title: Computed tomography angiography provides limited benefit in the evaluation of patients with pelvic fractures.
abstract: BACKGROUND
  Computed tomography angiography (CTA) has been applied in imaging studies for the assessment of most abdominal and pelvic injuries in some trauma centers. However, in most institutions, CTA is not routinely performed as part of the computed tomography scan protocol. In this study, we aimed to assess the efficiency of CTA in the evaluation of patients with pelvic fractures.
  
  
  METHODS
  During the study period, patients with pelvic fracture were retrospectively analyzed. In addition to conventional computed tomography scanning that includes only the single venous phase, CTA with an additional arterial phase was used to obtain more information regarding vascular injuries. Further angiographic examination was performed in the patients with positive results in either the arterial or venous phase. The sensitivity and specificity of the multiphasic CTA images in the evaluation of active arterial hemorrhage were investigated. Furthermore, the results obtained for the arterial and venous phases were also combined to evaluate associated active arterial hemorrhage.
  
  
  RESULTS
  A total of 144 patients with pelvic fractures who underwent CTA were enrolled in this study. Of these patients, 49 (34.0%) had active arterial hemorrhage. The sensitivities of the venous and arterial phase CTA images in the evaluation of active arterial hemorrhage were 100% (49/49) and 89.8% (44/49), respectively. Furthermore, all of the patients with positive results based on the arterial phase images were included in the group of patients with positive results based on the venous phase images. Although there were 4 patients without active arterial hemorrhage based on the angiographic examination, they still underwent embolization.
  
  
  CONCLUSIONS
  In the management of patients with pelvic fractures, CTA provides limited benefits in the evaluation of the active arterial hemorrhage. The additional arterial phase may be helpful for distinguishing between arterial and venous hemorrhage. However, this study showed that subsequent treatment was not changed.
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: drfu5564@yahoo.com.tw.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: shangyusubmit@gmail.com.
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: surgymet@gmail.com.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: sckang@adm.cgmh.org.tw.
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Kang
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: yupao@cgmh.org.tw.
authors.forename: Yu-Pao
authors.initials: YP
authors.lastname: Hsu
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: linbc@cgmh.org.tw.
authors.forename: Being-Chuan
authors.initials: BC
authors.lastname: Lin
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: kcyuan@cgmh.org.tw.
authors.forename: Kuo-Ching
authors.initials: KC
authors.lastname: Yuan
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. Electronic address: DETV090@yahoo.com.tw.
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Ouyang
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001158:Arteries / Q000293:injuries*; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000000981:diagnostic imaging*; D006470:Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000293:injuries*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D057772:Vascular System Injuries / Q000150:complications / Q000000981:diagnostic imaging*; D014680:Veins / Q000293:injuries*