Semi-Automated Trajectory Analysis of Deep Ballistic Penetrating Brain Injury

ABSTRACTBackground: Penetrating head injuries (PHIs) are common in combat operations and most have visible wound paths on computed tomography (CT). Objective: We assess agreement between an automated trajectory analysis-based assessment of brain injury and manual tracings of encephalomalacia on CT. Methods: We analyzed 80 head CTs with ballistic PHI from the Institutional Review Board approved Vietnam head injury registry. Anatomic reports were generated from spatial coordinates of projectile entrance and terminal fragment location. These were compared to manual tracings of the regions of encephalomalacia. Dice's similarity coefficients, kappa, sensitivities, and specificities were calculated to assess agreement. Times required for case analysis were also compared. Results: Results show high specificity of anatomic regions identified on CT with semiautomated anatomical estimates and manual tracings of tissue damage. Radiologist's and medical students' anatomic region reports were similar (Kappa 0.8, t-tes...