Do we really need the arterial phase on CT in pelvic trauma patients?

Abstract

Purpose To evaluate whether an arterial phase scan improves the diagnostic performance of computed tomography to identify pelvic trauma patients who received angiographic intervention on demand of the trauma surgeon. Methods This retrospective single-center study was performed at an academic Scandinavian trauma center with approximately 2000 trauma admissions annually. Pelvic trauma patients with arterial and portal venous phase CT from 2009 to 2015 were included. The patients were identified from the institutional trauma registry. Images were interpreted by two radiologists with more than 10 years of trauma radiology experience. Positive findings for extravasation on portal venous phase alone or on both arterial and portal venous phase were compared, with angiographic intervention as clinical outcome. Results One hundred fifty-seven patients (54 females, 103 males) with a median age of 45 years were enrolled. Sixteen patients received angiographic intervention. Positive CT findings on portal venous phase only had a sensitivity and specificity of 62% and 86%, vs. 56% and 93% for simultaneous findings on arterial and portal venous phase. Specificity was significantly higher for positive findings in both phases compared with portal venous phase only. Applying a threshold > 0.9 cm of extravasation diameter to portal venous phase only resulted in sensitivity and specificity identical to those of both phases. Conclusion Arterial phase scan in addition to portal venous phase scan did not improve patient selection for angiography. Portal venous phase extravasation size alone may be used as an imaging-based biomarker of the need for angiographic intervention.

Haemoperitoneum secondary to rupture of a superficial vein on a subserosal uterine fibroid: a case report

“…In our patient, only portal venous phase images were taken and hence extravasation could not be identified. Arterial phase CT is not routinely performed even in trauma patients, unless the attending physician specifically orders it to investigate extravasation from bleeding vessels, as arterial phase requires higher radiation doses and slightly more time to perform 10 . Therefore, dual-phase CT (combined arterial and portal venous CT) should be ordered for patients with a large uterine fibroid presenting with unexplained haemoperitoneum when patients are haemodynamically stable to undergo CT of the abdomen and pelvis.…”

Contrast-enhanced Computed Tomography Versus Contrast and Non-contrast Enhanced Computed Tomography for Detecting Blunt Abdominal Injury

“…Each CECT phase has a clear benefit for detecting different organ injuries. The arterial phase is useful for evaluating vascular injury, and identifying active bleeding, pseudoaneurysms, and arteriovenous fistulas that require treatment 9,10 . The portalvenous or nephrographic phase, which is used in routine studies, is the most suitable phase for evaluating the visceral parenchyma in solid organ injury, while the excretory phase is critical for evaluating the pelvicalyceal system [10][11][12] .…”