Keywords:
Trauma, Embolisation, CT-Angiography, Catheter arteriography, Interventional vascular, Pelvis
Authors:
G. Harisis, J. Lee, W. Clements, G. S. Goh; Melbourne/AU
DOI:
10.1594/ranzcr2018/R-0036
Conclusion
Limitations
1. The results of this study are likely confounded by the relatively small sample size in both PV-CT and DB-CT groups.
Several patients with severe pelvic trauma and evidence of bleeding on initial CT were transferred to theatre for operative intervention rather than DSA however were excluded from analysis given a lack of documentation regarding the presence or absence of active bleeding in the operative notes.
2. The median time from trauma CT to DSA was 2.5 and 2 hrs in the PV-CT and DB-CT groups respectively.
It is possible that the active bleeding initially seen on CT may have ceased by the time the subsequent DSA was performed,
artificially increasing the rate of reviewer false positives.
Conclusion
1. Single phase DB-CT yields higher inter-observer agreement in the identification of the types of pelvic bleeding due to trauma (arterial vs venous) when compared to a single phase portal venous scan however individual radiologist accuracy in the identification of arterial vs venous bleeding was not comparatively different between the DBCT and single phase PV-CT.
2. Individual radiologists demonstrate high sensitivity in the identification of any type of bleeding on both DB-CT and single phase PV-CT,
although specificity is comparatively low.
3. Both DB-CT and single phase portal venous scanning yield only 51.9-79% sensitivity in detecting arterial bleeding.
Dual phase arterial and venous phase scanning of the pelvis may yield better results and could be a focus for future studies.