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

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.