each point; the longest segment is determined to be ‘B’. This enables the automatic calculation of the lesion’s volume using the ABC/2 formula

One researcher (XKW) meticulously selected 17 NPs from our department for the study, adhering to pre-defined work experience categories: seven NPs with less than three years of experience (category Low), five with three to five years (category Medium), and five with over five years (category High). Selection within these categories was executed randomly to ensure a representative sample. Initially, these NPs underwent an approximately one-hour training session, which primarily focused on the history, principles, and detailed measurement procedures of the ABC/2 method. This session also included interactive discussions and hands-on practice. On the subsequent day, each NP was provided with DICOM data for all patients, the MicroDicom viewing software, and a blank Excel spreadsheet. They were instructed to measure the dimensions A, B, and C for each tumor case as per the training, calculate the volume using the ABC/2 formula (with volume calculations being auto-generated by Excel formulas), and record the time spent on each case. The NPs were instructed to submit the compiled data by the tenth day following the training. The gathered data was subsequently aggregated by another researcher (XWC).

Statistical analysis

The statistical analysis in this study was executed using Python 3.11.5, with the assistance of libraries including numpy, pandas, scipy, and pingouin. Statistical figures and graphs were created using the library matplotlib and seaborn. All tests were conducted as two-sided, with a significance threshold set at a p-value of less than 0.05. Comprehensive descriptive statistics were utilized to summarize the data, with continuous variables presented as medians with interquartile ranges (IQR) and categorical variables as numbers and percentages. The Shapiro-Wilk test was employed to evaluate data normality. Paired sample t-tests were used to analyze differences in tumor volumes measured by NPs compared to the gold standard method, and the clinical impact of these differences was further examined through percentage differences and effect size, incorporating Cohen’s d for analysis. Consistency in measurements was assessed using Bland-Altman analysis and Intraclass Correlation Coefficient (ICC) analysis. Additionally, the Analysis of Variance (ANOVA) was applied to investigate variability in measurement accuracy among NPs, taking into account their varying levels of work experience.

Results

This study collected clinical data from 265 meningioma patients (Table 1). Among these cases, 221 were low-grade meningiomas (83.40%), and 44 were high-grade meningiomas (16.60%). The gender distribution included 75 male patients (28.30%) and 190 female patients (71.70%), with a male-to-female ratio of 1:2.53. The average age of patients at the time of surgery was 52.67 years (IQR 46–60 years).

Table 1 Patients’ demographic data

Patient Characteristics
(N = 265)	N (%)	
Gender		
 Male	75 (28.30%)	
 Female	190 (71.70%)	
Age at the time of surgery (yrs, mean with IQR)	52.67 (46–60)	
Classification		
 Low-grade	221 (83.40%)	
 High-grade	44 (16.60%)	
Tumor location		
 Convexity	77 (29.06%)	
 Parasagittal	69 (26.04%)	
 Anterior Cranial Fossa	17 (6.42%)	
 Middle cranial fossa	44 (16.60%)	
 Posterior Cranial Fossa	44 (16.60%)	
 Other	14 (5.28%)	
Volume (mL, mean with IQR)	39.57 (14.50–51.34)	

Measured according to the gold standard method, the average volume of the tumors was 39.57 ml (IQR 14.50-51.34 ml) (Table 2). 17 NPs were involved in measuring tumor volume in this study, the average measurement time was 27.47 s (IQR 22–33 s). The average volume measured was 36.95 ml (IQR 13.54–47.84 ml) (Fig. 2). The volumes measured by NPs demonstrated a statistically significant difference from those obtained via the automated ABC/2 method (p < 0.05). However, further analysis of the percentage difference and the effect size (Cohen’s d) revealed that the NPs-based measurements underestimated tumor volumes by approximately 6.59% (standard deviation = 1.91%), with a Cohen’s d value of 0.08, which implies a modest impact in actual clinical practice.

