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Emergency Radiology |
1 From the Departments of Diagnostic Radiology (P.A.P., S.E.M., K.S., K.L.K.) and Interventional Radiology (D.C.), University of Maryland Medical Center and Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; and the Department of Radiology, Division of Diagnostic and Interventional Radiology, University Hospital of Geneva, Switzerland (P.A.P.). Received July 15, 1999; revision requested September 21; revision received December 29; accepted January 12, 2000. Address correspondence to S.E.M. (e-mail: smirvis@rad1.ummc.umaryland.edu).
PURPOSE: To determine the contrast material–enhanced computed tomographic (CT) criteria for selection of hemodynamically stable patients with blunt hepatic injury for angiographic evaluation.
MATERIALS AND METHODS: Seventy-two patients with blunt liver injury underwent CT and hepatic angiography. Hepatic injuries were graded with CT-based classification. Scans were assessed for evidence of contrast extravasation and laceration or contusion extending into the hepatic vein(s), inferior vena cava, porta hepatis, or gallbladder fossa. Medical, angiographic, and surgical records were reviewed to determine angiographic findings, surgical indications and findings, and outcomes.
RESULTS: Compared with hepatic angiography, CT was 65% (11 of 17 patients) sensitive and 85% (41 of 48 patients) specific for detection of arterial vascular injury. When CT severity grades 2 and 3 were analyzed, the sensitivity and specificity of CT were 100% (three of three patients) and 94% (34 of 36 patients), respectively (P < .001). Injury involving at least one major hepatic vein was found in 15 (88%) of 17 patients who required liver-related surgery and in 23 (42%) of 55 of the other patients (P < .01).
CONCLUSION: CT-based criteria, including hepatic injury grade, signs of arterial vascular injury, and presence or absence of major hepatic venous involvement assists in selecting patients for hepatic angiography and those at increased risk of ongoing or delayed hepatic bleeding or other posttraumatic complications.
Index terms: Liver, angiography, 761.1242 • Liver, CT, 761.12112 • Liver, hemorrhage, 952.7192 • Liver, injuries, 761.41, 952.412
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