Advertisement

La radiologia medica

, Volume 116, Issue 7, pp 1076–1082 | Cite as

Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma

  • F. Lv
  • J. Tang
  • Y. Luo
  • Z. Li
  • X. Meng
  • Z. Zhu
  • T. Li
Abdominal Radiology / Radiologia Addominale

Abstract

Purpose

The aim of this study was to evaluate contrast-enhanced ultrasound (CEUS) imaging of active bleeding from hepatic and splenic trauma.

Materials and methods

Three hundred and ninety-two patients with liver or/and spleen trauma (179 liver and 217 spleen injuries), who underwent CEUS examinations following contrast-enhanced computed tomography (CT), were enrolled in this retrospective study over a period of >4 years. CEUS detected contrast medium extravasation or pooling in 16% (63/396) of liver or spleen lesions in 61 patients, which was confirmed by contrast-enhanced CT. Special attention was paid to observing the presence, location, and characteristics of the extravasated or pooled contrast medium.

Results

The CEUS detection rate for active bleeding was not different from that of contrast-enhanced CT (p=0.333). Information from surgery, minimally invasive treatment and conservative treatment was used as reference standard, and the sensitivities of the two techniques were not different (p=0.122). Of 63 lesions in 61 patients, CEUS showed that 74.6% (47/63) (21 liver lesions and 26 spleen lesions) presented contrast medium extravasation or pooling, both in the organ and out the capsule, in 14.3% (9/63) and only outside the capsule in 11.1% (7/63). CEUS imaging of active bleeding from hepatic and splenic trauma presented various characteristics, and the sizes and shapes of the active bleeding due to contrast medium extravasation or pooling were variable.

Conclusions

CEUS can show the active bleeding associated with hepatic and splenic trauma with various imaging characteristics, thus making it possible to diagnose active bleeding using CEUS.

Keywords

Liver Spleen Trauma Active bleeding Contrast media Ultrasonography Microbubbles 

Ecografia con mezzo di contrasto nel sanguinamento attivo associato a trauma epatico e splenico

Riassunto

Obiettivo

Scopo di questo lavoro è stato valutare l’imaging con ecografia con mezzo di contrasto (CEUS) nel sanguinamento attivo nei traumi epatici e splenici.

Materiali e metodi

Trecentonovantadue pazienti con trauma epatico e/o splenico (179 traumi epatici e 217 splenici), sottoposti ad esame CEUS seguito da tomografia computerizzata (CT) con mezzo di contrasto, sono stati arruolati in questo studio retrospettivo per un periodo di più di 4 anni. La CEUS ha rilevato lo stravaso o l’accumulo di mdc nel 16% (63/396) delle lesioni epatiche o spleniche in 61 pazienti, confermato poi dalla TC con mezzo di contrasto. È stata prestata particolare attenzione nell’osservare la presenza, la localizzazione e il carattere dello stravaso o dell’accumulo del mezzo di contrasto.

Risultati

La capacità della CEUS di individuare un sanguinamento attivo non si è dimostrata differente da quella della TC con mezzo di contrasto (p=0.333). Le informazioni ottenute dalla chirurgia, sia dal trattamento minimamente invasivo sia da quello conservativo, presi come riferimento standard, e la sensibilità delle due tecniche non si sono dimostrate differenti (p=0.122). Nelle 63 lesioni in 61 pazienti, la CEUS ha mostrato che il 74,6% (47/63) delle lesioni (21 lesioni epatiche e 26 spleniche) ha presentato stravaso o accumulo di mdc, entrambi all’interno dell’organo o fuori dalla capsula nel 14,3% (9/63) e solo fuori dalla capsula nell’11,1% (7/63). L’imaging CEUS del sanguinamento attivo da traumi epatici e splenici presenta differenti caratteristiche, e le dimensioni e le forme del sanguinamento attivo dovuto allo stravaso o all’accumulo del mezzo di contrasto sono variabili.

Conclusioni

La CEUS può mostrare il sanguinamento attivo associato a trauma epatico e splenico con diverse caratteristiche di imaging, rendendo quindi possibile diagnosticare il sanguinamento attivo.

Parole chiave

Fegato Milza Trauma Sanguinamento attivo Mezzo di contrasto Ecografia Microbolle 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References/Bibliografia

