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Split-bolus single-pass CT in splenic injury: does it miss relevant vascular injury? : Article type: original
Sadia R Qamar1,2, Ferco H Berger3,4,5, Tjarda N Tromp6
1Emergency and Trauma Radiology Division, Department of Medical Imaging, Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Ontario, M4N 3M5, Toronto, Canada.
Purpose:
To evaluate diagnostic performance of split-bolus single-pass CT (SBSP-CT) for splenic vascular injury (SVI) and clinically relevant splenic vascular injury requiring treatment (CR-SVI) in trauma patients with splenic injury.
Methods:
This retrospective observer study included 111 consecutive trauma patients (76% male), mean age 37 years (9-81), median ISS 27 (interquartile range (IQR) 26-33), with splenic injury and primary SBSP-CT at a level-1 trauma center between December 2012 and December 2018. Four radiologists independently scored CTs for SVI presence and likelihood. Consensus reference standards for SVI and CR-SVI were based on clinical, imaging and 3-month follow-up data. Image adequacy was assessed quantitively and qualitatively and diagnostic performance and interobserver agreement analyzed.
Results:
37 of 111 (33.3%) patients had SVI and 27 (24.3%) had CR-SVI requiring treatment. Five patients died prior to SVI treatment from unrelated injuries; no mortality was attributed to undetected SVI. Two patients had delayed splenic rupture, both survived. Median attenuation was 292 HU (IQR 250-348) in the aorta and 130 HU (IQR 114-150) in splenic parenchyma. Images were adequate in 107 of 111 (96.4%) patients. Interobserver agreement for SVI was substantial (0.741; 95% CI: 0.67-0.82). NPV for SVI ranged from 89.2 to 94.4% (95% CI: 89.2-97.4) and for CR-SVI from 94.4 to 97.1% (95% CI: 88.5-98.9). AUROC for SVI ranged from 0.825 to 0.862 and for CR-SVI from 0.825 to 0.862.
Conclusion:
SBSP-CT provides adequate image quality and high diagnostic confidence for evaluating splenic vascular injury with high negative predictive value for relevant splenic vascular injuries.
