Application of Enhanced CT in Assessing the Source of Active Haemorrhage in Patients with Abdominal and Pelvic Trauma
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摘要: 目的：通过与数字减影（DSA）造影对比，评价增强CT在急诊腹部及盆腔创伤中检测活动性出血的应用价值。方法：回顾性分析2016年1月至2019年2月间急诊收治的腹盆部创伤患者，所有患者入院后均行腹盆部增强CT，并于受伤24h内行DSA造影或栓塞治疗，将CT与DSA图像（金标准）对比，得出CT诊断活动性出血灵敏度、特异度、阳性预测值、阴性预测值等指标。结果：期间共有33名患者同时行增强CT及DSA造影，其中10名患者增强CT与DSA均未发现出血，其中20名患者增强CT和DSA均阳性，有1例增强CT阳性而随后DSA未发现出血，2例增强CT阴性而随后DSA证实有出血。与DSA对比，增强CT诊断出血的灵敏度（SE）、特异度（SP）、阳性预测值（PPV）、阴性预测值（NPV）分别为：90.9%、90.9%、95.2%和83.3%。结论：增强CT对诊断腹盆部创伤患者活动性出血有较高灵敏性及阳性预测值，为患者后续治疗提供较好的引导作用。Abstract: Objective: To assess the ability of contrast enhanced computed tomography(CECT) to detect active haemorrhage in abdominal and pelvic trauma patients, using angiographic findings as paired gold standards.Methods: A retrospective analysis of patients with abdominal and pelvic trauma from January 2016 to February2019, all patients underwent abdominal-pelvic enhanced CT after admission, and DSA angiography or embolization within 24 hours of injury, all CT and DSA images were judged by two relevant professional physicians(one of whom is the deputy chief physician).we obtain sensitivity, specificity, positive predictive value, negative predictive value of CT detect hemorrhage by compared with DSA images(as gold standard).Results: During the periods, 33 adult trauma patients sustaining enhanced CT scan of abdominal and pelvic followed by angiography.Ten patients were negative for extravasations from either of the tests.Twenty of 33 patients had both positive CT scans and angiograms.Only one patient with positive CT scans did not have bleeding on angiogram.Two with positive angiograms did not show any extravasations of contrast on CT scan.The sensitivity(SE), specificity(SP), positive predictive value(PPV) and negative predictive value(NPV) of CECT in detecting active abdominopelvic haemorrhage, as compared to DSA, were 90.9%, 90.9%, 95.2% and 83.3%, respectively.Conclusions: Contrast enhanced CT shows high sensitivity and positive predictive value for the detection of active haemorrhage in patients with blunt abdominopelvic trauma, when compared with DSA, and can be used to triage patients for management.
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Keywords:
- enhanced CT /
- abdominal and pelvic trauma /
- angiography
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