title: Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients.
abstract: BACKGROUND
  To determine the accuracy of contrast-enhanced multidetector CT (MDCT) in demonstrating splenic vascular injury based on results of splenic angiography and operation.
  
  
  METHODS
  This institutional review board-approved study included 392 hemodynamically stable blunt trauma patients whose admission MDCTs demonstrated splenic injury. Images were assessed for parenchymal injury grade, hemoperitoneum volume, and evidence of bleeding and nonbleeding splenic vascular injury. Splenic arteriography was performed for high splenic injury grade and splenic vascular injury. Medical records were reviewed to determine arteriographic interpretation, surgery indications and findings, outcomes, and demographics. Sensitivity, specificity, predictive values, and accuracy of MDCT in detecting vascular injury were calculated based on results of arteriography and operation.
  
  
  RESULTS
  Splenic vascular injury was seen in 22% of patients (86 of 392) on MDCT. Presence of a vascular injury correlated with the CT-based parenchymal splenic injury grade (p < 0.0001). Active splenic bleeding was associated with subsequent clinical deterioration (p < 0.0001). Overall, MDCT had a sensitivity of 76% (76 of 100); specificity of 90% (95 of 106); negative and positive predictive values of 80% (95 of 119) and 87% (76 of 87), respectively; and accuracy of 83% (171 of 206) in detecting vascular injury compared with reference standards. The success rate of nonoperative management was 96%.
  
  
  CONCLUSIONS
  MDCT provides valuable information to direct initial clinical management of patients with blunt splenic trauma by demonstrating both active bleeding and nonbleeding vascular injuries. Not all vascular injuries are detected on MDCT, and splenic angiography is still indicated for high-grade parenchymal injury.
authors.affiliation: Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Marmery
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Mirvis
authors.forename: Howard
authors.initials: H
authors.lastname: Richard
authors.forename: Clint
authors.initials: C
authors.lastname: Sliker
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Miller
authors.forename: James M
authors.initials: JM
authors.lastname: Haan
authors.forename: David
authors.initials: D
authors.lastname: Witlus
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery