title: Volumetric analysis of pelvic hematomas after blunt trauma using semi-automated seeded region growing segmentation: a method validation study.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA. daviddreizin@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Dreizin
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Bodanapally
authors.affiliation: Department of Mathematics and Statistics, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD, 21250, USA.
authors.forename: Nagaraj
authors.initials: N
authors.lastname: Neerchal
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
authors.forename: Nikki
authors.initials: N
authors.lastname: Tirada
authors.affiliation: Emergency Radiology Division, Department of Radiology, Hamilton General Hospital, 237 Barton Street, East Hamilton, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Patlas
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Herskovits
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications*
chemical_list: D003287:Contrast Media
keywords: Bleeding pelvic fractures; Hematoma volume; Manual segmentation; Pelvic trauma; Seeded region growing segmentation; Semi-automated volumetric analysis