Atluri Sumanth, Richard Howard M, Shanmuganathan Kathirkamanathan
Department of Radiology, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201, USA.
Emerg Radiol. 2011 Aug;18(4):307-12. doi: 10.1007/s10140-011-0961-8. Epub 2011 May 26.
Nonoperative management of blunt splenic injury is the treatment of choice in hemodynamically stable patients. Detection of vascular injury by multidetector CT (MDCT) is the most significant factor predicting the need for endovascular treatment. This study evaluated the timing of the appearance of vascular lesions during angiography. Images from 20 patients embolized for pseudoaneurysms (PSA) were evaluated. Angiograms were reviewed for phase and timing of PSA. Admission MDCT was reviewed for injury grade and PSA. Initial MDCT evaluation indicated grade III and IV splenic injuries in 9 and 11 patients, respectively. PSA was seen on MDCT in 14/20 (70%) patients. Time from opacification of the aorta to vascular injury was 1.32 s for arterial phase injuries compared with 2.05 s for postcapillary injuries (P=0.097). Angiography demonstrated 15 vascular injuries during the arterial and 5 in the venous phase. Of injuries seen during arterial phase angiography, 10/15 (66%) were identified on MDCT. Of the five injuries that exhibited postcapillary-phase findings, 4/5 (80%) demonstrated PSA (P=0.5). Vascular lesions are a better indicator of subsequent clinical deterioration than splenic injury grade. PSAs are more frequently seen in postcapillary vascular injuries than arterial phase lesions with the current timing of MDCT. In a subset of patients in whom splenic injury grades III and IV warrant angiography, PSAs are not initially demonstrated on MDCT. Therefore, alteration of MDCT timing parameters to better correlate with arterial phase angiography may improve initial diagnosis of vascular injury.
钝性脾损伤的非手术治疗是血流动力学稳定患者的首选治疗方法。通过多排螺旋CT（MDCT）检测血管损伤是预测是否需要血管内治疗的最重要因素。本研究评估了血管造影术中血管病变出现的时间。对20例因假性动脉瘤（PSA）接受栓塞治疗的患者的图像进行了评估。对血管造影图像的PSA分期和出现时间进行了回顾。对入院时的MDCT进行回顾以评估损伤分级和PSA情况。初始MDCT评估显示，分别有9例和11例患者为Ⅲ级和Ⅳ级脾损伤。20例患者中有14例（70%）在MDCT上可见PSA。动脉期损伤从主动脉显影到血管损伤的时间为1.32秒，而毛细血管后损伤为2.05秒（P = 0.097）。血管造影显示动脉期有15处血管损伤，静脉期有5处。在动脉期血管造影中发现的损伤，15例中有10例（66%）在MDCT上被识别。在表现为毛细血管后期表现的5处损伤中，5例中有4例（80%）显示有PSA（P = 0.5）。血管病变比脾损伤分级更能预示随后的临床恶化。按照目前MDCT的检查时间，PSA在毛细血管后血管损伤中比动脉期病变更常见。在脾损伤分级为Ⅲ级和Ⅳ级且需要进行血管造影的部分患者中，MDCT最初未显示PSA。因此，改变MDCT的时间参数以更好地与动脉期血管造影相匹配，可能会改善血管损伤的初始诊断。
