MSCT Detection of active arterial contrast extravasation after blunt abdominal trauma in polytraumatized patients

Ziele: The purpose of this study was to evaluate the use of a standardized contrast-enhanced MSCT examination to show sites of active haemorrhage as a guide for conservative, surgical or angiographic treatment in patients sustaining blunt abdominal or pelvic trauma. Methode: Retrospectively, 375 patients (01/2000–08/2003) with initial diagnosis „polytrauma“ underwent a standardized MS-CT examination. MS-CT scans were performed with a Lightspeed QX/i®(GE) using collimation of 5.0mm, pitch 1.5 (High Speed), RI 2, FOV diaphragm – pelvis. In all patients 120ml contrast-agent was injected with a flow-rate of 3,5ml/s. The scans were started with a delay of 70s. Benefits of MS-CT and especially in vascular injuries various postprocessing algorithms (MPR) were displayed. Ergebnis: In 14/375 (4%) patients an active extravasation of contrast agent as reference of an active haemorrhage was detected. The locations of active haemorrhage as determined by extravasation of contrast agent shown on MSCT scans included the abdomen (spleen, liver, kidney)-9/14 (64%), pelvis –2/14 (14%), retroperitoneum –1/14 (8%), and abdominal/thoracic wall –2/14 (14%). The origin of haemorrhage was confirmed in all cases to correspond to the anatomic region in which extravasated contrast agent was shown by MSCT. The CT attenuation of active haemorrhage was in all cases greater than 100 H, in comparison clotted blood showed CT attenuation of 70–90H. Schlussfolgerung: MSCT examination rapidly can detect active blood extravasation in polytraumatized hemodynamicly stable patients. MSCT accurately shows the anatomic location of haemorrhage and the probable vascular origin. CT imaging findings consequently can be used as a guide for angiographic or surgical treatment.

Key words

MSCT - Polytrauma - Kontrastmittel - aktive Extravasation