Mark Foley MD, Presenter: Nothing to Disclose

Felipe Munera MD, Abstract Co-Author: Nothing to Disclose

Luis Rivas MD, Abstract Co-Author: Nothing to Disclose

Michelle Gina Ferrari MD, Abstract Co-Author: Nothing to Disclose

Robert P. Henry MD, Abstract Co-Author: Nothing to Disclose

Kim M. Caban MD, Abstract Co-Author: Nothing to Disclose

To determine if whole body CT angiography in arterial phase alone can confidently identify injuries to the solid organs of the abdomen in the setting of severe blunt polytrauma or if an additional phase of scanning is necessary to improve sensitivity, specificity, and positive and negative predictive values.

102 Consectutive CT angiograms performed in a level one trauma center from Feb 7 2010 to March 10 2010 of the whole body performed for blunt trauma were reviewed in only the arterial phase using a consensus approach.  The portal venous phase images of the upper abdomen were subsequently reviewed at a separate date.  The complete datasets comprising of the arterial, portal venous phase studies, and multiplanar reformatted images as well as 5 minute delayed phase studies when available were then reviewed as per our institutes standard protocol.  Clinical information including discharge summaries and operative notes were also reviewed.

 Of the 102 Trauma protocol CT angiograms performed, a total of 17 solid organ injuries were identified involving the liver (6) spleen (6) and kidney (5). Arterial phase scanning alone suggested a total of 20 solid organ injuries involving the liver (8) , spleen (7) and kidney (5). Portal venous phase scanning suggested 19 organ injuries involving the liver (8) spleen (6) and kidney (5). None of the true injuries were missed on reviewing either the arterial or portal phase scans alone, however there was a tendency to overcall liver and splenic injuries in the early arterial phase scan, likely secondary to heterogeneous splenic enhancement and arterial phase enhancement of the liver.

 Whole body CT angiography performed only in arterial phase does not appear to miss significant injuries involving the solid organs of the abdomen (liver, spleen and kidney) while also providing a means to adequately evaluate the large arteries of the neck, chest, abdomen and pelvis. There is however a tendency to overcall injuries to the liver and spleen on arterial phase scanning suggesting that a selective acquisition of a second phase pass through the upper abdomen may be necessary for clarification in cases with positive findings.  

Arterial phase CT angiography alone in blunt trauma is effective for identifying injuries to the solid organs of the abdomen, however with a higher false positive rate than dual phase scanning.

Foley, M, Munera, F, Rivas, L, Ferrari, M, Henry, R, Caban, K, Whole Body CT Angiography for Blunt Trauma: The Role of Dual Phase Image Acquisition for Solid Abdominal Organ Injury Evaluation.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008737.html