Optimizing trauma multidetector CT protocol for blunt splenic injury: Need for arterial and portal venous phase scans

Alexis R. Boscak, Kathirkamanathan Shanmuganathan, Stuart E. Mirvis, Thorsten R. Fleiter, Lisa A. Miller, Clint W. Sliker, Scott Steenburg, Melvin Alexander

Research output: Contribution to journalArticle

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Abstract

Purpose: To retrospectively compare the diagnostic performance of arterial, portal venous, and dual-phase computed tomography (CT) for blunt traumatic splenic injury. Materials and Methods: Informed consent was waived for this institutional review board-approved, HIPAA-compliant study. Retrospective record review identified 120 blunt trauma patients (87 male [72.5%] 33 female [27.5%]; age range, 18-94 years) who had undergone dual-phase abdominal CT within 5 years, including 30 without splenic injury, 30 with parenchymal injury only, 30 with splenic active bleeding, and 30 with intrasplenic pseudoaneurysm. Six radiologists each performed blinded review of 20 different cases, and scored the presence of pseudoaneurysm, active bleeding, parenchymal injury, and hematoma; 20 cases were interpreted by all radiologists. Data analysis included calculation of diagnostic performance measures with confidence intervals, areas under receiver operating characteristic curves, and interobserver agreement/variability. Results: For intrasplenic pseudoaneurysm, arterial phase imaging was more sensitive (70% [21 of 30] vs 17% [five of 30]; P , .0002) and more accurate (87% [78 of 90] vs 72% [65 of 90]; P = .0165) than portal venous phase imaging. For active bleeding, arterial phase imaging was less sensitive (70% [21 of 30] vs 93% [28 of 30]; P = .0195) and less accurate (89% [80 of 90] vs 98% [88 of 90]; P = .0168) than portal venous phase imaging. For parenchymal injury, arterial phase CT was less sensitive (76% [68 of 90] vs 93% [84 of 90]; P = .001) and less accurate (81% [nine of 120] vs 95% [114 of 120]; P = .0008) than portal venous phase CT. For all injuries, dual-phase review was equivalent to or better than single-phase review. Conclusion: For CT evaluation of blunt splenic injury, arterial phase is superior to portal venous phase imaging for pseudoaneurysm but inferior for active bleeding and parenchymal disruption; dual-phase CT provides optimal overall performance.

Original languageEnglish
Pages (from-to)79-88
Number of pages10
JournalRadiology
Volume268
Issue number1
DOIs
StatePublished - Jul 2013

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Nonpenetrating Wounds
Multidetector Computed Tomography
False Aneurysm
Tomography
Wounds and Injuries
Hemorrhage
Health Insurance Portability and Accountability Act
Observer Variation
Research Ethics Committees
Informed Consent
ROC Curve
Hematoma
Confidence Intervals

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Boscak, A. R., Shanmuganathan, K., Mirvis, S. E., Fleiter, T. R., Miller, L. A., Sliker, C. W., ... Alexander, M. (2013). Optimizing trauma multidetector CT protocol for blunt splenic injury: Need for arterial and portal venous phase scans. Radiology, 268(1), 79-88. https://doi.org/10.1148/radiol.13121370

Optimizing trauma multidetector CT protocol for blunt splenic injury : Need for arterial and portal venous phase scans. / Boscak, Alexis R.; Shanmuganathan, Kathirkamanathan; Mirvis, Stuart E.; Fleiter, Thorsten R.; Miller, Lisa A.; Sliker, Clint W.; Steenburg, Scott; Alexander, Melvin.

In: Radiology, Vol. 268, No. 1, 07.2013, p. 79-88.

Research output: Contribution to journalArticle

Boscak, AR, Shanmuganathan, K, Mirvis, SE, Fleiter, TR, Miller, LA, Sliker, CW, Steenburg, S & Alexander, M 2013, 'Optimizing trauma multidetector CT protocol for blunt splenic injury: Need for arterial and portal venous phase scans', Radiology, vol. 268, no. 1, pp. 79-88. https://doi.org/10.1148/radiol.13121370
Boscak, Alexis R. ; Shanmuganathan, Kathirkamanathan ; Mirvis, Stuart E. ; Fleiter, Thorsten R. ; Miller, Lisa A. ; Sliker, Clint W. ; Steenburg, Scott ; Alexander, Melvin. / Optimizing trauma multidetector CT protocol for blunt splenic injury : Need for arterial and portal venous phase scans. In: Radiology. 2013 ; Vol. 268, No. 1. pp. 79-88.
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abstract = "Purpose: To retrospectively compare the diagnostic performance of arterial, portal venous, and dual-phase computed tomography (CT) for blunt traumatic splenic injury. Materials and Methods: Informed consent was waived for this institutional review board-approved, HIPAA-compliant study. Retrospective record review identified 120 blunt trauma patients (87 male [72.5{\%}] 33 female [27.5{\%}]; age range, 18-94 years) who had undergone dual-phase abdominal CT within 5 years, including 30 without splenic injury, 30 with parenchymal injury only, 30 with splenic active bleeding, and 30 with intrasplenic pseudoaneurysm. Six radiologists each performed blinded review of 20 different cases, and scored the presence of pseudoaneurysm, active bleeding, parenchymal injury, and hematoma; 20 cases were interpreted by all radiologists. Data analysis included calculation of diagnostic performance measures with confidence intervals, areas under receiver operating characteristic curves, and interobserver agreement/variability. Results: For intrasplenic pseudoaneurysm, arterial phase imaging was more sensitive (70{\%} [21 of 30] vs 17{\%} [five of 30]; P , .0002) and more accurate (87{\%} [78 of 90] vs 72{\%} [65 of 90]; P = .0165) than portal venous phase imaging. For active bleeding, arterial phase imaging was less sensitive (70{\%} [21 of 30] vs 93{\%} [28 of 30]; P = .0195) and less accurate (89{\%} [80 of 90] vs 98{\%} [88 of 90]; P = .0168) than portal venous phase imaging. For parenchymal injury, arterial phase CT was less sensitive (76{\%} [68 of 90] vs 93{\%} [84 of 90]; P = .001) and less accurate (81{\%} [nine of 120] vs 95{\%} [114 of 120]; P = .0008) than portal venous phase CT. For all injuries, dual-phase review was equivalent to or better than single-phase review. Conclusion: For CT evaluation of blunt splenic injury, arterial phase is superior to portal venous phase imaging for pseudoaneurysm but inferior for active bleeding and parenchymal disruption; dual-phase CT provides optimal overall performance.",
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AU - Fleiter, Thorsten R.

