{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:01:24Z","timestamp":1787320884186,"version":"build-2736575974"},"reference-count":51,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T00:00:00Z","timestamp":1658448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000070","name":"National Institute of Biomedical Imaging and Bioengineering","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000070","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Radio"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Trials of non-operative management (NOM) have become the standard of care for blunt splenic injury (BSI) in hemodynamically stable patients. However, there is a lack of consensus regarding the utility of follow-up CT exams and relevant CT features. The purpose of this study is to determine imaging predictors of splenectomy on follow-up CT using quantitative volumetric measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Adult patients who underwent a trial of non-operative management (NOM) with follow-up CT performed for BSI between 2017 and 2019 were included (\n                      <jats:italic>n<\/jats:italic>\n                      = 51). Six patients (12% of cohort) underwent splenectomy; 45 underwent successful splenic salvage. Voxelwise measurements of splenic laceration, hemoperitoneum, and subcapsular hematoma were derived from portal venous phase images of admission and follow-up scans using 3D slicer. Presence\/absence of pseudoaneurysm on admission and follow-up CT was assessed using arterial phase images. Multivariable logistic regression was used to determine independent predictors of decision to perform splenectomy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Factors significantly associated with splenectomy in bivariate analysis incorporated in multivariate logistic regression included final hemoperitoneum volume (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003), final subcapsular hematoma volume (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.001), change in subcapsular hematoma volume between scans (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.09) and new\/persistent pseudoaneurysm (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.003). Independent predictors of splenectomy in the logistic regression were final hemoperitoneum volume (unit OR = 1.43 for each 100 mL change; 95% CI: 0.99\u20132.06) and new\/persistent pseudoaneurysm (OR = 160.3; 95% CI: 0.91\u201328315.3). The AUC of the model incorporating both variables was significantly higher than AAST grading (0.91 vs. 0.59,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.025). Mean combined effective dose for admission and follow up CT scans was 37.4 mSv.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Follow-up CT provides clinically valuable information regarding the decision to perform splenectomy in BSI patients managed non-operatively. Hemoperitoneum volume and new or persistent pseudoaneurysm at follow-up are independent predictors of splenectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fradi.2022.941863","type":"journal-article","created":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T08:12:10Z","timestamp":1658477530000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Blunt splenic injury: Assessment of follow-up CT utility using quantitative volumetry"],"prefix":"10.3389","volume":"2","author":[{"given":"David","family":"Dreizin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlynn","family":"Motley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan J.","family":"Morrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,7,22]]},"reference":[{"key":"B1","first-page":"367","article-title":"A nonoperative approach to the adult ruptured spleen sustained from blunt trauma","volume":"51","author":"Tom","year":"1985","journal-title":"Am Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1016\/0002-9610(63)90151-X","article-title":"Laceration of the spleen due to nonpenetrating trauma: one hundred cases","volume":"106","author":"Stivelman","year":"1963","journal-title":"Am J Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1148\/radiology.178.2.1987612","article-title":"Splenic trauma: can CT grading systems enable prediction of successful nonsurgical treatment?","volume":"178","author":"Umlas","year":"1991","journal-title":"Radiology."},{"key":"B4","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1016\/S0891-5520(05)70322-6","article-title":"Overwhelming postsplenectomy infection","volume":"10","author":"Lynch","year":"1996","journal-title":"Infect Dis Clin North Am."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1002\/bjs.1800780904","article-title":"Postsplenectomy sepsis and its mortality rate: actual versus perceived risks","volume":"78","author":"Holdsworth","year":"1991","journal-title":"Br J Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13037-019-0218-0","article-title":"Splenic injury severity, not admission hemodynamics, predicts need for surgery in pediatric blunt splenic trauma","volume":"14","author":"Teuben","year":"2020","journal-title":"Patient Saf Surg."},{"key":"B7","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1097\/00005373-198611000-00007","article-title":"Late septic complications in adults following splenectomy for trauma: a prospective analysis in 144 patients","volume":"26","author":"Green","year":"1986","journal-title":"J Trauma."},{"key":"B8","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1097\/00005373-199503000-00007","article-title":"Unnecessary laparotomies for trauma: a prospective study of morbidity","volume":"38","author":"Renz","year":"1995","journal-title":"J Trauma."