Shanmuganathan K, Mirvis S E, Sover E R
Department of Diagnostic Radiology, University of Maryland Medical Center, Baltimore 21201.
AJR Am J Roentgenol. 1993 Jul;161(1):65-9. doi: 10.2214/ajr.161.1.8517323.
The purpose of this retrospective study was to evaluate the use of contrast-enhanced CT to show sites of active hemorrhage as a guide for surgical or angiographic treatment in patients sustaining blunt abdominal or pelvic trauma.
Twenty-six CT scans were reviewed to compare the location or locations of extravasated contrast material (representing hemorrhage) detected on CT scans with the site or sites of active hemorrhage determined by surgery (eight patients), angiography (14 patients), or autopsy (one patient). (The three remaining patients had no additional studies done.) The attenuation of extravasated contrast material on CT scans was measured and compared with the CT attenuation of an adjacent artery. The attenuation of clotted blood within the abdomen or pelvis was also measured in 20 other patients with blunt trauma.
The locations of active bleeding as determined by extravasation of contrast material shown on CT scans included the pelvis (nine), spleen (five), retroperitoneum (four), kidney (three), liver (three), adrenal glands (one), and abdominal wall (one). Two patients had venous extravasation. The origin of bleeding was confirmed in all cases to correspond to the anatomic region in which extravasated contrast material was shown by CT. Three patients had only CT evidence of vascular extravasation of contrast material. The CT attenuation of active hemorrhage ranged from 85 to 370 H (mean, 132 H). A review of 20 additional CT scans that showed clotted blood in the abdomen or pelvis resulting from blunt abdominal trauma revealed a CT attenuation range of 40-70 H (mean, 51 H). These values were significantly different (p < .001) from the values for active hemorrhage.
Active extravasation of contrast material (representing bleeding) can be detected in trauma patients who are physiologically stable enough to undergo CT of the abdomen or pelvis. Extravasated contrast material can be distinguished from clotted blood by measuring CT attenuation. CT accurately shows the anatomic location of bleeding and indicates the probable vascular origin. CT, therefore, can be used as a guide for angiographic or surgical intervention.
本回顾性研究的目的是评估使用对比增强CT显示活动性出血部位，以此作为钝性腹部或盆腔创伤患者手术或血管造影治疗的指导。
回顾了26例CT扫描，以比较CT扫描上检测到的造影剂外渗（代表出血）的位置与通过手术（8例患者）、血管造影（14例患者）或尸检（1例患者）确定的活动性出血部位。（其余3例患者未进行其他检查。）测量CT扫描上造影剂外渗的衰减，并与相邻动脉的CT衰减进行比较。还对另外20例钝性创伤患者腹部或盆腔内凝血块的衰减进行了测量。
CT扫描显示造影剂外渗所确定的活动性出血部位包括骨盆（9例）、脾脏（5例）、腹膜后（4例）、肾脏（3例）、肝脏（3例）、肾上腺（1例）和腹壁（1例）。2例患者为静脉外渗。所有病例中出血的起源均被证实与CT显示造影剂外渗的解剖区域相对应。3例患者仅CT有造影剂血管外渗的证据。活动性出血的CT衰减范围为85至370 H（平均132 H）。回顾另外20例显示钝性腹部创伤导致腹部或盆腔内凝血块的CT扫描，发现CT衰减范围为40 - 70 H（平均51 H）。这些值与活动性出血的值有显著差异（p < .001）。
在生理状况稳定到足以接受腹部或盆腔CT检查的创伤患者中，可以检测到造影剂的活动性外渗（代表出血）。通过测量CT衰减，可将外渗的造影剂与凝血块区分开来。CT能准确显示出血的解剖位置并提示可能的血管起源。因此，CT可作为血管造影或手术干预的指导。