Table 2 Overview of tumor volume measurements by nurses and automatic ABC/2

	Work Experience	Mean Volume	Median Volume	IQR	p Value	% Difference	
Automatic ABC/2	—	39.57 ± 35.95	28.52	14.50–51.34	—	—	
Nurses overall	—	36.95 ± 33.64	26.82	13.68–47.83	< 0.05	6.59	
Nurse 1	2	36.74 ± 33.60	26.12	13.66–46.92	< 0.05	6.97	
Nurse 2	3	37.66 ± 34.41	27.07	13.68–48.84	< 0.05	4.72	
Nurse 3	3	36.78 ± 33.90	26.93	13.32–47.37	< 0.05	6.93	
Nurse 4	2	36.15 ± 32.75	25.79	13.07–47.27	< 0.05	8.46	
Nurse 5	3	36.79 ± 33.72	26.68	13.16–47.13	< 0.05	7.34	
Nurse 6	3	36.43 ± 32.74	26.39	13.60–48.49	< 0.05	7.26	
Nurse 7	2	38.09 ± 35.59	27.10	14.46–49.57	< 0.05	4.26	
Nurse 8	4	38.08 ± 35.96	26.34	13.56–48.78	< 0.05	5.15	
Nurse 9	4	36.79 ± 34.05	25.90	13.29–47.33	< 0.05	6.82	
Nurse 10	5	37.15 ± 33.26	27.27	14.02–49.47	< 0.05	5.32	
Nurse 11	4	38.26 ± 35.14	26.93	14.30–49.92	< 0.05	3.34	
Nurse 12	5	36.54 ± 34.09	26.50	13.54–47.71	< 0.05	7.92	
Nurse 13	7	37.75 ± 34.63	26.90	13.74–49.34	< 0.05	4.75	
Nurse 14	10	34.69 ± 31.12	25.66	12.59–45.70	< 0.05	11.46	
Nurse 15	8	35.62 ± 32.09	25.80	12.68–46.58	< 0.05	9.71	
Nurse 16	9	37.12 ± 34.74	27.05	13.77–47.32	< 0.05	6.23	
Nurse 17	8	37.50 ± 34.50	26.69	13.87–48.10	< 0.05	5.44	
Note: (1) Measurements are presented in the following units – Work experience: years; Volume: milliliters (ml); IQR: milliliters (ml), presented as the range from the 25th to the 75th percentile; Absolute percentage difference: %. (2) Data for averages are expressed as mean ± standard deviation. (3) The overall performance of nurses is summarized in the ‘Nurses overall’ row.

Fig. 2 Boxplots of different volume measurements

Boxplot showing the distribution of tumor volume measurements across different evaluators. ‘Automatic ABC/2’ represents the reference standard for tumor volume assessment, while ‘Nurses Overall’ indicates the overall average of measurements taken by the nurses. Additionally, the boxplot includes individual evaluations from Nurse 1 to Nurse 17. The central line in each box represents the median volume measurement, the edges of the box are the interquartile range (IQR), and the whiskers extend to the most extreme data points not considered outliers, which are represented by the individual dots

In addition, the Bland-Altman analysis demonstrated that the majority of the cases fell within the limits of agreement, indicating a general consistency between these two methods (Fig. 3). The satisfactory performance in measurement consistency was confirmed by the ICC analysis, with a value exceeding 0.99.

Fig. 3 Bland–Altman plot illustrating nurse measurement averages against automatic ABC/2

The Bland–Altman plot demonstrates a good agreement between the average measurements taken by nurses and the automated ABC/2 method. While a few points lie beyond the 95% Limits of Agreement, the majority are contained within the interval, with a Mean Difference of 2.62 ml and a Standard Deviation of Difference of 2.58 ml

We further analyzed the differences in measurements among the NPs (Table 3). According to the ANOVA results, the measurements demonstrated a high degree of consistency among individual NPs (p > 0.05). A more detailed examination, based on their varying levels of work experience – categorized as low, medium, and high – also revealed a similar pattern of consistency in measurement results. These findings suggest that the ABC/2 method for tumor volume estimation is applied consistently by NPs, regardless of their work experience.

Table 3 Volume measurement variability among nurses analyzed with ANOVA

	Groups	SS	df	MS	F Value	p Value	
Nurses overall	All nurses (n = 17)	3.20	16	0.20	0.20	0.99	
Groups based on work experience	Low (n = 7)	0.08	2	0.04	0.04	0.96	
Medium (n = 5)	
High (n = 5)	
Note: (1) SS stands for Sum of Squares, df stands for Degrees of Freedom, and MS stands for Mean Square. These values are calculated based on between-group differences. (2) Work experience categorization is as follows: less than 3 years for the Low group, 3–5 years for the Medium group, and over 5 years for the High group.

