title: Comparison of MDCT protocols in trauma patients with suspected splenic injury: superior results with protocol that includes arterial and portal venous phase imaging.
abstract: OBJECTIVE
  We aimed to determine which intravenous contrast-enhanced multidetector computed tomography (MDCT) protocol produced the most accurate results for the detection of splenic vascular injury in hemodynamically stable patients who had sustained blunt abdominal trauma.
  
  
  METHODS
  We retrospectively reviewed 88 patients from 2003 to 2011 who sustained blunt splenic trauma and underwent contrast-enhanced MDCT and subsequent angiography. Results of MDCT scans utilizing single phase (portal venous only, n=8), dual phase (arterial + portal venous or portal venous + delayed, n=42), or triple phase (arterial + portal venous + delayed, n=38) were compared with results of subsequent splenic angiograms for the detection of splenic vascular injury.
  
  
  RESULTS
  Dual phase imaging was more sensitive and accurate than single phase imaging (P = 0.016 and P = 0.029, respectively). When the subsets of dual phase imaging were compared, arterial + portal venous phase imaging was more sensitive and accurate than portal venous + delayed phase imaging (P = 0.005 and P = 0.002, respectively). Triple phase imaging was more accurate (P = 0.015) than dual phase; however, when compared with the dual phase subset of arterial + portal venous, there was no statistical difference in either sensitivity or accuracy.
  
  
  CONCLUSIONS
  Our results support the use of dual phase contrast-enhanced MDCT, which includes the arterial phase, in patients with suspected splenic injury and question the utility of obtaining a delayed sequence.
authors.affiliation: Departments of Radiology and Acute Care Surgical Service, Virginia Commonwealth University Medical Center, Richmond, VA, USA. MelikianR@vcu.edu.
authors.forename: Raymond
authors.initials: R
authors.lastname: Melikian
authors.forename: Stephanie
authors.initials: S
authors.lastname: Goldberg
authors.forename: Brian James
authors.initials: BJ
authors.lastname: Strife
authors.forename: Robert A
authors.initials: RA
authors.lastname: Halvorsen
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D003287:Contrast Media / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011169:Portal Vein / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013157:Splenic Artery / Q000293:injuries*; D013162:Splenic Vein / Q000293:injuries*; D057772:Vascular System Injuries / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D003287:Contrast Media