Dormagen Johann B, Tötterman Anna, Røise Olav, Sandvik Leiv, Kløw Nils-E
Department of Radiology, Oslo University Hospital - Ullevål, Oslo, Norway.
Acta Radiol. 2010 Feb;51(1):107-16. doi: 10.3109/02841850903286703.
Immediate angiography is warranted in pelvic trauma patients with suspected arterial injury (AI) in order to stop ongoing bleeding. Prior to angiography, plain pelvic radiography (PPR) and abdominopelvic computer tomography (CT) are performed to identify fracture and hematoma sites.
To investigate if PPR and CT can identify the location of AI in trauma patients undergoing angiography.
95 patients with pelvic fractures on PPR (29 women, 66 men), at a mean age of 44 (9-92) years, underwent pelvic angiography for suspected AI. Fifty-six of them underwent CT additionally. Right and left anterior and posterior fractures on PPR were registered, and fracture displacement was recorded for each quadrant. Arterial blush on CT was registered, and the size of the hematoma in each region was measured in cm(2). AIs were registered for anterior and posterior segments of both internal iliac arteries. Presence of fractures, arterial blush, and hematomas were correlated with AI.
Presence of fracture in the corresponding skeletal segment on PPR showed sensitivity and specificity of 0.86 and 0.58 posteriorly, and 0.87 and 0.44 anteriorly. The area under the curve (AUC) was 0.77 and 0.69, respectively. Fracture displacement on PPR >0.9 cm posteriorly and >1.9 cm anteriorly revealed specificity of 0.84. Sensitivities of arterial blush and hematoma on CT were 0.38 and 0.82 posteriorly, and 0.24 and 0.82 anteriorly. The specificities were 0.96 and 0.58 posteriorly, and 0.79 and 0.53 anteriorly, respectively. For hematomas, the AUC was 0.79 posteriorly and 0.75 anteriorly. Size of hematoma >22 cm(2) posteriorly and >29 cm(2) anteriorly revealed specificity of 0.85 and 0.86, respectively.
CT findings of arterial blush and hematoma predicted site of arterial bleeding on pelvic angiography. Also, PPR predicted the site of bleeding using location of fracture and size of displacement. In the hemodynamically unstable patient, PPR may contribute equally to effective assessment of injured arteries.
对于怀疑有动脉损伤（AI）的骨盆创伤患者，应立即进行血管造影以停止持续出血。在血管造影之前，需进行骨盆平片（PPR）和腹部盆腔计算机断层扫描（CT）以确定骨折和血肿部位。
研究PPR和CT能否识别接受血管造影的创伤患者中AI的位置。
95例PPR显示有骨盆骨折的患者（29例女性，66例男性），平均年龄44岁（9 - 92岁），因怀疑AI接受了骨盆血管造影。其中56例还接受了CT检查。记录PPR上左右前后方骨折情况，并记录每个象限的骨折移位情况。记录CT上的动脉造影剂外渗情况，并测量每个区域血肿的大小（以平方厘米为单位）。记录双侧髂内动脉前后段的AI情况。骨折、动脉造影剂外渗和血肿的存在情况与AI进行相关性分析。
PPR上相应骨骼段存在骨折时，后方的敏感性和特异性分别为0.86和0.58，前方为0.87和0.44。曲线下面积（AUC）分别为0.77和0.69。PPR上后方骨折移位>0.9 cm和前方>1.9 cm时，特异性为0.84。CT上动脉造影剂外渗和血肿的敏感性后方分别为0.38和0.82，前方为0.24和0.82。特异性后方分别为0.96和0.58，前方为0.79和0.53。对于血肿，后方的AUC为0.79，前方为0.75。后方血肿大小>22平方厘米和前方>29平方厘米时，特异性分别为0.85和0.86。
CT上动脉造影剂外渗和血肿的表现可预测骨盆血管造影时动脉出血的部位。此外，PPR可利用骨折位置和移位大小预测出血部位。在血流动力学不稳定的患者中，PPR可能同样有助于有效评估受损动脉。