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N2 - Purpose: To retrospectively compare the diagnostic performance of arterial, portal venous, and dual-phase computed tomography (CT) for blunt traumatic splenic injury. Materials and Methods: Informed consent was waived for this institutional review board-approved, HIPAA-compliant study. Retrospective record review identified 120 blunt trauma patients (87 male [72.5%] 33 female [27.5%]; age range, 18-94 years) who had undergone dual-phase abdominal CT within 5 years, including 30 without splenic injury, 30 with parenchymal injury only, 30 with splenic active bleeding, and 30 with intrasplenic pseudoaneurysm. Six radiologists each performed blinded review of 20 different cases, and scored the presence of pseudoaneurysm, active bleeding, parenchymal injury, and hematoma; 20 cases were interpreted by all radiologists. Data analysis included calculation of diagnostic performance measures with confidence intervals, areas under receiver operating characteristic curves, and interobserver agreement/variability. Results: For intrasplenic pseudoaneurysm, arterial phase imaging was more sensitive (70% [21 of 30] vs 17% [five of 30]; P , .0002) and more accurate (87% [78 of 90] vs 72% [65 of 90]; P = .0165) than portal venous phase imaging. For active bleeding, arterial phase imaging was less sensitive (70% [21 of 30] vs 93% [28 of 30]; P = .0195) and less accurate (89% [80 of 90] vs 98% [88 of 90]; P = .0168) than portal venous phase imaging. For parenchymal injury, arterial phase CT was less sensitive (76% [68 of 90] vs 93% [84 of 90]; P = .001) and less accurate (81% [nine of 120] vs 95% [114 of 120]; P = .0008) than portal venous phase CT. For all injuries, dual-phase review was equivalent to or better than single-phase review. Conclusion: For CT evaluation of blunt splenic injury, arterial phase is superior to portal venous phase imaging for pseudoaneurysm but inferior for active bleeding and parenchymal disruption; dual-phase CT provides optimal overall performance.

AB - Purpose: To retrospectively compare the diagnostic performance of arterial, portal venous, and dual-phase computed tomography (CT) for blunt traumatic splenic injury. Materials and Methods: Informed consent was waived for this institutional review board-approved, HIPAA-compliant study. Retrospective record review identified 120 blunt trauma patients (87 male [72.5%] 33 female [27.5%]; age range, 18-94 years) who had undergone dual-phase abdominal CT within 5 years, including 30 without splenic injury, 30 with parenchymal injury only, 30 with splenic active bleeding, and 30 with intrasplenic pseudoaneurysm. Six radiologists each performed blinded review of 20 different cases, and scored the presence of pseudoaneurysm, active bleeding, parenchymal injury, and hematoma; 20 cases were interpreted by all radiologists. Data analysis included calculation of diagnostic performance measures with confidence intervals, areas under receiver operating characteristic curves, and interobserver agreement/variability. Results: For intrasplenic pseudoaneurysm, arterial phase imaging was more sensitive (70% [21 of 30] vs 17% [five of 30]; P , .0002) and more accurate (87% [78 of 90] vs 72% [65 of 90]; P = .0165) than portal venous phase imaging. For active bleeding, arterial phase imaging was less sensitive (70% [21 of 30] vs 93% [28 of 30]; P = .0195) and less accurate (89% [80 of 90] vs 98% [88 of 90]; P = .0168) than portal venous phase imaging. For parenchymal injury, arterial phase CT was less sensitive (76% [68 of 90] vs 93% [84 of 90]; P = .001) and less accurate (81% [nine of 120] vs 95% [114 of 120]; P = .0008) than portal venous phase CT. For all injuries, dual-phase review was equivalent to or better than single-phase review. Conclusion: For CT evaluation of blunt splenic injury, arterial phase is superior to portal venous phase imaging for pseudoaneurysm but inferior for active bleeding and parenchymal disruption; dual-phase CT provides optimal overall performance.

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