Chapter 14 Spontaneous Intracerebral Hemorrhage Image Analysis Methods: A Survey Noel P´ erez, Jose Vald´ es, Miguel Guevara, and Augusto Silva 14.1 Introduction Spontaneous intracerebral hemorrhages (ICH) account for 10–30% of all strokes and are a result of acute bleeding into the brain due to ruptures of small penetrating arteries. Despite major advancements in the management of ischemic strokes and other causes of hemorrhagic strokes, such as ruptured aneurysm, arteriovenous mal- formations (AVMs), or cavernous angioma, during the past several decades, limited progress has been made in the treatment of ICH, and the prognosis for patients who suffer them remains poor. The societal impact of these hemorrhagic strokes is mag- nified by the fact that affected patients typically are a decade younger than those afflicted with ischemic strokes. The ICH continues to kill or disable most of their victims. Some studies show that those who suffer ICH have a 30-day mortality rate of 35–44% and a 6-month mortality rate approaching 50%. Approximately 700,000 new strokes occur in the United States annually and approximately 15% are hem- orrhagic strokes related to ICH. The poor outcome associated with ICH is related to the extent of brain damage. ICH produces direct destruction and compression of surrounding brain tissue. Direct compression causes poor perfusion and venous drainage to surrounding penumbra at risk, resulting in ischemia to the tissues that most need perfusion [16]. Diagnosis of ICH is based largely on clinical history and corroborative Com- puter Tomography (CT) scanning of the brain. The head CT scan has a sensitivity and specificity that approach 100% for acute ICH. The hemorrhage volume is the most important predictor of clinical outcome after ICH [20]. The volume of ICH can be estimated rapidly with a head CT. It is an important prognostic indicator N. P´ erez, J. Vald´ es, and M. Guevara Centre for Advanced Computer Sciences Technologies. Computer Sciences Faculty, Ciego de Avila University, Cuba M. Guevara and A. Silva Electronic, Telecommunications and Informatics Department, Aveiro University, Portugal J.M.R.S. Tavares, R.M.N. Jorge (eds.), Advances in Computational Vision 235 and Medical Image Processing, Computational Methods in Applied Sciences 13, c  Springer Science+Business Media B.V. 2009