Abstract
Objective
Manually segmented traumatic pelvic hematoma volumes are strongly predictive of active bleeding at conventional angiography, but the method is time intensive, limiting its clinical applicability. We compared volumetric analysis using semi-automated region growing segmentation to manual segmentation and diameter-based size estimates in patients with pelvic hematomas after blunt pelvic trauma.
Materials and methods
A 14-patient cohort was selected in an anonymous randomized fashion from a dataset of patients with pelvic binders at MDCT, collected retrospectively as part of a HIPAA-compliant IRB-approved study from January 2008 to December 2013. To evaluate intermethod differences, one reader (R1) performed three volume measurements using the manual technique and three volume measurements using the semi-automated technique. To evaluate interobserver differences for semi-automated segmentation, a second reader (R2) performed three semi-automated measurements. One-way analysis of variance was used to compare differences in mean volumes. Time effort was also compared. Correlation between the two methods as well as two shorthand appraisals (greatest diameter, and the ABC/2 method for estimating ellipsoid volumes) was assessed with Spearman’s rho (r).
Results
Intraobserver variability was lower for semi-automated compared to manual segmentation, with standard deviations ranging between ±5–32 mL and ±17–84 mL, respectively (p = 0.0003). There was no significant difference in mean volumes between the two readers’ semi-automated measurements (p = 0.83); however, means were lower for the semi-automated compared with the manual technique (manual: mean and SD 309.6 ± 139 mL; R1 semi-auto: 229.6 ± 88.2 mL, p = 0.004; R2 semi-auto: 243.79 ± 99.7 mL, p = 0.021). Despite differences in means, the correlation between the two methods was very strong and highly significant (r = 0.91, p < 0.001). Correlations with diameter-based methods were only moderate and nonsignificant. Mean semi-automated segmentation time effort was 2 min and 6 s and 2 min and 35 s for R1 and R2, respectively, vs. 22 min and 8 s for manual segmentation.
Conclusion
Semi-automated pelvic hematoma volumes correlate strongly with manually segmented volumes. Since semi-automated segmentation can be performed reliably and efficiently, volumetric analysis of traumatic pelvic hematomas is potentially valuable at the point-of-care.
Similar content being viewed by others
References
Rothe JH, Grieser C, Lehmkuhl L, et al. (2013) Size determination and response assessment of liver metastases with computed tomography—comparison of RECIST and volumetric algorithms. Eur J Radiol 82:1831–1839
Monsky WL, Kim I, Loh S, et al. (2010) Semiautomated segmentation for volumetric analysis of intratumoral ethiodol uptake and subsequent tumor necrosis after chemoembolization. Am J Roentgenol 195:1220–1230
Monsky W, Garza A, Kim I, et al. (2011) treatment planning and volumetric response assessment for yttrium-90 radioembolization: semiautomated determination of liver volume and volume of tumor necrosis in patients with hepatic malignancy. Cardiovasc Intervent Radiol 34:306–318
Fabel M, von Tengg-Kobligk H, Giesel FL, et al. (2008) Semi-automated volumetric analysis of lymph node metastases in patients with malignant melanoma stage III/IV-A feasibility study. Eur Radiol 18:1114–1122
IntelliSpace Portal (ISP): Advanced visualization for real-time radiology (brochure). In: Koninklijke Philips Electronics NV, 2012
Syngo.via—Get the full picture: the 3D routine and advanced reading solution (brochure). In: Siemens AG, 2013
iNtuition: Sophistication and power in the datacenter. Simplicity and elegance at your fingertips (brochure). In: TeraRecon, Inc., 2013
Becher R, Colonna A, Enniss T, et al. (2012) An innovative approach to predict the development of adult respiratory distress syndrome in patients with blunt trauma. J Trauma Acute Care Surg 73:1229–1235
Freeman W, Barrett K, Bestic J, et al. (2008) Computer-assisted volumetric analysis compared with ABC/2 method for assessing warfarin-related intracranial hemorrhage volumes. Neurocrit Care 9:307–312
Bardera A, Boada I, Feixas M, et al. (2009) Semi-automated method for brain hematoma and edema quantification using computed tomography. Comput Med Imaging Graph 33:304–311
Yoon W, Kim JK, Jeong YY, et al. (2004) Pelvic arterial hemorrhage in patients with pelvic fractures: detection with contrast-enhanced CT. RadioGraphics 24:1591–1605
Demetriades D, Karaiskakis M, Toutouzas K, et al. (2002) Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg 195:1–10
Holstein J, Culemann U, Pohlemann T (2012) What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res 470:2090–2097
Heckbert S, Vedder N, Hoffman W, et al. (1998) Outcome after hemorrhagic shock in trauma patients. J Trauma 45:545–549
Sathy AK, Starr AJ, Smith WR, et al. (2009) the effect of pelvic fracture on mortality after trauma: an analysis of 63,000 trauma patients. J Bone Joint Surg 91:2803–2810
Dreizin D, Munera F (2012) Blunt polytrauma: evaluation with 64-section whole-body CT angiography. RadioGraphics 32:609–631
Blackmore C, Jurkovich GJ, Linnau KF, et al. (2003) Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg 138:504–509
Rubin GD (2000) Data explosion: the challenge of multidetector-row CT. Eur J Radiol 36:74–80
Cullinane DC, Schiller HJ, Zielinski MD, et al. (2011) Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture—update and systematic review. Journal of Trauma and Acute Care Surgery 71:1850–1868
Brown CV, Kasotakis G, Wilcox A, et al. (2005) Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture? Am Surg 71:759–762
Elzik ME, Dirschl DR, Dahners LE (2006) Correlation of transfusion volume to change in hematocrit. Am J Hematol 81:145–146
Miller PR, Moore PS, Mansell E, Meredith JW, Chang MC (2003) External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by markers of arterial hemorrhage. J Trauma Acute Care Surg 54:437–443
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
Edward H. Herskovits has equity in Galileo Clinical Decision Support, Inc.
Ethical approval
This work was part of a larger study approved by our institutional review board and was carried out in accordance with established national and international guidelines for ethical research.
Rights and permissions
About this article
Cite this article
Dreizin, D., Bodanapally, U.K., Neerchal, N. et al. Volumetric analysis of pelvic hematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study. Abdom Radiol 41, 2203–2208 (2016). https://doi.org/10.1007/s00261-016-0822-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-016-0822-8