Contribution of Three-Dimensional Reconstructions from CT-Scan for Assessing the Factors Associated with Blunt Splenic Injury Severity

Abstract

Purpose Analysis of influence of anthropomorphometry, splenic variability and crash’s circumstances on the severity of splenic injury. Methods Seventy-seven patients with blunt splenic trauma had a tomodensitometry at time of admission. Localisation, type, and lesion’s severity (AAST classification), were determined. Severe splenic lesion was defined by: Grade 4 or 5, lesion of entire parenchyma, or fracture. Three-dimensional splenic segmentation allowed calculation of volume, orientation (colatitude and azimuth), morphometry, morphology and span of hilar vessels. Anthropometric parameters were: Age, gender, BMI, and morphotype. Relationships between spleen, stomach, liver and 10th left rib were detailed. Results In univariate analysis, splenic parameters for a severer lesion were: Orientation of hilar side turned towards vertebral column (azimuth, p=0.05), spread conformation of hilar vessels (p=0.10), and high splenic volume (p=0.06). The younger the patient, the more severe was the splenic lesion (p=0.07). A full stomach and a left liver overflowing in the left hypochondrium, were associated with low gravity splenic lesion, (p=0.02 and p=0.03). In multivariable analysis, injured patients whose hilar area was vertically oriented, were more at risk of severe splenic lesion (OR=0.92, 95% CI (0.85-0.99), p=0.02). An abdominal-shaped liver was associated with low gravity splenic lesion (OR= 0.13, 95% CI (0.02-0.93), p=0.04). Conclusions Topographic and morphologic variability of the spleen condition its vulnerability in trauma cases. Using this analysis and the biomechanical behaviour of splenic tissue will allow for the creation of a splenic numerical model, and its integration in the virtual human scientific application of modern traumatology.