Perinephric hematoma: semi-automated quantification of volume on MDCT: a feasibility study

Automated segmentation of the injured kidney due to abdominal trauma

The objective of this study is to propose and validate a computer-aided segmentation system which performs the automated segmentation of injured kidney in the presence of contusion, peri-, intra-, sub-capsular hematoma, laceration, active extravasation and urine leak due to abdominal trauma. In the present study, total multi-phase CT scans of thirty-seven cases were used; seventeen of them for the development of the method and twenty of them for the validation of the method. The proposed algorithm contains three steps: determination of the kidney mask using Circular Hough Transform, segmentation of the renal parenchyma of the kidney applying the symmetry property to the histogram, and estimation of the kidney volume. The results of the proposed method were compared using various metrics. The kidney quantification led to 92.3 ± 4.2% Dice coefficient, 92.8 ± 7.4%/92.3 ± 5.1% precision/sensitivity, 1.4 ± 0.6 mm/2.0 ± 1.0 mm average surface distance/root-mean-squared error for intact and 87.3 ± 8.4% Dice coefficient, 84.3 ± 13.8%/92.2 ± 3.8% precision/sensitivity and 2.4 ± 2.2 mm/4.0 ± 4.2 mm average surface distance/root-mean-squared error for injured kidneys. The segmentation of the injured kidney was satisfactorily performed in all cases. This method may lead to the automated detection of renal lesions due to abdominal trauma and estimate the intraperitoneal blood amount, which is vital for trauma patients.

The associations between initial radiographic findings and interventions for renal hemorrhage after high-grade renal trauma: Results from the Multi-Institutional Genitourinary Trauma Study

BACKGROUND

Indications for intervention after high-grade renal trauma (HGRT) remain poorly defined. Certain radiographic findings can be used to guide the management of HGRT. We aimed to assess the associations between initial radiographic findings and interventions for hemorrhage after HGRT and to determine hematoma and laceration sizes predicting interventions.

METHODS

The Genitourinary Trauma Study is a multicenter study including HGRT patients from 14 Level I trauma centers from 2014 to 2017. Admission computed tomography scans were categorized based on multiple variables, including vascular contrast extravasation (VCE), hematoma rim distance (HRD), and size of the deepest laceration. Renal bleeding interventions included angioembolization, surgical packing, renorrhaphy, partial nephrectomy, and nephrectomy. Mixed-effect Poisson regression was used to assess the associations. Receiver operating characteristic analysis was used to define optimal cutoffs for HRD and laceration size.

RESULTS

In the 326 patients, injury mechanism was blunt in 81%. Forty-seven (14%) patients underwent 51 bleeding interventions, including 19 renal angioembolizations, 16 nephrectomies, and 16 other procedures. In univariable analysis, presence of VCE was associated with a 5.9-fold increase in risk of interventions, and each centimeter increase in HRD was associated with 30% increase in risk of bleeding interventions. An HRD of 3.5 cm or greater and renal laceration depth of 2.5 cm or greater were most predictive of interventions. In multivariable models, VCE and HRD were significantly associated with bleeding interventions.

CONCLUSION

Our findings support the importance of certain radiographic findings in prediction of bleeding interventions after HGRT. These factors can be used as adjuncts to renal injury grading to guide clinical decision making.

LEVEL OF EVIDENCE

Prognostic and Epidemiological Study, Level III and Therapeutic/Care Management, Level IV.

Complication and Readmission Rates following Same-Day Discharge after Percutaneous Renal Tumor Ablation

PURPOSE

To evaluate readmission rate and complications in patients undergoing same-day discharge following percutaneous thermal ablation of renal tumors.

MATERIALS AND METHODS

Patients undergoing same-day discharge following thermal ablation of renal tumors were reviewed. The primary outcome was the rate of readmission within 30 days of same-day discharge. The secondary outcomes included the rate and clinical outcomes of periprocedural complications.

RESULTS

Same-day discharge occurred in 166/174 patients (95%), of whom 2/166 (1%) required short-term readmission due to pulmonary embolism and acute-on-chronic kidney injury. Both patients recovered without permanent morbidity. Admission due to complications occurred in 8/174 (5%) cases, the majority of which were related to hemorrhage. No significant differences in rates of complications or admission were found between cryoablation and RF ablation. Major complications (Clavien-Dindo grade II or higher, SIR grade C or higher) occurred in 7/174 (4%) cases, the majority related to hemorrhage. All cases were detected in the standard 4 hour postprocedural observation period and managed conservatively. The mean hemorrhage volume was significantly larger in patients requiring admission versus those discharged the same day (289 mL vs 34 mL; P = .02). Higher-volume hemorrhage occurred in larger tumors (mean, 4.0 cm vs 3.0 cm; P = .04). There was no association between major complications and central tumor or age.

CONCLUSIONS

Routine same-day discharge following percutaneous renal tumor thermal ablation can be performed with a low rate of short-term readmission. The majority of periprocedural complications can be managed conservatively, and patients can be discharged the same day.