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Optimization of Selection for Nonoperative Management of Blunt Splenic Injury: Comparison of MDCT Grading Systems

¹ Department of Diagnostic Radiology, University of Maryland School of Medicine, 22 S Greene St., Baltimore, MD 21201.
² Present address: Department of Radiology, Nuffield Orthopaedic Hospital, Oxford, UK.
³ National Study Center for Trauma and Emergency Medical Systems, Baltimore, MD.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —36-year-old man with active splenic bleeding who was admitted after motor vehicle collision. Portal venous phase (A) and renal excretory phase (B) axial maximum-intensity-projection MDCT images show active bleeding (arrowheads) into peritoneum from splenic injury. Active bleeding was increased on delayed image.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —36-year-old man with active splenic bleeding who was admitted after motor vehicle collision. Portal venous phase (A) and renal excretory phase (B) axial maximum-intensity-projection MDCT images show active bleeding (arrowheads) into peritoneum from splenic injury. Active bleeding was increased on delayed image.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —76-year-old woman with splenic vascular injury who was admitted after motor vehicle collision. Portal venous phase (A) and renal excretory phase (B) axial MDCT images show vascular injury (arrowhead, A). Vascular injury loses density from washout of contrast material and becomes isodense with adjacent splenic parenchyma.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —76-year-old woman with splenic vascular injury who was admitted after motor vehicle collision. Portal venous phase (A) and renal excretory phase (B) axial MDCT images show vascular injury (arrowhead, A). Vascular injury loses density from washout of contrast material and becomes isodense with adjacent splenic parenchyma.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Receiver operating characteristic (ROC) curves for arteriography and surgery combined. Diagonal dashed lines indicate 45° angle tangent line marked at point that provides best discrimination between true-positives and false-positives, assuming that false-positives and false-negatives have similar costs. Graph shows ROC curve for American Association for the Surgery of Trauma grade. Area under curve (AUC) = 0.852.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Receiver operating characteristic (ROC) curves for arteriography and surgery combined. Diagonal dashed lines indicate 45° angle tangent line marked at point that provides best discrimination between true-positives and false-positives, assuming that false-positives and false-negatives have similar costs. Graph shows ROC curve for new grading system. AUC = 0.892.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Receiver operating characteristic (ROC) curves for arteriography. Diagonal dashed lines indicate 45° angle tangent line marked at point that provides best discrimination between true-positives and false-positives, assuming that false-positives and false-negatives have similar costs. Graph shows ROC curve for American Association for the Surgery of Trauma grade. Area under curve (AUC) = 0.8199.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Receiver operating characteristic (ROC) curves for arteriography. Diagonal dashed lines indicate 45° angle tangent line marked at point that provides best discrimination between true-positives and false-positives, assuming that false-positives and false-negatives have similar costs. Graph shows ROC curve for new grading system. AUC = 0.8696.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —Receiver operating characteristic (ROC) curves for surgery. Diagonal dashed lines indicate 45° angle tangent line marked at point that provides best discrimination between true-positives and false-positives, assuming that false-positives and false-negatives have similar costs. Graph shows ROC curve for American Association for the Surgery of Trauma grade. Area under curve (AUC) = 0.7918.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —Receiver operating characteristic (ROC) curves for surgery. Diagonal dashed lines indicate 45° angle tangent line marked at point that provides best discrimination between true-positives and false-positives, assuming that false-positives and false-negatives have similar costs. Graph shows ROC curve for new grading system. AUC = 0.81806.

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