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Shen X, Zhou Y, Shi X, Zhang S, Ding S, Ni L, Dou X, Chen L. The application of deep learning in abdominal trauma diagnosis by CT imaging. World J Emerg Surg 2024; 19:17. [PMID: 38711150 DOI: 10.1186/s13017-024-00546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Abdominal computed tomography (CT) scan is a crucial imaging modality for creating cross-sectional images of the abdominal area, particularly in cases of abdominal trauma, which is commonly encountered in traumatic injuries. However, interpreting CT images is a challenge, especially in emergency. Therefore, we developed a novel deep learning algorithm-based detection method for the initial screening of abdominal internal organ injuries. METHODS We utilized a dataset provided by the Kaggle competition, comprising 3,147 patients, of which 855 were diagnosed with abdominal trauma, accounting for 27.16% of the total patient population. Following image data pre-processing, we employed a 2D semantic segmentation model to segment the images and constructed a 2.5D classification model to assess the probability of injury for each organ. Subsequently, we evaluated the algorithm's performance using 5k-fold cross-validation. RESULTS With particularly noteworthy performance in detecting renal injury on abdominal CT scans, we achieved an acceptable accuracy of 0.932 (with a positive predictive value (PPV) of 0.888, negative predictive value (NPV) of 0.943, sensitivity of 0.887, and specificity of 0.944). Furthermore, the accuracy for liver injury detection was 0.873 (with PPV of 0.789, NPV of 0.895, sensitivity of 0.789, and specificity of 0.895), while for spleen injury, it was 0.771 (with PPV of 0.630, NPV of 0.814, sensitivity of 0.626, and specificity of 0.816). CONCLUSIONS The deep learning model demonstrated the capability to identify multiple organ injuries simultaneously on CT scans and holds potential for application in preliminary screening and adjunctive diagnosis of trauma cases beyond abdominal injuries.
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Affiliation(s)
- Xinru Shen
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR China
| | - Yixin Zhou
- School of Computing and Information, Information Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xueyu Shi
- School of Computing and Information, Information Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shiyun Zhang
- School of Computing and Information, Information Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shengwen Ding
- School of Computing and Information, Information Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Liangliang Ni
- School of Software, Hefei University of Technology, Hefei, Anhui, PR China
| | - Xiaobing Dou
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR China.
| | - Lin Chen
- School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, PR China.
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Pallares-Mendez R, Cervantes-Miranda DE, Castillo-Godinez ES, de la Cruz-de la Cruz C, Aguilar-Méndez MA, Gutierrez-Gonzalez A, Mendoza-Castillo F, Mata-Torres H, Ochoa-Arvizo M, Montelongo-Rodriguez F, Hernandez-Aranda KL, Cota-Agüero JA. Predictive factors for nephrectomy in renal trauma; assessment of a 6-point score. Eur J Trauma Emerg Surg 2023; 49:2241-2248. [PMID: 35670816 DOI: 10.1007/s00068-022-02006-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate predictive and associated risk factors for nephrectomy in renal trauma and assess a 6-point score for surgical decision-making. PATIENTS AND METHODS This multicenter, retrospective, and observational study assessed 247 subjects with blunt or penetrating kidney trauma. Kidney injuries were classified according to the American Association for the Surgery of Trauma (AAST) Injury Scoring Scale. Renal trauma was classified as "low-grade" (Grades I-III), Grade IV, and Grade V. Subjects were compared according to conservative treatment (CTrt.) or nephrectomy. Predictive factors were evaluated with a multiple regression model. A 6-point score was evaluated with a ROC analysis. RESULTS Patients requiring nephrectomy had a lower mean arterial pressure MAP compared to CTrt, 64.71 mmHg (SD ± 10.26) and 73.86 (SD ± 12.42), respectively (p = < 0.001). A response to IV solutions was observed in 90.2% of patients undergoing CTrt. (p = < 0.001, OR = 0.211, 95%CI = 0.101-0.442). Blood lactate ≥ 4 mmol/L was associated with nephrectomy (p = < 0.001). A hematoma ≥ 25 mm was observed in 41.5% of patients undergoing nephrectomy compared to 20.1% of CTrt. (p = 0.004, OR = 9.29, 95% CI = 1.37-5.58). A logistic regression analysis (p = < 0.001) showed that blood lactate ≥ 4 mmol/L (p = 0.043), an inadequate response to IV solutions (p = 0.041) and renal trauma grade IV-V (p = < 0.001), predicted nephrectomy. A 6-point score with a cut-off value ≥ 3 points showed 83% sensitivity and 87% specificity for nephrectomy with an AUC of 89.9% (p = < 0.001). CONCLUSIONS An inadequate response to IV solutions, a lactate level ≥ 4 mmol/L, and grade IV-V renal trauma predict nephrectomy. A score ≥ 3 points showed a good performance in this population.
