CT criteria for management of blunt liver trauma: correlation with angiographic and surgical findings.
OBJECTIVE
To determine the contrast material-enhanced computed tomographic (CT) criteria for selection of hemodynamically stable patients with blunt hepatic injury for angiographic evaluation.


METHODS
Seventy-two patients with blunt liver injury underwent CT and hepatic angiography. Hepatic injuries were graded with CT-based classification. Scans were assessed for evidence of contrast extravasation and laceration or contusion extending into the hepatic vein(s), inferior vena cava, porta hepatis, or gallbladder fossa. Medical, angiographic, and surgical records were reviewed to determine angiographic findings, surgical indications and findings, and outcomes.


RESULTS
Compared with hepatic angiography, CT was 65% (11 of 17 patients) sensitive and 85% (41 of 48 patients) specific for detection of arterial vascular injury. When CT severity grades 2 and 3 were analyzed, the sensitivity and specificity of CT were 100% (three of three patients) and 94% (34 of 36 patients), respectively (P <.001). Injury involving at least one major hepatic vein was found in 15 (88%) of 17 patients who required liver-related surgery and in 23 (42%) of 55 of the other patients (P <.01).


CONCLUSIONS
CT-based criteria, including hepatic injury grade, signs of arterial vascular injury, and presence or absence of major hepatic venous involvement assists in selecting patients for hepatic angiography and those at increased risk of ongoing or delayed hepatic bleeding or other posttraumatic complications.
Departments of Diagnostic Radiology, University of Maryland Medical Center and Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201, USA.
P A
PA
Poletti
S E
SE
Mirvis
K
K
Shanmuganathan
K L
KL
Killeen
D
D
Coldwell
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001158:Arteries / Q000293:injuries; D016009:Chi-Square Distribution; D003287:Contrast Media; D003288:Contusions / Q000000981:diagnostic imaging; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D005704:Gallbladder / Q000293:injuries; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006503:Hepatic Veins / Q000293:injuries; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000293:injuries; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy
D003287:Contrast Media