},{"key":"B9","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1097\/TA.0000000000000782","article-title":"The splenic injury outcomes trial: an American Association for the Surgery of Trauma multi-institutional study","volume":"79","author":"Zarzaur","year":"2015","journal-title":"J Trauma Acute Care Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1097\/00005373-200102000-00007","article-title":"Failures of splenic nonoperative management: is the glass half empty or half full?","volume":"50","author":"Bee","year":"2001","journal-title":"J Trauma."},{"key":"B11","doi-asserted-by":"crossref","DOI":"10.1097\/00005373-200008000-00002","article-title":"Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma","volume-title":"J Trauma.","author":"Peitzman","year":"2000"},{"key":"B12","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1097\/00005373-200105000-00010","article-title":"Outcome of the current management of splenic injuries","volume":"50","author":"Nix","year":"2001","journal-title":"J Trauma."},{"key":"B13","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.jamcollsurg.2005.03.037","article-title":"Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences","volume":"201","author":"Peitzman","year":"2005","journal-title":"J Am Coll Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1097\/TA.0000000000000228","article-title":"Delayed hemorrhagic complications in the nonoperative management of blunt splenic trauma: early screening leads to a decrease in failure rate","volume":"76","author":"Leeper","year":"2014","journal-title":"J Trauma Acute Care Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1148\/radiology.194.1.7997589","article-title":"Splenic trauma: value of follow-up CT","volume":"194","author":"Lawson","year":"1995","journal-title":"Radiology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1148\/radiology.194.1.7997559","article-title":"Splenic trauma: is follow-up CT of value?","volume":"194","author":"Federle","year":"1995","journal-title":"Radiology."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1097\/TA.0b013e318047b7c2","article-title":"The utility of serial computed tomography imaging of blunt splenic injury: still worth a second look?","volume":"62","author":"Weinberg","year":"2007","journal-title":"J Trauma Acute Care Surg."},{"key":"B18","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.jss.2016.11.062","article-title":"Delayed splenic vascular injury after nonoperative management of blunt splenic trauma","volume":"211","author":"Furlan","year":"2017","journal-title":"J Surg Res."},{"key":"B19","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1097\/01.TA.0000154575.49388.74","article-title":"Nonoperative management of blunt splenic injury: a 5-year experience","volume":"58","author":"Haan","year":"2005","journal-title":"J Trauma Acute Care Surg."},{"key":"B20","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.amjsurg.2005.05.026","article-title":"Is anything new in adult blunt splenic trauma?","volume":"190","author":"Harbrecht","year":"2005","journal-title":"Am J Surg."},{"key":"B21","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1097\/00005373-199711000-00003","article-title":"Nonoperative management of splenic injury: are follow-up computed tomographic scans of any value?","volume":"43","author":"Thaemert","year":"1997","journal-title":"J Trauma Acute Care Surg."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e000075","DOI":"10.1136\/tsaco-2017-000075","article-title":"An update on nonoperative management of the spleen in adults","volume":"2","author":"Zarzaur","year":"2017","journal-title":"Trauma Surg Acute Care Open."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1337","DOI":"10.1016\/j.injury.2011.09.010","article-title":"Meta-analysis of predictive factors and outcomes for failure of non-operative management of blunt splenic trauma","volume":"43","author":"Bhangu","year":"2012","journal-title":"Injury."},{"key":"B24","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1007\/s00068-015-0575-z","article-title":"Non operative management of blunt splenic trauma: a prospective evaluation of a standardized treatment protocol","volume":"42","author":"Brillantino","year":"2016","journal-title":"Eur J Trauma Emerg Surg."},{"key":"B25","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1308\/003588408X242033","article-title":"Recent changes in the management of blunt splenic injury: effect on splenic trauma patients and hospital implications","volume":"90","author":"Sinha","year":"2008","journal-title":"Ann R Coll Surg Engl."},{"key":"B26","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s10140-019-01734-8","article-title":"A 2019 international survey to assess trends in follow-up imaging of blunt splenic trauma","volume":"27","author":"Odedra","year":"2020","journal-title":"Emerg Radiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1148\/radiol.13121370","article-title":"Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans","volume":"268","author":"Boscak","year":"2013","journal-title":"Radiology."},{"key":"B28","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1148\/radiol.13121242","article-title":"Active hemorrhage and vascular injuries in splenic trauma: utility of the arterial phase in multidetector CT","volume":"270","author":"Uyeda","year":"2014","journal-title":"Radiology."},{"key":"B29","doi-asserted-by":"publisher","first-page":"395","DOI":"10.5152\/dir.2016.15232","article-title":"Comparison of MDCT protocols in trauma patients with suspected splenic injury: superior results with protocol that includes arterial and portal venous phase imaging","volume":"22","author":"Melikian","year":"2016","journal-title":"Diagn Interv Radiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1148\/radiology.148.1.6856833","article-title":"Hemoperitoneum studied by computed tomography","volume":"148","author":"Federle","year":"1983","journal-title":"Radiology."},{"key":"B31","doi-asserted-by":"publisher","first-page":"e190220","DOI":"10.1148\/ryai.2020190220","article-title":"A multiscale deep learning method for quantitative visualization of traumatic hemoperitoneum at CT: assessment of feasibility and comparison with subjective categorical estimation","volume":"2","author":"Dreizin","year":"2020","journal-title":"Radiology."