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Lanier MH, Mellnick VM. Invited Commentary: Agreement for Blunt Splenic Injuries Has Room for Improvement. Can Assoc Radiol J 2024; 75:26-27. [PMID: 37531212 DOI: 10.1177/08465371231189681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Affiliation(s)
- M Hunter Lanier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
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Spiliopoulos S, Theodosis A, Palialexis K, Efthimiou E, Reppas L, Argentos S, Filippiadis D, Kelekis N, Brountzos E. MDCTA volumetric analysis for the quantification and grading of acute non-cerebral, non-gastrointestinal hemorrhage: a feasibility study. Emerg Radiol 2021; 28:1151-1159. [PMID: 34365575 DOI: 10.1007/s10140-021-01975-6] [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: 05/24/2021] [Accepted: 07/27/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the feasibility of multi-detector computed tomography angiography (MDCTA) volumetry for the quantification and grading of acute non-cerebral, non-gastrointestinal bleeding. METHODS This retrospective, single-center study investigated consecutive patients with MDCTA positive for active non-cerebral, non-gastrointestinal bleeding, between January 2020 and June 2020. Outcome measures were the quantification of active extravasation at the arterial and parenchymal phase using volumetry measurements, the calculation of active bleeding rate and bleeding grading, 30-day mortality rate, identification of independent predictors of mortality and correlation between volumetric analysis, various clinical features, and the decision to proceed with an intervention. RESULTS In total 30 patients (17 females; 56.6%; mean age 70.0 ± 16.0 years) were analyzed. Volumetric analysis was feasible in all cases resulting in excellent inter-observer variability (interclass correlation coefficient 0.999 for arterial and 0.919 for venous volume measurements). Mean volume of contrast extravasation was 1.06 ± 1.09 ml and 3.07 ± 2.48 ml at the arterial and parenchymal phases, respectively. Mean bleeding rate was 6.95 ± 7.82 ml/min. High bleeding volume at arterial phase (grade 4 bleeding) was the only independent predictor of 30-day mortality (HR 1383.58; p = 0.042). There was a positive correlation between bleeding volume at arterial phase (rs = 0.340; p = 0.033) and arterial bleeding rate (rs = 0.381; p = 0.019) with the decision to proceed with an intervention. Bleeding volume of 0.6 ml was the cutoff value for the prediction of intervention (sensitivity 96.3%; specificity 66.7%). CONCLUSIONS MDCTA volumetric analysis for the quantification and grading of acute hemorrhage was feasible with excellent inter-observer agreement. The proposed bleeding grading system could optimize decision making and predict clinical outcomes.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece.
| | - Antonios Theodosis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
| | - Evgenia Efthimiou
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
| | - Stylianos Argentos
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, 1st Rimini St, GR 12461, Chaidari, Athens, Greece
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