title: The utility of CT for predicting bile leaks in hepatic trauma.
abstract: The purpose of this study was to determine the efficacy of CT to predict the development of bile leaks in hepatic trauma. This HIPAA-compliant retrospective study was IRB approved and consent was waived. All patients who sustained hepatic trauma between January 1, 2006, and January 31, 2012, and who underwent CT and hepatobiliary scans during the same hospital admission were included. One hundred and thirty-two patients met the inclusion criteria. Comparison between the presence of biliary injury relative to American Association for the Surgery of Trauma (AAST) hepatic injury grade and mean distance of the hepatic laceration to the inferior vena cava (IVC) was made. The ability of free fluid to predict bile injury was analyzed. Forty-one (31 %) of the 132 patients had positive hepatobiliary scans. Of these 41 patients, seven (17 %) sustained low-grade and 34 (83 %) sustained high-grade hepatic injury compared with the 37 (41 %) low-grade and 54 (59 %) high-grade hepatic injuries in the negative hepatobiliary scan group. The mean distance to the IVC was 2.4 cm (SD 2.9 cm) and 3.6 cm (SD 3.3 cm) in patients with and without bile leaks, respectively. A statistically significant difference in the proportion of high-grade injuries and the mean distance from the IVC between the two groups was identified. The presence of free fluid on CT is sensitive, but not specific, for detecting a bile leak. CT findings, including AAST liver injury grade and location of the liver laceration, are able to predict which patients are at risk for developing bile leaks as seen on hepatobiliary scintigraphy, whereas the presence of free fluid is not.
authors.affiliation: Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 820 Harrison Ave, Boston, MA, 02118, USA, christina.lebedis@bmc.org.
authors.forename: Christina A
authors.initials: CA
authors.lastname: LeBedis
authors.forename: Stephan W
authors.initials: SW
authors.lastname: Anderson
authors.forename: Gustavo
authors.initials: G
authors.lastname: Mercier
authors.forename: Steven
authors.initials: S
authors.lastname: Kussman
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Coleman
authors.forename: Louis
authors.initials: L
authors.lastname: Golden
authors.forename: David R
authors.initials: DR
authors.lastname: Penn
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Uyeda
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Soto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000814:Aniline Compounds; D001646:Bile; D003287:Contrast Media; D005260:Female; D005998:Glycine; D006801:Humans; D007098:Imino Acids; D015601:Injury Severity Score; D022125:Lacerations / Q000000981:diagnostic imaging; D008099:Liver / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D019785:Technetium Tc 99m Disofenin; D014057:Tomography, X-Ray Computed; D014283:Triiodobenzoic Acids; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*
chemical_list: D000814:Aniline Compounds; D003287:Contrast Media; D007098:Imino Acids; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D014283:Triiodobenzoic Acids; C034837:technetium Tc 99m mebrofenin; C054871:ioversol; D019785:Technetium Tc 99m Disofenin; D005998:Glycine