Abstract
Purpose
The aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma.
Materials and methods
Three hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium.
Results
The CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable.
Conclusions
CEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.
Riassunto
Obiettivo
Scopo di questo lavoro è stato valutare l’imaging con ecografia con mezzo di contrasto (CEUS) nel sanguinamento attivo nei traumi epatici e splenici.
Materiali e metodi
Trecentonovantadue pazienti con trauma epatico e/o splenico (179 traumi epatici e 217 splenici), sottoposti ad esame CEUS seguito da tomografia computerizzata (CT) con mezzo di contrasto, sono stati arruolati in questo studio retrospettivo per un periodo di più di 4 anni. La CEUS ha rilevato lo stravaso o l’accumulo di mdc nel 16% (63/396) delle lesioni epatiche o spleniche in 61 pazienti, confermato poi dalla TC con mezzo di contrasto. È stata prestata particolare attenzione nell’osservare la presenza, la localizzazione e il carattere dello stravaso o dell’accumulo del mezzo di contrasto.
Risultati
La capacità della CEUS di individuare un sanguinamento attivo non si è dimostrata differente da quella della TC con mezzo di contrasto (p=0.333). Le informazioni ottenute dalla chirurgia, sia dal trattamento minimamente invasivo sia da quello conservativo, presi come riferimento standard, e la sensibilità delle due tecniche non si sono dimostrate differenti (p=0.122). Nelle 63 lesioni in 61 pazienti, la CEUS ha mostrato che il 74,6% (47/63) delle lesioni (21 lesioni epatiche e 26 spleniche) ha presentato stravaso o accumulo di mdc, entrambi all’interno dell’organo o fuori dalla capsula nel 14,3% (9/63) e solo fuori dalla capsula nell’11,1% (7/63). L’imaging CEUS del sanguinamento attivo da traumi epatici e splenici presenta differenti caratteristiche, e le dimensioni e le forme del sanguinamento attivo dovuto allo stravaso o all’accumulo del mezzo di contrasto sono variabili.
Conclusioni
La CEUS può mostrare il sanguinamento attivo associato a trauma epatico e splenico con diverse caratteristiche di imaging, rendendo quindi possibile diagnosticare il sanguinamento attivo.
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References/Bibliografia
Shanmuganathan K, Mirvis SE, Sover ER (1993) Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 161:65–69
Anderson SW, Lucey BC, Rhea JT, Soto JA (2007) 64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation. Emerg Radiol 14:151–159
Yoon W, Jeong YY, Kim JK (2005) CT in blunt liver trauma. Radiographics 25:87–104
Ryan MF, Hamilton PA, Chu P, Hanaghan J (2004) Active extravasation of arterial contrast agent on posttraumatic abdominal computed tomography. Can Assoc Radiol J 55:160–169
Kitase M, Mizutani M, Tomita H et al (2007) Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization. Vasa 36:108–113
Velmahos GC, Demetriades D, Chahwan S et al (1999) Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen. Am J Surg. 178:367–373
Carrillo EH, Wohltmann C, Richardson JD, Polk HC Jr (2001) Evolution in the treatment of complex blunt liver injuries. Curr Probl Surg 38:1–60
Murdock D (2008) Trauma: when there’s no time to count. AORN J 87:322–328
Gao JM, Gao YH, Zeng JB et al (2006) Polytrauma with thoracic and/or abdominal injuries: experience in 1540 cases. Chin J Traumatol 9:108–114
Thorelius L (2004) Contrast-enhanced ultrasound for extrahepatic lesions: preliminary experience. Eur J Radiol 51(Suppl):S31–S38
Tang J, Wang Y, Mei X et al (2007) The value of contrast-enhanced grayscale ultrasound in the diagnosis of hepatic trauma: an animal experiment. J Trauma 62:1468–1472
Tang J, Zhang H, Lv F et al (2008) Percutaneous injection treatment for blunt splenic trauma guided by contrast-enhanced ultrasound. J Ultras Med 27:925–933
Catalano O, Sandomenico F, Raso MM, Siani A (2005) Real-time, contrastenhanced sonography: a new tool for detecting active bleeding. J Trauma 59:933–939
Clevert DA, Weckbach S, Minaifar N et al (2008) Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma. Clin Hemorheol Microcirc 39:155–169
Morel DR, Schwieger I, Hohn L et al (2000) Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging. Invest Radiol 35:80–85
Tang J, Lv F, Li W et al (2008) Contrast-enhanced sonographic guidance for local injection of a hemostatic agent for management of blunt hepatic hemorrhage: a canine study. AJR Am J Roentgenol 191:W107–W111
Oldenburg A, Albrecht T (2008) Baseline and contrast-enhanced ultrasound of the liver in tumor patients. Ultraschall Med 29:488–498
Tang J, Yang JC, Luo Y et al (2008) Enhancement characteristics of benign and malignant focal peripheral nodules in the peripheral zone of the prostate gland studied using contrast-enhanced transrectal ultrasound. Clin Radiol 63:1086–1091
Miele V, Buffa V, Stasolla A et al (2004) Contrast enhanced ultrasound with second-generation contrast agent in traumatic liver lesions. Radiol Med 108:82–91
Valentino M, Serra C, Zironi G et al (2006) Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol 186:1361–1367
Catalano O, Lobianco R, Raso MM, Siani A (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application. J Ultrasound Med 24:299–310
Valentino M, Ansaloni L, Catena F et al (2009) Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med 114:1080–1093
Manetta R, Pistoia ML, Bultrini C et al (2009) Ultrasound enhanced with sulphur-hexafluoride-filled microbubbles agent (SonoVue) in the follow-up of mild liver and spleen trauma. Radiol Med 114:771–779
Catalano O, Cusati B, Nunziata A (2006) Active abdominal bleeding: contrast-enhanced sonography. Abdom Imaging 31:9–16
Marmery H, Shanmuganathan K, Mirvis SE et al (2008) Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg 206:685–693
Fang JF, Chen RJ, Wong YC et al (1998) Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Am J Surg 176:315–319
Fang JF, Chen RJ, Wong YC et al (2000) Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma. J Trauma. 49:1083–1088
Ochsner MG (2001) Factors of failure for nonoperative management of blunt liver and splenic injuries. World Surg 25:1393–1396
Nwomeh BC, Nadler EP, Meza MP (2004) Contrast extravasation predicts the need for operative intervention in children with blunt splenic trauma. J Trauma 56:537–541
Hamilton JD, Kumaravel M, Censullo ML et al (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28:1603–1616
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Lv, F., Tang, J., Luo, Y. et al. Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma. Radiol med 116, 1076–1082 (2011). https://doi.org/10.1007/s11547-011-0680-y
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DOI: https://doi.org/10.1007/s11547-011-0680-y