Anderson Stephan W, Varghese Jose C, Lucey Brian C, Burke Peter A, Hirsch Erwin F, Soto Jorge A
Department of Radiology, Boston University Medical Center, Boston, MA 02215, USA.
Radiology. 2007 Apr;243(1):88-95. doi: 10.1148/radiol.2431060376. Epub 2007 Feb 9.
To retrospectively evaluate delayed-phase computed tomography (CT) in the differentiation of active splenic hemorrhage requiring emergent treatment from contained vascular injuries (pseudoaneurysms or arteriovenous fistulas) that can be treated electively or managed conservatively.
The institutional review board approved this HIPAA-compliant retrospective study; the informed consent requirement was waived. Forty-seven patients with blunt splenic injury diagnosed at CT after blunt abdominal trauma were evaluated. Abdominal and pelvic dual-phase CT was performed; images were obtained 60-70 seconds and 5 minutes after contrast material injection. Scans were reviewed in consensus by two radiologists. Splenic injuries were graded with the American Association for the Surgery of Trauma Splenic Injury Scale. Patients with intrasplenic hyperattenuating foci on portal venous phase images were classified as having active splenic hemorrhage (group 1) or a contained vascular injury (group 2) on the basis of delayed-phase imaging findings. Findings suggestive of active hemorrhage included areas that remained hyperattenuating or increased in size on delayed-phase images. The clinical outcome of these patients was determined by reviewing their medical records. Relationships between several factors were tested with the Fisher exact test, including (a) the presence or absence of hyperattenuating foci and management and (b) the presence of contained vascular injury or active extravasation and management.
Portal venous phase CT revealed a focal high-attenuation parenchymal contrast material collection in 19 patients: nine patients were classified as group 1 and 10 were classified as group 2. All patients in group 1 underwent emergent splenectomy, and all patients in group 2 were initially treated without surgery. Significant differences in management were noted on the basis of whether hyperattenuating foci were seen on portal venous phase images (P < .001) and whether hyperattenuating foci seen at portal venous phase imaging were further characterized as active splenic hemorrhage or a contained vascular injury at delayed-phase CT (P < .001).
In blunt splenic injury, delayed-phase CT helps differentiate patients with active splenic hemorrhage from those with contained vascular injuries.
回顾性评估延迟期计算机断层扫描（CT）在鉴别需要紧急治疗的活动性脾出血与可择期治疗或保守处理的局限性血管损伤（假性动脉瘤或动静脉瘘）中的应用。
机构审查委员会批准了这项符合健康保险流通与责任法案（HIPAA）的回顾性研究；豁免了知情同意要求。对47例腹部钝性创伤后CT诊断为钝性脾损伤的患者进行评估。行腹部和盆腔双期CT检查；在注射对比剂后60 - 70秒和5分钟获取图像。由两名放射科医生共同对扫描图像进行评估。脾损伤采用美国创伤外科学会脾损伤分级量表进行分级。根据延迟期成像结果，将门静脉期图像上脾内出现高密度灶的患者分为活动性脾出血组（第1组）或局限性血管损伤组（第2组）。提示活动性出血的表现包括延迟期图像上仍为高密度或体积增大的区域。通过查阅这些患者的病历确定其临床结局。采用Fisher确切概率检验对几个因素之间的关系进行检验，包括（a）高密度灶的有无与处理方式，以及（b）局限性血管损伤或活动性外渗的存在与处理方式。
门静脉期CT显示19例患者脾实质内有局灶性高密度对比剂聚集：9例患者被归为第1组，10例患者被归为第2组。第1组所有患者均接受了急诊脾切除术，第2组所有患者最初均未接受手术治疗。根据门静脉期图像上是否可见高密度灶（P <.001）以及门静脉期成像时所见的高密度灶在延迟期CT上是否进一步表现为活动性脾出血或局限性血管损伤（P <.001），处理方式存在显著差异。
在钝性脾损伤中，延迟期CT有助于区分活动性脾出血患者与局限性血管损伤患者。
