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...
Methods and materials
This retrospective study was conducted at a level 1 tertiary trauma centre in Melbourne,
Australia with institutional ethics approval. Patients over a 6 year period who underwent a single phase trauma portal venous CT abdomen and pelvis (first 3 year period) or dual-bolus CT abdomen and pelvis (second 3 year period) and were diagnosed with active bleeding were included (See Figure 1 for details of the dual bolus protocol).
Of these patients,
only those that subsequently proceeded to digital subtraction angiography (DSA) were included for...
Table 1provides a summary of patient data from the different scanning methods between the first and second 3 year periods.
The median time to DSA following the initial trauma CT (rather than mean) was used as a better representation of the central value.
Radiologist accuracy in identifying bleeding of any source
Table 2provides a summary of individual radiologist accuracy in the diagnosis of active pelvic bleeding of any source.
Sensitivity for the identification of active bleeding was high for both radiologists while specificity...
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...
Vascular and intervenational radiology in blunt abdominopelvic trauma- institutional practice and review of the literature.
J Trauma Treat.
2016; 5: 324
Pelvic CT angiography: application to blunt trauma using 64MDCT.
Whole body 16-row multislice CT in emergency room: effects of different protocols and scanning time,
image quality and radiation exposure.