Alexis Rose Boscak MD, Presenter: Nothing to Disclose

Kathirkamanathan Shanmuganathan MD, Abstract Co-Author: Nothing to Disclose

Stuart E. Mirvis MD, Abstract Co-Author: Nothing to Disclose

Thorsten Roger Fleiter MD, Abstract Co-Author: Nothing to Disclose

Lisa Anne Miller MD, Abstract Co-Author: Nothing to Disclose

Clint W. Sliker MD, Abstract Co-Author: Nothing to Disclose

Scott David Steenburg MD, Abstract Co-Author: Nothing to Disclose

Melvin Alexander, Abstract Co-Author: Nothing to Disclose

There is no consensus regarding optimal CT protocol for assessment of abdominal injury after blunt trauma. The goal of this study was to compare use of a single arterial (ART) or single portal venous (P-V) phase scan versus a combined dual-phase protocol in order to determine which optimally demonstrates blunt splenic injuries including contained vascular injury (CVI including pseudoaneurysm and arteriovenous fistula), active bleeding (AB) and parenchymal injury.

Admission MDCT protocol for blunt abdominal trauma at our institution includes ART as well as P-V phase scans. 30 cases of angiographically-proven CVI, 30 cases of splenic AB, 30 cases of splenic parenchymal injury without vascular lesion, and 30 cases without splenic injury on admission CT were identified from the radiology database. The 120 total cases were randomized into six sets of 20 cases. Six radiologists reviewed their assigned 20 cases on three separate occasions: interpreting ART phase images only, P-V phase images only, and ART and P-V phases together. Phases were reviewed for presence or absence of CVI, AB and splenic parenchymal injury, with grading of phase/study quality and diagnostic confidence.

ART phase MDCT was more sensitive than P-V phase CT (85% versus 44%), and more accurate (91% versus 84%), but less specific (94% versus 100%) for diagnosis of CVI. ART phase MDCT was less sensitive and accurate than P-V phase CT for active bleeding (82% and 94% versus 95% and 97%) and parenchymal injury (90% and 91% versus 96% and 97%), with similar specificity (98-100%). For all types of splenic injury studied, review of ART and P-V phases together provided better sensitivity, specificity and accuracy than either phase alone.

ART phase CT is superior to P-V phase CT for demonstration of splenic CVI after blunt abdominal trauma, but P-V phase provides better depiction of active bleeding and splenic parenchymal injury; using both ART phase and P-V phase images provides optimal assessment of splenic injury.

MDCT with both arterial and portal venous phase imaging is required for optimal diagnosis of blunt splenic injury; arterial phase imaging improves sensitivity for demonstration of splenic CVI.

Boscak, A, Shanmuganathan, K, Mirvis, S, Fleiter, T, Miller, L, Sliker, C, Steenburg, S, Alexander, M, Optimizing Trauma MDCT Protocol for Blunt Splenic Injury: Need for Arterial and Portal Venous Phase Scans.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005950.html