Discussion

This study primarily aimed to assess the precision of intracranial lesion volume measurements conducted by NPs using the ABC/2 method, and our findings present some insightful observations. As the results indicate, the tumor volumes measured by nursing staff showed a statistically significant variation from those obtained via the automated ABC/2 method. However, it’s essential to contextualize this variation within clinical settings. Further analysis, which focused on the percentage difference and the effect size indicated by Cohen’s d, revealed that the measurements conducted by NPs tended to underestimate tumor volumes by approximately 6.59% (standard deviation = 1.91%), with a Cohen’s d value of only 0.08. These findings suggest that, although there is a statistical difference from the gold standard, the practical discrepancy in these measurements is relatively minor. In essence, this indicates that NPs can effectively use this method to quickly obtain reasonably accurate estimates of lesion volumes, providing valuable support in the diagnosis and treatment of neurosurgical diseases. The findings from the Bland-Altman and ICC analysis reinforce the clinical utility of NPs-derived measurements in estimating tumor volumes. Despite the inherent variability in manual measurements, the average values provided by the nursing staff were in good agreement with the gold standard method. This agreement is crucial for clinical settings where quick and reliable tumor volume estimations are needed.

The relationship between clinical expertise and years of work experience is an extensively-explored area, with several studies indicating a positive correlation. For instance, Takase et al. observed a substantial increase in nurses’ competence during their initial ten years of clinical practice, primarily due to an enhanced capacity for absorbing skills and knowledge [14]. Similarly, Faraji et al. reported that nurses with more extended work experience generally showed higher clinical competence than their less experienced peers [15]. In contrast to these findings, our study did not find a significant difference in lesion volume measurement accuracy among NPs with different lengths of work experience. This disparity might be due to the straightforward and intuitive nature of the ABC/2 method, which can be mastered with minimal clinical experience. This notion receives some support from the works of Bahreini et al. and Liu et al., who found a minimal correlation between clinical competence and years of experience [16, 17]. Consequently, our study highlights the practicality of the ABC/2 method for NPs, and also emphasizes the crucial role of targeted training sessions and hands-on experience in nursing education for effective specialized skill acquisition.

The global shortage of primary care physicians might be alleviated through the integration of NPs. Equipped to administer medical treatments, order diagnostic tests, and manage chronic diseases, NPs fulfill roles similar to those of physicians. This capability is particularly vital in underserved and rural areas, where the scarcity of physicians is more pronounced [7, 18]. Increasingly, NPs are becoming the usual source of care for many patients, offering a holistic approach to healthcare that emphasizes health education, preventive care, and disease management. Such an approach effectively supplements the care provided by physicians, proving crucial in managing patients especially with non-severe or chronic conditions [19, 20]. Moreover, the collaboration between NPs and physicians is fostering more comprehensive and coordinated care. NPs bring unique skills in patient education and common disease management, while physicians are more adept at handling acute or complex cases. This partnership is pivotal in addressing the increasing healthcare demands of aging populations and societies with prevalent chronic diseases [21]. Thus, their integration into the healthcare system is not only enhancing access to care but is also a crucial response to the declining number of physicians in certain regions.

In the specialized domain of neurosurgery care, the role of NPs is increasingly recognized as pivotal. NPs are key members of the neurosurgery team, performing essential tasks such as frequent neurologic assessments, rapid detection of neurologic deterioration, and effective communication with both the healthcare team and patients’ families. Their ability to promptly identify and act upon deterioration in neurologic status is crucial, particularly for patients with neurologic pathology, where such actions can be life-saving [22]. Moreover, NPs play instrumental roles in delivering care and are central to the stability and cohesion in intensive care settings, although the full impact of their involvement on patient care and satisfaction is still evolving [23, 24]. Their comprehensive training, focusing on neuroanatomy, neurologic assessment, and the management of neurologic deterioration, is critical for handling the complexities of neurosurgical conditions and postoperative care [22, 25]. The integration of skilled nursing staff in neurosurgery care not only enhances the quality of patient care but also addresses the complex management of neurologic conditions, underscoring the importance of ongoing professional development in this specialized area.

