How Good Is CT Active Extravasation for Pelvic Fracture Arterial Injury?

January 9, 2020

Written by Clay Smith

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CT with contrast was 80% sensitive for detecting arterial injury with contrast extravasation. Subgroup analysis considering 64-slice scanners or better found sensitivity was 94%, specificity 89%.

Why does this matter?
Angiographic embolization (AE) is an early approach to stop arterial hemorrhage from pelvic fractures. Active extravasation of IV contrast on CT is one indication that arterial injury is present. The other cause of massive hemorrhage from pelvic fractures is oozing from the pelvic venous plexus. Venous bleeding tends to improve with reduction of pelvic volume and external fixation. Arterial injury benefits from AE. How accurate is CT for picking up active extravasation and need for AE?

“My broken relationship with the pelvis makes me blush.” External Pudendal Artery
This was a meta-analysis of 23 studies to determine the diagnostic accuracy of CT with contrast to detect extravasation of contrast in the setting of pelvic fractures compared with the gold standard of arterial bleeding on subsequent angiography and need for AE. Studies went back to 1996. Twelve had <64-slice scanners. Taking all studies into account, sensitivity was 80%, specificity 95%. The authors performed several subgroup analyses. In the subgroup of studies with 64-slice or better CT scanners (7 studies), the sensitivity was 94% (95%CI 86 to 97%); specificity 89% (95%CI 81 to 93%). Multiphasic vs monophasic (single scan) sequences improved the diagnostic accuracy for all studies. Of course, multiphasic means more time and radiation exposure as well. In short, CT with contrast in current generation scanners is a good test to determine if AE will be needed in trauma patients with pelvic fractures.

Source
Diagnostic value of CT contrast extravasation for major arterial injury after pelvic fracture: A meta-analysis. Am J Emerg Med. 2019 Nov 28. pii: S0735-6757(19)30777-6. doi: 10.1016/j.ajem.2019.11.038. [Epub ahead of print]

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