},{"key":"B32","doi-asserted-by":"publisher","first-page":"2648","DOI":"10.1007\/s00261-019-02000-8","article-title":"A comparison of segmented abdominopelvic fluid volumes with conventional CT signs of abdominal compartment syndrome in a trauma population","volume":"44","author":"Battey","year":"2019","journal-title":"Abdom Radiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1148\/radiol.2018170997","article-title":"CT prediction model for major arterial injury after blunt pelvic ring disruption","volume":"287","author":"Dreizin","year":"2018","journal-title":"Radiology."},{"key":"B34","doi-asserted-by":"publisher","first-page":"3953","DOI":"10.1007\/s00330-018-5303-8","article-title":"Quantitative MDCT assessment of binder effects after pelvic ring disruptions using segmented pelvic haematoma volumes and multiplanar caliper measurements","volume":"28","author":"Dreizin","year":"2018","journal-title":"Eur Radiol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"798","DOI":"10.1148\/radiol.2233011026","article-title":"Volumetric growth rate of stage I lung cancer prior to treatment: serial CT scanning","volume":"223","author":"Winer-Muram","year":"2002","journal-title":"Radiology."},{"key":"B36","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.acra.2009.07.030","article-title":"The use of volumetric CT as an imaging biomarker in lung cancer","volume":"17","author":"Buckler","year":"2010","journal-title":"Acad radiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1097\/TA.0000000000001323","article-title":"Western Trauma Association Critical Decisions in Trauma: management of adult blunt splenic trauma-\u22122016 updates","volume":"82","author":"Rowell","year":"2017","journal-title":"J Trauma Acute Care Surg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1097\/TA.0b013e31818c29ea","article-title":"Proximal splenic angioembolization does not improve outcomes in treating blunt splenic injuries compared with splenectomy: a cohort analysis","volume":"65","author":"Duchesne","year":"2008","journal-title":"J Trauma Acute Care Surg."},{"key":"B39","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1001\/archsurg.135.6.674","article-title":"Nonoperative management of splenic injuries: have we gone too far?","volume":"135","author":"Velmahos","year":"2000","journal-title":"Arch Surg."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.1016\/j.mri.2012.05.001","article-title":"3D Slicer as an image computing platform for the Quantitative Imaging Network","volume":"30","author":"Fedorov","year":"2012","journal-title":"Magn Reson Imaging."},{"key":"B41","doi-asserted-by":"publisher","first-page":"2556","DOI":"10.1007\/s00261-020-02892-x","article-title":"Added value of deep learning-based liver parenchymal CT volumetry for predicting major arterial injury after blunt hepatic trauma: a decision tree analysis","volume":"46","author":"Dreizin","year":"2021","journal-title":"Abdom Radiol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s10278-019-00207-1","article-title":"Performance of a deep learning algorithm for automated segmentation and quantification of traumatic pelvic hematomas on CT","volume":"33","author":"Dreizin","year":"2020","journal-title":"J Digit Imaging."},{"key":"B43","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve","volume":"143","author":"Hanley","year":"1982","journal-title":"Radiology."},{"key":"B44","doi-asserted-by":"publisher","first-page":"S294","DOI":"10.1097\/TA.0b013e3182702afc","article-title":"Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline","volume":"73","author":"Stassen","year":"2012","journal-title":"J Trauma Acute Care Surg."},{"key":"B45","doi-asserted-by":"crossref","DOI":"10.1097\/00000658-199805000-00011","article-title":"Changing patterns in the management of splenic trauma: the impact of nonoperative management","volume-title":"Ann Surg.","author":"Pachter","year":"1998"},{"key":"B46","doi-asserted-by":"publisher","first-page":"234","DOI":"10.3389\/fphy.2020.00234","article-title":"Cancer risk of low dose ionizing radiation","volume":"8","author":"Ali","year":"2020","journal-title":"Front Phys."},{"key":"B47","year":""},{"key":"B48","first-page":"1142","volume-title":"Radiation Risk From Medical Imaging","author":"Lin","year":"2010"},{"key":"B49","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.1007\/s00261-016-0822-8","article-title":"Volumetric analysis of pelvic hematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study","volume":"41","author":"Dreizin","year":"2016","journal-title":"Abdom Radiol."},{"key":"B50","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1007\/s10140-018-1646-3","article-title":"Abdominopelvic bleed rate on admission CT correlates with mortality and transfusion needs in the setting of blunt pelvic fractures: a single institution pilot study","volume":"26","author":"Borror","year":"2019","journal-title":"Emerg Radiol."},{"key":"B51","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1109\/TMI.2021.3139637","article-title":"External attention assisted multi-phase splenic vascular injury segmentation with limited data","volume":"41","author":"Zhou","year":"2021","journal-title":"IEEE Trans Med Imaging"}],"container-title":["Frontiers in Radiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2022.941863\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T08:12:16Z","timestamp":1658477536000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2022.941863\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,22]]},"references-count":51,"alternative-id":["10.3389\/fradi.2022.941863"],"URL":"https:\/\/doi.org\/10.3389\/fradi.2022.941863","relation":{},"ISSN":["2673-8740"],"issn-type":[{"value":"2673-8740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,22]]},"article-number":"941863"}}