Our study addresses a question of practical clinical significance, primarily focusing on the estimation of intracranial lesion volumes using the ABC/2 method. This relevance is underscored by the fact that many intracranial pathologies, such as meningiomas, gliomas, cerebral hematomas, epidural hematomas, and infarcts, often present with ellipsoid shapes; hence, the ABC/2 method theoretically provides a relatively accurate estimation of their volumes. Moreover, this method is simple and user-friendly, with a minimal learning curve, making it accessible for clinical application. Significantly, NPs, who are at the forefront of patient management and often observe clinical changes, including assessments of imaging data like CT and MRI scans, can provide early insights into the patient’s condition. Their ability to perform preliminary assessments of lesion volumes and convey this critical information to physicians can undoubtedly aid in diagnosis and treatment, potentially improving patient outcomes. Furthermore, involving NPs in comprehensive patient care, including understanding lesion volumes, not only enhances their engagement and satisfaction in the therapeutic process but also indirectly improves overall nursing care quality. Our study not only preliminarily answers the question of the usability of the ABC/2 method by NPs but also aims to serve as a reference for further research in this area. We hope to explore in future studies whether other clinical diagnostic and therapeutic tasks could be partially undertaken by nursing staff. Through this research, we seek to explore the feasibility and extent of NPs involvement in clinical diagnosis and treatment, thus enhancing the role of nursing in patient care.

In addressing our study’s limitations, we note several key factors. Firstly, our focus on meningioma cases, dictated by data availability, narrows the scope of our conclusions. Including a wider range of intracranial pathologies in future studies could broaden our understanding of the ABC/2 method’s applicability. Efforts are underway to obtain access to a more diverse set of clinical and imaging data. Secondly, our study involved NPs with up to ten years of experience. Future research incorporating a larger, more varied group of NPs could provide deeper insights into how experience affects measurement accuracy. Thirdly, the use of the automated ABC/2 method as a gold standard, despite being theoretically less precise than planimetry, was a strategic choice to assess NPs’ measurement accuracy more effectively. Fourthly, conducting the study in a single tertiary hospital may limit the wider applicability of our results. Multi-center studies could yield richer, more diverse data, thereby enhancing the findings’ external validity. Lastly, the one-hour training for NPs, though useful, may not fully convey the ABC/2 method’s intricacies. Future research should explore varied training formats and durations to optimize education for healthcare professionals in this methodology.

Conclusions

In conclusion, this study highlights the integral role of NPs in neurosurgical practices, particularly in lesion volume estimation using the ABC/2 method. While our focus was on meningioma cases, the findings hint at the method’s wider applicability for different intracranial pathologies. NPs, irrespective of their work experience, showed good consistency in their measurements, providing estimates as reliable as those obtained via automated methods. This underscores the potential of NPs in playing a pivotal role in clinical scenarios, especially in the context of growing physician shortages. Beyond validating NPs’ capabilities in specialized tasks, our study paves the way for future research aimed at further expanding and enhancing their roles across various clinical settings.

Acknowledgements

None.

Author contributions

TTH, QY, and PY were involved in data curation, formal analysis, and methodology, and also authored the initial draft. XKW contributed to data curation as well, with additional responsibilities in conceptualization, project administration, and drafting the manuscript. GFY and XWC concentrated on conceptualization and project administration, while also participating in the manuscript’s writing, review, and editing processes. PFY’s role encompassed conceptualization and methodology, along with contributing to the writing, review, and editing of the manuscript. All authors critically reviewed and refined the manuscript.

Funding

This work was supported by grants from Department of Science and Technology of Hubei Province (2021CFB593).

Data availability

Data will be made available on request.

Declarations

Ethics approval and consent to participate

The study received approval from the Ethics Committee of Wuhan Union Hospital. Due to its retrospective design, the requirement for written informed consent was waived. All procedures were conducted in strict compliance with applicable guidelines and regulations.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.

Abbreviations

NPs Nurse Practitioners

ABC/2 A method used for lesion volume estimation

ICC Intraclass Correlation Coefficient

CT Computed Tomography

MR Magnetic Resonance

DICOM Digital Imaging and Communications in Medicine

T1WI T1-Weighted Imaging

FLAIR Fluid-Attenuated Inversion Recovery

CE T1WI-Contrast-Enhanced T1-Weighted Imaging

TR Repetition Time

TE Echo Time

EVD External Ventricular Drain

ANOVA Analysis of Variance

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Tingting Hu, Qiong Yan, and Xianke Wang contributed equally to this paper.
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