Does Delayed Phase Imaging in CT Angiography Provide Additional Information in Patients with Suspected Active Bleeding?

Overview

Journal Emerg Radiol

Specialties Emergency Medicine
Radiology

Date 2024 May 17

PMID 38760647

Authors

Mihran Khdhir

Youssef Ghosn

Yara Jabbour

Nada Abbas

Ziad Tarcha

Mohamad Kayali

Riad Khouzami

Mustafa Natout

Nadim Muallem

Affiliations

Soon will be listed here.

Abstract

Purpose: We hypothesize that delayed phase imaging does not provide additional diagnostic information in patients who undergo multi-phasic CTA for suspected active bleeding.

Methods: Data on patients who underwent multiphasic CTA (pre-contrast, arterial, porto-venous, and delayed phases) for suspected acute bleed were retrospectively collected between January 2019 and November 2021. CTA images were reviewed by a general radiologist, an interventional radiologist, and a body imaging radiologist independently. Each reader evaluated if delayed phase images provided additional information that would change the final impression of the CTA report. Additional information regarding bleeding location, time needed for delayed image acquisition, and radiation exposure were also obtained.

Results: A total of 104 patients with CTAs were analyzed with an average age of 58 years ± 22. Studies rated with absent additional findings on delayed images were 102 (98.1%) by the interventional radiologist, 101 (97.1%) by the body imaging radiologist, and 100 (96.1%) by the general radiologist with percent agreement of 96.15% (kappa 0.54, p < 0.001). All the findings were characterized as unlikely to be clinically significant. Mean time added to complete a delayed phase images was 3.61 ± 3.4 min. The average CT dose length product (DLP) for the total exam was 3621.78 ± 2129.57 mGy.cm with delayed acquisition adding a mean DLP of 847.75 ± 508.8 mGy.cm.

Conclusion: Delayed phase imaging does not provide significant additional diagnostic information in evaluating patients with suspected active bleeding but is associated with increased examination time and radiation exposure.

References

Novelline R, Rhea J, Rao P, Stuk J . Helical CT in emergency radiology. Radiology. 1999; 213(2):321-39. DOI: 10.1148/radiology.213.2.r99nv01321. View

Shuman W . CT of blunt abdominal trauma in adults. Radiology. 1997; 205(2):297-306. DOI: 10.1148/radiology.205.2.9356606. View

Novelline R, Rhea J, Bell T . Helical CT of abdominal trauma. Radiol Clin North Am. 1999; 37(3):591-612, vi-vii. DOI: 10.1016/s0033-8389(05)70113-5. View

Boscak A, Shanmuganathan K, Mirvis S, Fleiter T, Miller L, Sliker C . Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology. 2013; 268(1):79-88. DOI: 10.1148/radiol.13121370. View

Hagiwara A, Yukioka T, Ohta S, Nitatori T, Matsuda H, Shimazaki S . Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol. 1996; 167(1):159-66. DOI: 10.2214/ajr.167.1.8659363. View

Marmery H, Shanmuganathan K, Alexander M, Mirvis S . Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol. 2007; 189(6):1421-7. DOI: 10.2214/AJR.07.2152. View

Marmery H, Shanmuganathan K, Mirvis S, Richard 3rd H, Sliker C, Miller L . Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg. 2008; 206(4):685-93. DOI: 10.1016/j.jamcollsurg.2007.11.024. View

Fang J, Wong Y, Lin B, Hsu Y, Chen M . The CT risk factors for the need of operative treatment in initially hemodynamically stable patients after blunt hepatic trauma. J Trauma. 2006; 61(3):547-53. DOI: 10.1097/01.ta.0000196571.12389.ee. View

Thompson B, Thompson B, Munera F, Cohn S, MacLean A, Cameron J . Novel computed tomography scan scoring system predicts the need for intervention after splenic injury. J Trauma. 2006; 60(5):1083-6. DOI: 10.1097/01.ta.0000218251.67141.ef. View

10.

Rhodes C, Dinan D, Jafri S, Howells G, McCarroll K . Clinical outcome of active extravasation in splenic trauma. Emerg Radiol. 2005; 11(6):348-52. DOI: 10.1007/s10140-005-0416-1. View

11.

Murphy D, Aghayev A, Steigner M . Vascular CT and MRI: a practical guide to imaging protocols. Insights Imaging. 2018; 9(2):215-236. PMC: 5893493. DOI: 10.1007/s13244-018-0597-2. View

12.

Baliyan V, Verdini D, Meyersohn N . Noninvasive aortic imaging. Cardiovasc Diagn Ther. 2018; 8(Suppl 1):S3-S18. PMC: 5949599. DOI: 10.21037/cdt.2018.02.01. View

13.

Shyu J, Khurana B, Soto J, Biffl W, Camacho M, Diercks D . ACR Appropriateness Criteria® Major Blunt Trauma. J Am Coll Radiol. 2020; 17(5S):S160-S174. DOI: 10.1016/j.jacr.2020.01.024. View

14.

Hamilton J, Kumaravel M, Censullo M, Cohen A, Kievlan D, West O . Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics. 2008; 28(6):1603-16. DOI: 10.1148/rg.286085522. View

15.

Anderson S, Lucey B, Rhea J, Soto J . 64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation. Emerg Radiol. 2007; 14(3):151-9. DOI: 10.1007/s10140-007-0600-6. View

16.

Stuhlfaut J, Lucey B, Varghese J, Soto J . Blunt abdominal trauma: utility of 5-minute delayed CT with a reduced radiation dose. Radiology. 2006; 238(2):473-9. DOI: 10.1148/radiol.2382042096. View

17.

Park J . Diagnostic imaging utilization in cases of acute appendicitis: multi-center experience. J Korean Med Sci. 2014; 29(9):1308-16. PMC: 4168187. DOI: 10.3346/jkms.2014.29.9.1308. View

18.

Soto J, Anderson S . Multidetector CT of blunt abdominal trauma. Radiology. 2012; 265(3):678-93. DOI: 10.1148/radiol.12120354. View

19.

Alagic Z, Eriksson A, Drageryd E, Motamed S, Wick M . A new low-dose multi-phase trauma CT protocol and its impact on diagnostic assessment and radiation dose in multi-trauma patients. Emerg Radiol. 2017; 24(5):509-518. PMC: 5596047. DOI: 10.1007/s10140-017-1496-4. View

20.

Yaniv G, Portnoy O, Simon D, Bader S, Konen E, Guranda L . Revised protocol for whole-body CT for multi-trauma patients applying triphasic injection followed by a single-pass scan on a 64-MDCT. Clin Radiol. 2013; 68(7):668-75. DOI: 10.1016/j.crad.2012.12.011. View