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dc.contributor.authorDreizin, David
dc.contributor.authorYu, Theresa
dc.contributor.authorMotley, Kaitlynn
dc.contributor.authorLi, Guang
dc.contributor.authorMorrison, Jonathan J
dc.contributor.authorLiang, Yuanyuan
dc.date.accessioned2022-09-21T17:03:33Z
dc.date.available2022-09-21T17:03:33Z
dc.date.issued2022-07-22
dc.identifier.urihttp://hdl.handle.net/10713/19829
dc.description.abstractPurpose: 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. Methods: 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 = 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. Results: Factors significantly associated with splenectomy in bivariate analysis incorporated in multivariate logistic regression included final hemoperitoneum volume (p = 0.003), final subcapsular hematoma volume (p = 0.001), change in subcapsular hematoma volume between scans (p = 0.09) and new/persistent pseudoaneurysm (p = 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: 0.99-2.06) and new/persistent pseudoaneurysm (OR = 160.3; 95% CI: 0.91-28315.3). The AUC of the model incorporating both variables was significantly higher than AAST grading (0.91 vs. 0.59, p = 0.025). Mean combined effective dose for admission and follow up CT scans was 37.4 mSv. Conclusion: 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.en_US
dc.description.urihttps://doi:10.3389/fradi.2022.941863en_US
dc.language.isoenen_US
dc.relationThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.en_US
dc.relation.ispartofFrontiers in radiologyen_US
dc.subjectabdominal traumaen_US
dc.subjectblunt splenic injury (BSI)en_US
dc.subjectcomputed tomographyen_US
dc.subjectfollow-upen_US
dc.subjectquantitative CTen_US
dc.subjectspleenen_US
dc.subjecttraumaen_US
dc.subjectvolumetryen_US
dc.titleBlunt splenic injury: Assessment of follow-up CT utility using quantitative volumetry.en_US
dc.typeArticleen_US
dc.identifier.doi10.3389/fradi.2022.941863
dc.source.journaltitleFrontiers in radiology
dc.source.volume2
dc.source.countryUnited States
dc.source.countrySwitzerland


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