title: Assessing splenomegaly: automated volumetric analysis of the spleen.
abstract: OBJECTIVE
  To define systematic volumetric thresholds to identify and grade splenomegaly and retrospectively evaluate the performance of radiologists to assess splenomegaly in computed tomography (CT) image data.
  
  
  METHODS
  A clinical tool was developed to segment spleens from 172 contrast-enhanced clinical CT studies. There were 45 normal and 127 splenomegaly cases confirmed by radiological reports. Spleen volumes were compared to manual measurements using overlap/error. Volumetric thresholds for mild/massive splenomegaly were defined at 1/2.5 standard deviations above the average splenic volume of the healthy population. The thresholds were validated against consensus reports. The performance of radiologists in assessing splenomegaly was retrospectively evaluated.
  
  
  RESULTS
  The automated segmentation of spleens was robust with volume overlap/error of 95.2/3.3%. There were no significant differences (P > .2) between manual and automated segmentations for either normal/splenomegaly subgroups. Comparable correlations between interobserver and manual-automated measurements were found (r = 0.99 for all). The average volume of normal spleens was 236.89 ± 77.58 mL. For splenomegaly, average volume was 1004.75 ± 644.27 mL. Volumetric thresholds of 314.47/430.84 mL were used to define mild/massive splenomegaly (±18.86 mL, 95% CI). Radiologists disagreed in 23.25% (n = 40) of the diagnosed cases. The area under the receiver operating characteristic curve of the volumetric criterion for splenomegaly detection was 0.96. Using the volumetric thresholds as the reference standard, the sensitivity of radiologists in detecting all/mild/massive splenomegaly was 95.0/66.6/99.0% at 78.0% specificity, respectively.
  
  
  CONCLUSIONS
  Thresholds for the identification and grading of splenomegaly from automatic volumetric spleen assessment were introduced. The volumetric thresholds match well with clinical interpretations for splenomegaly and may improve splenomegaly detection compared with splenic cephalocaudal height measurements or visual inspection commonly used in current clinical practice.
authors.affiliation: Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, 111 Michigan Avenue NW, Washington DC 20010, USA. mlingura@cnmc.org
authors.forename: Marius George
authors.initials: MG
authors.lastname: Linguraru
authors.forename: Jesse K
authors.initials: JK
authors.lastname: Sandberg
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Jones
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Summers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010363:Pattern Recognition, Automated / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging*; D013163:Splenomegaly / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
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