Contrast-enhanced ultrasound in delayed splenic vascular injury and active extravasation diagnosis

We describe the use of contrast-enhanced ultrasound (CEUS) in the diagnosis of delayed splenic vascular injury (DSVI) and active extravasation (DAE) during spleen injury follow-up. CEUS might be used instead of contrast-enhanced computed tomography (CECT) during spleen injury follow-up in order to reduce radiation exposure.

Assess diagnostic comparability between CEUS and CECT in the evaluation of DSVI and DAE during spleen injury follow-up.

A total of 139 trauma patients (101 males, 38 females; mean age 48.6 years) with CECT diagnosed spleen injury were prospectively evaluated. They performed CEUS and CECT follow-up. All CEUS studies were performed using the same ultrasound scan, convex probe, mechanical index and ultrasound contrast agent dose. Twelve patients performed digital subtraction angiography (DSA) during follow-up, and the diagnostic performance comparability between CEUS and DSA was evaluated.

CEUS showed 17 delayed spleen injury complications, and in 122 patients no complication was suspected. CECT diagnosed 16 delayed spleen injury complications in these 17 patients and showed a small DSVI in another patient. A total of 122 follow-up CT scans were negative. CEUS and CECT diagnostic comparability was 98.6%. Compared to DSA, CEUS showed a sensitivity of 100% and a positive predictive value of 91.7%.

CEUS can be used during spleen injury follow-up instead of CECT. Positive CEUS examinations could perform CECT and, when necessary, DSA in order to confirm and treat spleen injury complications.