  1. 1.
    Shanmuganathan K, Mirvis SE, Sover ER (1993) Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 161:65–69PubMedGoogle Scholar
  2. 2.
    Anderson SW, Lucey BC, Rhea JT, Soto JA (2007) 64 MDCT in multiple trauma patients: imaging manifestations and clinical implications of active extravasation. Emerg Radiol 14:151–159PubMedCrossRefGoogle Scholar
  3. 3.
    Yoon W, Jeong YY, Kim JK (2005) CT in blunt liver trauma. Radiographics 25:87–104PubMedCrossRefGoogle Scholar
  4. 4.
    Ryan MF, Hamilton PA, Chu P, Hanaghan J (2004) Active extravasation of arterial contrast agent on posttraumatic abdominal computed tomography. Can Assoc Radiol J 55:160–169PubMedGoogle Scholar
  5. 5.
    Kitase M, Mizutani M, Tomita H et al (2007) Blunt renal trauma: comparison of contrast-enhanced CT and angiographic findings and the usefulness of transcatheter arterial embolization. Vasa 36:108–113PubMedCrossRefGoogle Scholar
  6. 6.
    Velmahos GC, Demetriades D, Chahwan S et al (1999) Angiographic embolization for arrest of bleeding after penetrating trauma to the abdomen. Am J Surg. 178:367–373PubMedCrossRefGoogle Scholar
  7. 7.
    Carrillo EH, Wohltmann C, Richardson JD, Polk HC Jr (2001) Evolution in the treatment of complex blunt liver injuries. Curr Probl Surg 38:1–60PubMedCrossRefGoogle Scholar
  8. 8.
    Murdock D (2008) Trauma: when there’s no time to count. AORN J 87:322–328PubMedCrossRefGoogle Scholar
  9. 9.
    Gao JM, Gao YH, Zeng JB et al (2006) Polytrauma with thoracic and/or abdominal injuries: experience in 1540 cases. Chin J Traumatol 9:108–114PubMedGoogle Scholar
  10. 10.
    Thorelius L (2004) Contrast-enhanced ultrasound for extrahepatic lesions: preliminary experience. Eur J Radiol 51(Suppl):S31–S38PubMedCrossRefGoogle Scholar
  11. 11.
    Tang J, Wang Y, Mei X et al (2007) The value of contrast-enhanced grayscale ultrasound in the diagnosis of hepatic trauma: an animal experiment. J Trauma 62:1468–1472PubMedCrossRefGoogle Scholar
  12. 12.
    Tang J, Zhang H, Lv F et al (2008) Percutaneous injection treatment for blunt splenic trauma guided by contrast-enhanced ultrasound. J Ultras Med 27:925–933Google Scholar
  13. 13.
    Catalano O, Sandomenico F, Raso MM, Siani A (2005) Real-time, contrastenhanced sonography: a new tool for detecting active bleeding. J Trauma 59:933–939PubMedCrossRefGoogle Scholar
  14. 14.
    Clevert DA, Weckbach S, Minaifar N et al (2008) Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma. Clin Hemorheol Microcirc 39:155–169PubMedGoogle Scholar
  15. 15.
    Morel DR, Schwieger I, Hohn L et al (2000) Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging. Invest Radiol 35:80–85PubMedCrossRefGoogle Scholar
  16. 16.
    Tang J, Lv F, Li W et al (2008) Contrast-enhanced sonographic guidance for local injection of a hemostatic agent for management of blunt hepatic hemorrhage: a canine study. AJR Am J Roentgenol 191:W107–W111PubMedCrossRefGoogle Scholar
  17. 17.
    Oldenburg A, Albrecht T (2008) Baseline and contrast-enhanced ultrasound of the liver in tumor patients. Ultraschall Med 29:488–498PubMedCrossRefGoogle Scholar
  18. 18.
    Tang J, Yang JC, Luo Y et al (2008) Enhancement characteristics of benign and malignant focal peripheral nodules in the peripheral zone of the prostate gland studied using contrast-enhanced transrectal ultrasound. Clin Radiol 63:1086–1091PubMedCrossRefGoogle Scholar
  19. 19.
    Miele V, Buffa V, Stasolla A et al (2004) Contrast enhanced ultrasound with second-generation contrast agent in traumatic liver lesions. Radiol Med 108:82–91PubMedGoogle Scholar
  20. 20.
    Valentino M, Serra C, Zironi G et al (2006) Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol 186:1361–1367PubMedCrossRefGoogle Scholar
  21. 21.
    Catalano O, Lobianco R, Raso MM, Siani A (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application. J Ultrasound Med 24:299–310PubMedGoogle Scholar
  22. 22.
    Valentino M, Ansaloni L, Catena F et al (2009) Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med 114:1080–1093PubMedCrossRefGoogle Scholar
  23. 23.
    Manetta R, Pistoia ML, Bultrini C et al (2009) Ultrasound enhanced with sulphur-hexafluoride-filled microbubbles agent (SonoVue) in the follow-up of mild liver and spleen trauma. Radiol Med 114:771–779PubMedCrossRefGoogle Scholar
  24. 24.
    Catalano O, Cusati B, Nunziata A (2006) Active abdominal bleeding: contrast-enhanced sonography. Abdom Imaging 31:9–16PubMedCrossRefGoogle Scholar
  25. 25.
    Marmery H, Shanmuganathan K, Mirvis SE et al (2008) Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg 206:685–693PubMedCrossRefGoogle Scholar
  26. 26.
    Fang JF, Chen RJ, Wong YC et al (1998) Pooling of contrast material on computed tomography mandates aggressive management of blunt hepatic injury. Am J Surg 176:315–319PubMedCrossRefGoogle Scholar
  27. 27.
    Fang JF, Chen RJ, Wong YC et al (2000) Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma. J Trauma. 49:1083–1088PubMedCrossRefGoogle Scholar
  28. 28.
    Ochsner MG (2001) Factors of failure for nonoperative management of blunt liver and splenic injuries. World Surg 25:1393–1396Google Scholar
  29. 29.
    Nwomeh BC, Nadler EP, Meza MP (2004) Contrast extravasation predicts the need for operative intervention in children with blunt splenic trauma. J Trauma 56:537–541PubMedCrossRefGoogle Scholar
  30. 30.
    Hamilton JD, Kumaravel M, Censullo ML et al (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28:1603–1616PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • F. Lv
    • 1
  • J. Tang
    • 1
  • Y. Luo
    • 1
  • Z. Li
    • 1
  • X. Meng
    • 1
  • Z. Zhu
    • 1
  • T. Li
    • 1
  1. 1.Department of UltrasoundChinese People’s Liberation Army General HospitalBeijingChina

Personalised recommendations