title: Optimizing multidetector CT for visualization of splenic vascular injury. Validation by splenic arteriography in blunt abdominal trauma patients.
abstract: Nonoperative management of blunt splenic injury is the treatment of choice in hemodynamically stable patients. Detection of vascular injury by multidetector CT (MDCT) is the most significant factor predicting the need for endovascular treatment. This study evaluated the timing of the appearance of vascular lesions during angiography. Images from 20 patients embolized for pseudoaneurysms (PSA) were evaluated. Angiograms were reviewed for phase and timing of PSA. Admission MDCT was reviewed for injury grade and PSA. Initial MDCT evaluation indicated grade III and IV splenic injuries in 9 and 11 patients, respectively. PSA was seen on MDCT in 14/20 (70%) patients. Time from opacification of the aorta to vascular injury was 1.32 s for arterial phase injuries compared with 2.05 s for postcapillary injuries (P=0.097). Angiography demonstrated 15 vascular injuries during the arterial and 5 in the venous phase. Of injuries seen during arterial phase angiography, 10/15 (66%) were identified on MDCT. Of the five injuries that exhibited postcapillary-phase findings, 4/5 (80%) demonstrated PSA (P=0.5). Vascular lesions are a better indicator of subsequent clinical deterioration than splenic injury grade. PSAs are more frequently seen in postcapillary vascular injuries than arterial phase lesions with the current timing of MDCT. In a subset of patients in whom splenic injury grades III and IV warrant angiography, PSAs are not initially demonstrated on MDCT. Therefore, alteration of MDCT timing parameters to better correlate with arterial phase angiography may improve initial diagnosis of vascular injury.
authors: Department of Radiology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA.
authors: Sumanth
authors: S
authors: Atluri
authors: Howard M
authors: HM
authors: Richard
authors: Kathirkamanathan
authors: K
authors: Shanmuganathan
references: J Vasc Interv Radiol. 2008 May;19(5):652-6
references: 18440451
references: Radiology. 2007 Apr;243(1):88-95
references: 17293574
references: J Trauma. 2004 Mar;56(3):542-7
references: 15128125
references: J Trauma. 1995 Nov;39(5):818-25; discussion 826-7
references: 7473996
references: J Trauma. 1995 Mar;38(3):323-4
references: 7897707
references: AJR Am J Roentgenol. 1997 Jan;168(1):207-12
references: 8976947
references: AJR Am J Roentgenol. 2007 Dec;189(6):1421-7
references: 18029880
references: Radiographics. 1999 Nov-Dec;19(6):1465-85
references: 10555669
references: Radiology. 1998 Jan;206(1):137-42
references: 9423663
references: Eur Radiol. 2008 Jun;18(6):1206-14
references: 18270712
references: Emerg Radiol. 2005 Nov;11(6):348-52
references: 16344976
references: J Thorac Imaging. 2010 May;25(2):161-7
references: 20463535
references: J Trauma. 2001 May;50(5):835-42
references: 11371838
references: J Trauma. 2000 Aug;49(2):177-87; discussion 187-9
references: 10963527
references: J Trauma. 2001 Feb;50(2):230-6
references: 11242286
references: Eur J Radiol. 2011 Dec;80(3):692-8
references: 21111553
references: J Trauma. 2005 Mar;58(3):492-8
references: 15761342
references: Am Surg. 2009 Feb;75(2):133-9
references: 19280806