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Affiliation(s)
- Rigoberto Pallares-Mendez
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico.
| | - Daniel Eduardo Cervantes-Miranda
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico
| | | | - Carlos de la Cruz-de la Cruz
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico
| | | | - Adrian Gutierrez-Gonzalez
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico
| | | | - Héctor Mata-Torres
- Department of Legal Surgery, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico
| | - Mario Ochoa-Arvizo
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Fred Montelongo-Rodriguez
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Katherine Lyn Hernandez-Aranda
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Jesús Arturo Cota-Agüero
- Department of Urology, Facultad de Medicina y Hospital Universitario "Dr. Jose Eleuterio Gonzalez". Universidad Autonoma de Nuevo Leon, Av. Madero y Gonzalitos S/N, Mitras Centro, C.P. 64460, Monterrey, Mexico
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CT findings in renovascular injuries following abdominal trauma: a pictorial review. Emerg Radiol 2022; 29:595-604. [PMID: 35122178 DOI: 10.1007/s10140-022-02027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
Abstract
Renal vascular injuries are more devastating than parenchymal injuries alone, thus account for higher injury grade and require prompt recognition. Revised AAST organ injury scale (OIS) for renal trauma has incorporated CT-diagnosed vascular injuries into renal injury grading which includes pseudoaneurysm and arteriovenous fistula, along with addition of some new descriptors of renovascular injury. Dual-phase contrast-enhanced CT (with both arterial and venous phase) can easily pick up renovascular injuries and is the modality of choice for imaging renovascular trauma. Radiologist should be well versed with the imaging findings of renovascular injuries so that accurate injury grading can be done and further management can be planned at the earliest.
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Stein R, Bashir S, Kee-Sampson J. Interventional radiology in renal emergencies: a pictorial essay. Emerg Radiol 2022; 29:409-424. [PMID: 35001206 DOI: 10.1007/s10140-021-02004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/28/2021] [Indexed: 11/25/2022]
Abstract
Renal emergencies necessitate prompt diagnosis and management to stop active bleeding and retain kidney function. Causes of renal emergencies can be classified into traumatic, atraumatic, iatrogenic, and obstructive etiologies. Interventional radiology (IR) has emerged as an acceptable alternative to surgical treatment in the management of renal emergencies due to its minimally invasive nature. With the rise of interventional procedures, there is a need for further discussion of angiographic and fluoroscopic imaging in the setting of renal emergencies.
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Affiliation(s)
- Rachel Stein
- Department of Radiology, University of FL School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA.
| | - Saeed Bashir
- Department of Radiology, University of FL School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
| | - Joanna Kee-Sampson
- Department of Radiology, University of FL School of Medicine - Jacksonville, 655 West 8th Street, C90, 2nd Floor, Clinical Center, Jacksonville, FL, 32209, USA
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Ahn SR, Seo SH, Lee JH, Park CY. Non-Operative Management with Angioembolization of Grade IV and V Renal Injuries in a Hybrid Emergency Room System. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2021.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
<p>Renal injuries occur in more than 10% of patients who sustain blunt abdominal injuries. Non-operative management (NOM) is the established treatment strategy for lowgrade (I–III) renal injuries. However, despite some evidence that NOM can be successfully applied to high-grade (IV, V) renal injuries, it remains unclear whether NOM is appropriate in such cases. The authors report two cases of high-grade renal injuries that underwent NOM after embolization in a hybrid emergency room (ER) system with a 24/7 in-house interventional radiology (IR) team. A 29-year-old male visited Wonkwang University Hospital Regional Trauma Center complaining of right abdominal pain after being hit by a rope. Computed tomography (CT) was performed 16 minutes after arrival, and the CT scan indicated a grade V right renal injury. Arterial embolization was initiated within 31 minutes of presentation. A 56-year-old male was transferred to Wonkwang University Hospital Regional Trauma Center with a complaint of right flank pain. He had initially presented to a nearby hospital after falling from a 3-m height. Thanks to the key CT images sent from the previous hospital prior to the patient’s arrival, angiography was performed within 8 minutes of the patient’s arrival and arterial embolization was completed within 25 minutes. Both patients were treated successfully through NOM with angioembolization and preserved kidneys. Hematoma in the first patient and urinoma in the second patient resolved with percutaneous catheter drainage. The authors believe that the hybrid ER system with an in-house IR team could contribute to NOM and kidney preservation even in high-grade renal injuries.</p>
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White RD, Moore KS, Salahia MG, Thomas WR, Gordon AC, Williams IM, Wood AM, Zealley IA. Renal Arteries Revisited: Anatomy, Pathologic Entities, and Implications for Endovascular Management. Radiographics 2021; 41:909-928. [PMID: 33939544 DOI: 10.1148/rg.2021200162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The renal arteries (RAs) are important vessels that usually arise from the abdominal aorta and supply the kidneys; thus, these arteries play a vital role in physiologic functions such as hemofiltration and blood pressure regulation. An understanding of the basis for embryologic development and the frequently variable anatomy of the RAs is necessary to fully appreciate the range of diseases and the implications for procedural planning. Hemorrhage from an RA is relatively common and is typically traumatic or spontaneous, with the latter form often seen in association with underlying tumors or arteriopathy. Accurate diagnostic evaluation of RA disease due to conditions such as atherosclerosis, fibromuscular dysplasia, vasculitis, aneurysm, arteriovenous shunt, embolic disease, and dissection is dependent on the use of multimodality imaging and is essential for selecting appropriate clinical management, with endovascular therapy having a key role in treatment. Surgical considerations include extra-anatomic renal bypass, which remains an important treatment option even in this era of endovascular therapy, and RA embolization as an adjunct to tumor surgery. A novel area of research interest is the potential role of RA denervation in the management of refractory hypertension. ©RSNA, 2021.
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Affiliation(s)
- Richard D White
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Katherine S Moore
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - M Ghali Salahia
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - W Rhodri Thomas
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Andrew C Gordon
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Ian M Williams
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Andrew M Wood
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
| | - Ian A Zealley
- From the Departments of Radiology (R.D.W., K.S.M., M.G.S., W.R.T., A.C.G., A.M.W.) and Vascular Surgery (I.M.W.), University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales; and Department of Radiology, Ninewells Hospital and Medical School, Dundee, Scotland (I.A.Z.)
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Affiliation(s)
- John Pham
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX
| | - Justine Kemp
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX
| | - Jeffrey Pruitt
- Department of Radiology, Division of Abdominal Imaging, UT Southwestern Medical Center, Dallas, TX.
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Durso AM, Paes FM, Caban K, Danton G, Braga TA, Sanchez A, Munera F. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol 2020; 130:109187. [DOI: 10.1016/j.ejrad.2020.109187] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/11/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
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Chien LC, Herr KD, Archer-Arroyo K, Vakil M, Hanna TN. Review of Multimodality Imaging of Renal Trauma. Radiol Clin North Am 2020; 58:965-979. [PMID: 32792127 DOI: 10.1016/j.rcl.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Blunt trauma accounts for more than 95% of traumatic renal injury and results from shear forces from rapid acceleration or deceleration and/or collision against the spine or ribs. The use of multiphasic contrast-enhanced computed tomography (CT) has proven pivotal in the evaluation and management of traumatic kidney injury, and CT imaging features provide the basis for nonsurgical staging. This article describes the epidemiology and mechanisms of blunt and penetrating traumatic renal injury and reviews the range of findings from various imaging modalities, with a particular emphasis on contrast-enhanced CT.
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Affiliation(s)
- Ling-Chen Chien
- Department of Radiology and Imaging Sciences, Emory University, Emory University School of Medicine, 550 Peachtree Street, Atlanta, GA 30308, USA
| | - Keith D Herr
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA.
| | - Krystal Archer-Arroyo
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA. https://twitter.com/krystal_archer
| | - Mona Vakil
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA. https://twitter.com/MonaVakil
| | - Tarek N Hanna
- Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University, 550 Peachtree Street, Atlanta, GA 30308, USA. https://twitter.com/,ER_Rad_Hanna
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