The role of computed tomography in arterial injury evaluation in solid organ trauma

Abdominal solid organ trauma accounts for 86.9% of all blunt abdominal trauma cases, among which 5%-25% of cases are associated with arterial injuries. Aim: In this study, we aimed to determine the characteristics and diagnostic functions of computed tomography (CT) scans during the diagnosis of arterial injuries, including active extravasation, pseudoaneurysm, and arteriovenous fistula associated with solid organ trauma compared with digital subtraction angiography (DSA).

From July 2019 to March 2020, a retrospective study was performed on 44 patients who presented with clinical manifestations of blunt abdominal injury and CT diagnosis of arterial injuries due to solid organ trauma, including active extravasation, pseudoaneurysm, and arteriovenous fistula, and later underwent DSA at Vietduc Hospital, in Hanoi, Vietnam. The features of arterial lesions on CT scan was described. Value of CT scan for the diagnosis of arterial injuries was analyzed compared to the DSA findings.

There were 53 arterial lesions observed on CT scan including 15 active extravasations, 34 pseudoaneurysms, and 4 arteriovenous fistulas while 51 arterial lesions were observed on DSA including 15 active extravasations, 30 pseudoaneurysms, and 6 arteriovenous fistulas. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of active extravasation, pseudoaneurysm, and arteriovenous fistula on CT scan were 93.3%, 97.7%, 93.3%, 97.7% and 96.6% ; 90%, 75%, 79.4%, 87.5% and 82.8%; and 66.7%, 100%, 100%, 96.3% and 96.6%, respectively.

Our study showed that CT scans had high sensitivity and specificity for the diagnosis of active extravasation; however, CT scans demonstrated low specificity for detecting pseudoaneurysm and low sensitivity for the diagnosis of arteriovenous fistula.