Role of multidetector-row CT in assessing the source of arterial haemorrhage in patients with pelvic vascular trauma. Comparison with angiography

Abstract

Arterial haemorrhage is one of the most serious problems associated with pelvic fracture, and it remains the leading cause of death attributable to such fractures. MDCT provides diagnostic information regarding the presence of small pelvic fractures and, thanks to the contrast-enhanced angiographic technique, it is capable of identifying pelvic bleeding, with the demonstration in some cases of it source. The presence of contrast material extravasation is an indicator of injury to a specific artery passing through the region of the pelvis where the extravasation is noted on MDCT. Urgent angiography and subsequent transcatheter embolisation are the most effective methods for controlling ongoing arterial bleeding in pelvic injuries.

The role of multidetector computed tomography versus digital subtraction angiography in triaging care and management in abdominopelvic trauma

“…CECT had a sensitivity and PPV of 42.9% and 100%, respectively. (17) In the present study, CT angiography was not indicated in our trauma protocol, as the literature did not support the routine use of arterial phase studies in the abdomen and pelvis. In a study by Maturen et al, (14) the authors used PV phase trauma CT alone and had high sensitivity for the detection of active haemorrhage in the chest, abdomen and pelvis.…”

“…(8) Another study by Pinto et al in 2010 examined the role of triphasic CECT (arterial, PV and delayed phases) of the whole body (craniocerebral to pelvic) versus DSA in the assessment of arterial haemorrhage in patients with pelvic vascular trauma. (17) Multidetector CT identified pelvic bleeding in 21 (75.0%) of the 28 patients; most of the cases were detected in the delayed phase. Active arterial extravasation was detected in 12 of the 21 patients and haemorrhage was confirmed on DSA in ten of the 12 patients.…”

“…In a study by Maturen et al, (14) the authors used PV phase trauma CT alone and had high sensitivity for the detection of active haemorrhage in the chest, abdomen and pelvis. Although recent studies by Anderson et al (8) and Pinto et al (17) provide evidence on the role of CT angiography in pelvic trauma, no clear role for CT angiography in abdominal trauma has been shown in the literature. The dual-phase CECT protocol used in the present study is useful in guiding clinical decisions for patients with blunt pelvic trauma, as it is able to provide information on the presence and site of the haemorrhage.…”

Vascular Trauma: New Directions in Screening, Diagnosis and Management

“…CT reveals evidence of bleeding in up to 75% of cases, with arterial sources found in up to 57% of cases. However, the majority of arterial bleeds are due to injuries in branches of the internal iliac, injuries to the iliac arteries themselves are rare (Pinto, et al, 2010;Romano, et al, 2000). It has been noted that triple phase CT scanning (arterial, venous, and portal venous) may result in increased sensitivity and specificity for diagnosis of arterial injury as compared to the typical trauma scan utilizing just the portal venous phase (Vu, et al, 2010).…”

Embolization of Trauma-Associated Pelvic Hemorrhage: Feasibility of Super-Selective Catheterization in Heavily Injured Patients as a Damage Control for Life-Threatening Pelvic Bleeding

“…Currently, multi-detector CTA facilitates rapid and exact image diagnosis for trauma patients (18)(19)(20). Recently developed technically advanced angiography machines equipped with high-resolution digital flat panel detectors are now widely used.…”