title: Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography.
abstract: OBJECTIVE
  To assess the ability of contrast enhanced computed tomography (CECT) to detect active hemorrhage and other vascular injuries in chest, abdominal, and pelvic trauma patients, using angiographic findings and need for intervention as paired gold standards.
  
  
  METHODS
  We obtained approval from the Institutional review board for a retrospective search of the radiology information system: seeking trauma patients undergoing angiography within 24 hours of CECT for chest, abdominal, or pelvic injuries. CECT protocol was standard trauma CT, not specialized for CT angiography. Angiographic techniques varied with indication. Clinical and imaging reports and selected radiologic studies were reviewed, but the original dictated report was the interpretive standard. We used Fisher's exact test for statistical analysis.
  
  
  RESULTS
  During the 30-month study period, 466 patients underwent emergent interventional radiologic procedures. Of those, 418 were excluded for nontrauma indications or neuroangiographic procedures. Fourty-eight patients (33 male, 15 female, average age 43.4) thus constituted the study population in whom we evaluated 63 traumatic injuries. CT findings had statistically significant associations (p < 0.0001) with both angiographic evidence of active hemorrhage and the need for intervention, which were tabulated separately. CT had 94.1% sensitivity and 97.6% negative predictive value (NPV) for detection of active hemorrhage, and 92.6% sensitivity and 91.2% NPV for predicting need for surgical or endovascular intervention.
  
  
  CONCLUSIONS
  CECT findings correlate strongly with angiographic findings, though sensitivity remains imperfect. However, when CT is used in the context of other clinical features, particularly hemodynamic instability, it may enable clinicians to reserve emergent angiography for those patients in whom emergent intervention is planned.
authors.affiliation: Department of Radiology, Stanford University Hospital and Clinics, Stanford, CA 94305-5105, USA. katematuren@yahoo.com
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Maturen
authors.forename: Saroja
authors.initials: S
authors.lastname: Adusumilli
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Blane
authors.forename: Saman
authors.initials: S
authors.lastname: Arbabi
authors.forename: David M
authors.initials: DM
authors.lastname: Williams
authors.forename: James T
authors.initials: JT
authors.lastname: Fitzgerald
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Vine
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001808:Blood Vessels / Q000293:injuries*; D003287:Contrast Media; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000098:blood supply / Q000293:injuries*; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007472:Iohexol