title: Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans.
abstract: OBJECTIVE
  To retrospectively compare the diagnostic performance of arterial, portal venous, and dual-phase computed tomography (CT) for blunt traumatic splenic injury.
  
  
  METHODS
  Informed consent was waived for this institutional review board-approved, HIPAA-compliant study. Retrospective record review identified 120 blunt trauma patients (87 male [72.5%] 33 female [27.5%]; age range, 18-94 years) who had undergone dual-phase abdominal CT within 5 years, including 30 without splenic injury, 30 with parenchymal injury only, 30 with splenic active bleeding, and 30 with intrasplenic pseudoaneurysm. Six radiologists each performed blinded review of 20 different cases, and scored the presence of pseudoaneurysm, active bleeding, parenchymal injury, and hematoma; 20 cases were interpreted by all radiologists. Data analysis included calculation of diagnostic performance measures with confidence intervals, areas under receiver operating characteristic curves, and interobserver agreement/variability.
  
  
  RESULTS
  For intrasplenic pseudoaneurysm, arterial phase imaging was more sensitive (70% [21 of 30] vs 17% [five of 30]; P < .0002) and more accurate (87% [78 of 90] vs 72% [65 of 90]; P = .0165) than portal venous phase imaging. For active bleeding, arterial phase imaging was less sensitive (70% [21 of 30] vs 93% [28 of 30]; P = .0195) and less accurate (89% [80 of 90] vs 98% [88 of 90]; P = .0168) than portal venous phase imaging. For parenchymal injury, arterial phase CT was less sensitive (76% [68 of 90] vs 93% [84 of 90]; P = .001) and less accurate (81% [nine of 120] vs 95% [114 of 120]; P = .0008) than portal venous phase CT. For all injuries, dual-phase review was equivalent to or better than single-phase review.
  
  
  CONCLUSIONS
  For CT evaluation of blunt splenic injury, arterial phase is superior to portal venous phase imaging for pseudoaneurysm but inferior for active bleeding and parenchymal disruption; dual-phase CT provides optimal overall performance.
authors: Department of Diagnostic Radiology, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201, USA.
authors: Alexis R
authors: AR
authors: Boscak
authors: Kathirkamanathan
authors: K
authors: Shanmuganathan
authors: Stuart E
authors: SE
authors: Mirvis
authors: Thorsten R
authors: TR
authors: Fleiter
authors: Lisa A
authors: LA
authors: Miller
authors: Clint W
authors: CW
authors: Sliker
authors: Scott D
authors: SD
authors: Steenburg
authors: Melvin
authors: M
authors: Alexander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging; D003287:Contrast Media; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000000981:diagnostic imaging; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011172:Portography; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media; D007472:Iohexol