Mandlik Veronika, Prantl Lukas, Schreyer Andreas G
Center of Plastic-, Hand- and Reconstructive Surgery, University Hospital Regensburg, Germany.
Department of Radiology, University Hospital Regensburg, Germany.
Rofo. 2019 Jan;191(1):25-32. doi: 10.1055/a-0628-7095. Epub 2018 Jun 18.
Contrast extravasation events in daily radiological routine may lead to serious complications, especially during CT examinations. The resulting symptoms may vary from local pain up to skin ulcers, necrosis or even acute compartment syndrome.There are no uniformly accepted radiological guidelines or recommendations regarding detection and treatment of extravasation events and immanent complications in a timely manner.
Systematic literature research considering the last 35 years via PubMed using search terms "contrast medium extravasation/paravasation".
In the literature, there are conservative management approaches of contrast media extravasation without major evidence base, such as unguent dressings, cooling or splinting. This therapy is mostly symptomatic. Additionally, various invasive techniques are described. We discuss these techniques in the context of contemporary literature, such as the hyaluronidase Injection into the site of extravasation, suction/aspiration technique including flushing of the affected tissue areas and the squeezing technique. However, most citations lack scientific evidence: many articles include anecdotal enumerations, case studies or cite publications from the era, when ionic high osmolar contrast media was state-of-the-art. Besides, many authors derive their extravasation management from studies, where agents other than contrast media were investigated.
After detailed literature review, we suggest early (plastic) surgical consultation when non-ionic, low-osmolar contrast medium extravasation is about 150 cc or more. In case of extravasation less than 150 cc but in presence of additional symptoms such as impaired perfusion or altered sensibility, the (plastic) surgeon should also be consulted instantly. We do not recommend any invasive first line therapy when contrast media extravasation is less than 150 cc and the patient presents no additional symptoms, besides swelling and local pain. Nevertheless continuous monitoring and accurate conservative management such as active cooling and elevation, splinting of the affected extremity are mandatory as early detection of critical symptoms helps to initiate prompt surgical intervention and avoid sequelae.
· Morbidity after contrast media extravasation is extremely rare.. · Predicting sequelae after contrast extravasation is difficult at first sight.. · Treatments such as hyaluronidase injection, suction/aspiration, squeeze technique have been described.. · Surgical consultation is recommended for extravasation > 150 cc or when additional symptoms occur..
· Mandlik V, Prantl L, Schreyer AG. Contrast Media Extravasation in CT and MRI - A Literature Review and Strategies for Therapy. Fortschr Röntgenstr 2019; 191: 25 - 32.
在日常放射检查中，造影剂外渗事件可能会导致严重并发症，尤其是在CT检查期间。由此产生的症状可能从局部疼痛到皮肤溃疡、坏死甚至急性骨筋膜室综合征不等。目前尚无关于及时检测和治疗外渗事件及潜在并发症的统一认可的放射学指南或建议。
通过PubMed系统检索过去35年的文献，检索词为“造影剂外渗/旁渗”。
文献中存在造影剂外渗的保守处理方法，但缺乏主要的证据基础，如使用软膏敷料、冷敷或夹板固定。这种治疗大多只是对症处理。此外，还描述了各种侵入性技术。我们结合当代文献讨论了这些技术，如向外渗部位注射透明质酸酶、抽吸技术（包括冲洗受影响的组织区域）和挤压技术。然而，大多数引用缺乏科学证据：许多文章只是轶事列举、病例研究或引用离子型高渗造影剂为最新技术时的出版物。此外，许多作者的外渗处理方法源自对造影剂以外的其他药物进行研究的文献。
经过详细的文献综述，我们建议当非离子型低渗造影剂外渗量达到或超过150毫升时，应尽早（请整形外科医生）会诊。如果外渗量小于150毫升，但存在如灌注受损或感觉改变等其他症状，也应立即咨询（整形外科）医生。当造影剂外渗量小于150毫升且患者除肿胀和局部疼痛外无其他症状时，我们不建议进行任何侵入性一线治疗。尽管如此，持续监测和准确的保守处理，如积极冷敷、抬高患肢、对受影响肢体进行夹板固定等是必要的，因为早期发现关键症状有助于及时启动手术干预并避免后遗症。
·造影剂外渗后的发病率极其罕见。·乍一看，预测造影剂外渗后的后遗症很困难。·已描述了如注射透明质酸酶、抽吸/吸引、挤压技术等治疗方法。·外渗量>150毫升或出现其他症状时建议进行手术会诊。
·曼德利克V，普兰特尔L，施雷耶AG。CT和MRI中的造影剂外渗——文献综述与治疗策略。《德国放射学进展》2019年；191:25 - 32。
