Accuracy of dual bolus single acquisition computed tomography in the diagnosis and grading of adult traumatic splenic parenchymal and vascular injury

Marovic, Paul; Beech, Paul; Koukounaras, Jim; Kavnoudias, Helen; Goh, Gerard S

doi:10.1111/1754-9485.12619

Cited by 10 publications

(8 citation statements)

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“…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. Our institution’s dual‐bolus protocol has been previously described by Marovic et al 4 (see Fig. 1 for further details).…”

Section: Methodsmentioning

confidence: 99%

“…The downside of this technique is the relatively high radiation burden obtained from multiphase scanning 3 . A single‐phase 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 scan 3,4 . CT scanning protocols for trauma patients varies internationally with many centres performing an arterial phase chest (scanning to below the spleen and liver) followed by a portal venous phase abdomen and pelvis.…”

Section: Introductionmentioning

confidence: 99%

“…Occasionally, some multi‐trauma patients were scanned with a multiphase CT (non‐IV contrast, arterial and delayed acquisitions) though this was only performed in a select subset of patients at the discretion of the prescribing radiologist. Previous research assessing the diagnostic accuracy of DB‐CT in splenic vascular injuries demonstrated decreased sensitivity and specificity when compared to sequential multiphase techniques 4 . The purpose of this study was to compare individual radiologist accuracy and inter‐observer variability in the identification of traumatic pelvic bleeding with DB‐CT versus a single‐phase portal venous abdomen CT (PV‐CT).…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma

et al. 2020

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Introduction A single‐phase dual‐bolus CT (DB‐CT) simultaneously opacifies both arterial and venous systems and can be utilised in the trauma setting to aid in the diagnosis of active bleeding while also allowing for optimal assessment of the abdominal and pelvic viscera. Active bleeding can be venous or arterial, the latter being amenable to angiography and potentially embolisation. We aimed to establish the accuracy of single‐phase DB‐CT vs commonly performed portal venous CT (PV‐CT) in the diagnosis of active bleeding when compared to formal digital subtraction angiography as the gold standard. Methods All patients diagnosed with active bleeding on PV‐CT or DB‐CT at a level 1 tertiary centre over a 6‐year period and who subsequently proceeded to digital subtraction angiography (DSA) were included for analysis. The initial CT images were retrospectively reviewed by two consultant interventional radiologists who were blinded to the subsequent outcome of the DSA and to each other’s results. The sensitivity, specificity and inter‐observer agreement between the two readers was then able to be assessed. Results A total of 60 patients were included in the analysis. Sensitivity for the diagnosis for any active bleeding was high for both DB‐CT and PV‐CT (range 88.9%–100%) while diagnosis of specifically arterial bleeding was comparatively lower (51.9%–79%). Inter‐observer agreement for the identification of arterial bleeding was better for DB‐CT (fair) compared to PV‐CT (poor). Conclusion Both PV‐CT and DB‐CT demonstrate high sensitivity in the diagnosis of any active bleeding though identification of specifically arterial bleeding is lower for both scanning methods. Nevertheless, inter‐observer reliability for the identification of arterial bleeding is higher for DB‐CT. Multi‐phase arterial and venous CT may yield better results and could be a focus for future studies.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma

et al. 2020

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“…32 This technique is noninferior to conventional multiphase techniques in diagnosing traumatic injuries in the spleen but variable results in liver trauma. 34 Hence, for patients who are hemodynamically stable, multiphase CT has emerged as a preferred imaging to asses liver trauma and hemorrhage. The major drawback to multiphase imaging is the radiation exposure and time to acquire the images.…”

Section: A Preoperative Evaluationmentioning

confidence: 99%

Contemporary Management of Hepatic Trauma: What IRs Need to Know

Gilyard

Shinn

Nezami

et al. 2020

Semin intervent Radiol

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Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.

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“…This has allowed various vascular injuries to be treated acutely by either open or endovascular techniques, depending on which was more appropriate, and what other injuries may have been present. The increasing use of computed tomography among trauma patients has helped to identify and localize vascular injures, further enabling less invasive treatment [20][21][22][23]. Endovascular techniques by our vascular surgeons have been used to treat injures to the brachial, subclavian, common carotid, and superficial femoral arteries, iliac veins, and thoracic aorta.…”

Section: Introductionmentioning

confidence: 99%

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2018

SCTI

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Recently there has been a lot of attention on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for non-compressible torso hemorrhage and resuscitation in trauma [1][2][3]. This is not the first time that endovascular techniques have been explored for acute trauma care, but REBOA has been the first widely accepted endovascular acute trauma intervention. The excitement over REBOA has opened the door to further discussion regarding other uses of endovascular intervention in trauma patients. Here the techniques used in trauma settings and some of the reported experiences are reviewed. Citation: Fankhauser GT (2018) Increasing Role of Endovascular Techniques in the Management of Vascular Trauma. J Surg Curr Trend Innov 2: 009. AbstractJust as minimally invasive surgical techniques have flourished in general surgery, so too have less invasive techniques become more widespread in vascular surgery. Endovascular techniques are now first-line treatment for many vascular pathologies. Endovascular techniques have been more slowly adopted for vascular injury in trauma surgery, but the trend is starting to change, largely due to the advent of resuscitative endovascular balloon occlusion of the aorta.

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Accuracy of dual bolus single acquisition computed tomography in the diagnosis and grading of adult traumatic splenic parenchymal and vascular injury

Abstract: Dual Bolus Single Acquisition Computed Tomography may lead to reduced radiologist accuracy in the diagnosis of splenic injury, particularly pseudoaneurysm; however, such conclusions remain tentative given the small patient numbers examined.

Cited by 10 publications

References 30 publications

Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma

Accuracy of dual‐bolus CT in the diagnosis of active arterial bleeding in adult pelvic trauma

Contemporary Management of Hepatic Trauma: What IRs Need to Know

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