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
Purpose
Pelvic bleeding from traumatic injury is a major cause of morbidity and mortality in trauma patients1.
CT angiography can be performed using arterial,
portal venous and delayed phases to not only identify the presence of bleeding but to also characterize its nature (arterial vs venous) and to assess for the presence of associated findings such as pseudoaneurysms and AV fistulae2.
The downside of this technique is the relatively high radiation burden obtained from multiphase scanning3.
A dual-bolus IV contrast CT (DB-CT) opacifies both the portal venous and the arterial systems simultaneously in an attempt to decrease scan time and radiation dose as compared to a standard 2 or 3-phase CT scan3,4.
In mid 2014,
our institution adopted the DB-CT protocol for all trauma patients,
where prior to this,
the majority of trauma CTs were performed as an arterial phase chest followed by a portal venous phase abdomen and pelvis.
Previous research assessing the diagnostic accuracy of the DB-CT in splenic vascular injuries demonstrated decreased radiologist sensitivity and specificity when compared to sequential multiphase techniques4. The purpose of this study is to compare individual radiologist accuracy and inter-observer variability in the identification of traumatic pelvic bleeding with DB-CT versus a single phase trauma portal venous abdomen (PV-CT).