Departments of Emergency Medicine.
Orthopedic Surgery.
Ultrasound Q. 2023 Sep 1;39(3):179-185. doi: 10.1097/RUQ.0000000000000621.
In this study, we investigated the feasibility of using contrast-enhanced ultrasound (CEUS) to detect active hemorrhage in patients presenting with soft-tissue hematomas. Adult patients with clinically suspected, actively bleeding hematomas were prospectively enrolled. Contrast-enhanced ultrasound was used to assess for contrast extravasation. Ultrasound results were compared with those of multidetector computed tomographic (MDCT) imaging, operative findings, and clinical course. Sixteen patients (9 women, 7 men; mean age, 69 [SD, 13] years) were enrolled. Thirteen patients underwent MDCT imaging during their initial visit, and for 11, CEUS and computed tomography (CT) findings were concordant. The remaining patients had a negative CEUS study that was consistent with their clinical course. In 8 patients, CT imaging showed active extravasation (6 arterial, 1 indeterminate, 1 slow venous). Contrast-enhanced ultrasound and CT findings were concordant for all cases of arterial bleeding. For 1 patient, CEUS provided superior diagnostic information by identifying a pseudoaneurysm. The 2 discrepant patient cases had a ≥3-hour delay between CT and CEUS, and in 1 patient, CEUS was limited by body habitus. The second patient had no active bleeding identified in the operating room. Compared with CT, CEUS had a sensitivity and specificity of 75% and 100%, respectively, and positive and negative predictive values were 100% and 71%, respectively. Diagnostic accuracy was 85% in this limited study. Contrast-enhanced ultrasound is a promising alternative to MDCT in select patients and may sometimes provide superior clinical information. Limiting factors are large hematoma size, unfavorable anatomic location, and body habitus.
在这项研究中，我们调查了使用对比增强超声（CEUS）检测软组织血肿患者活动性出血的可行性。前瞻性纳入了临床上怀疑有活动性出血的成人血肿患者。使用对比增强超声评估对比剂外渗。将超声结果与多排 CT（MDCT）成像、手术结果和临床过程进行比较。纳入了 16 名患者（9 名女性，7 名男性；平均年龄 69 [标准差 13]岁）。13 名患者在初次就诊时接受了 MDCT 成像，11 名患者的 CEUS 和 CT 检查结果一致。其余患者的 CEUS 检查为阴性，与他们的临床过程一致。8 名患者的 CT 成像显示有活动性外渗（6 例动脉性，1 例不确定，1 例静脉性）。动脉性出血的所有病例中，CEUS 和 CT 检查结果一致。对于 1 名患者，CEUS 通过识别假性动脉瘤提供了更好的诊断信息。2 例不一致的患者病例在 CT 和 CEUS 之间有≥3 小时的延迟，1 例患者的 CEUS 受到体型的限制。另一名患者在手术室中未发现有活动性出血。与 CT 相比，CEUS 的敏感性和特异性分别为 75%和 100%，阳性和阴性预测值分别为 100%和 71%。在这项有限的研究中，诊断准确性为 85%。CEUS 是 MDCT 的一种有前途的替代方法，在某些患者中可能会提供更好的临床信息。限制因素包括血肿大、解剖位置不佳和体型。
