Role of arterial embolization on blunt hepatic trauma patients with type I contrast extravasation

Background

Our aim was to evaluate the clinical effectiveness of transcatheter arterial embolization (TAE) in the management of hemodynamically stable blunt hepatic trauma (BHT) patients with contrast material extravasation into the peritoneal cavity, known as type I contrast material extravasation, on computed tomography (CT) scan.

Methods

Adult patients who sustained BHT and who were hemodynamically stable after initial resuscitation underwent abdominal CT scan. If the abdominal CT scan revealed type I contrast material extravasation, patients who remained hemodynamically stable were sent for angiography.

Results

During a 30-month period, 8 patients were identified with type I contrast material extravasation. Three received immediate celiotomy because of hemodynamic instability. Five patients received angiography and subsequent TAE. One patient received celiotomy after TAE. The success rate of TAE was 50% (4/8).

Conclusion

With TAE, nonoperative management of hemodynamically stable BHT patients with type I contrast material extravasation on CT scan was achieved in half patients.     

CT增强高压注射外渗的相关因素分析

目的分析影响CT增强高压注射外渗的相关因素,并提出预警性的防护对策。方法以2019年4-10月于郑州大学第一附属医院进行CT增强检查的31595例患者作为研究对象,根据其是否发生高压注射外渗将患者分为外渗组(n=21)和无外渗组(n=31574),收集其临床资料,分析CT增强高压注射外渗的相关因素。结果进行CT增强检查31595例患者中发生高压注射外渗21例,占0.07%。单因素分析显示,外渗组患者年龄、注射速率、对比剂浓度、渗透压、是否有化疗史和注射护士的工作年限与无外渗组比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,患者年龄、注射速率、对比剂浓度、渗透压、化疗史和注射护士工作年限是影响CT增强高压注射外渗的相关因素(P<0.05)。结论影响CT增强高压注射外渗的相关因素包括患者年龄、疾病类型、注射速率、对比剂浓度、渗透压、注射护士工作年限、化疗史,采取积极防护措施对减少对比剂外渗和患者痛苦具有重要意义。     

Does IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes?

Objective

The purpose of the study was to evaluate if IV contrast extravasation on CT in anticoagulant-related rectus sheath and iliopsoas hematoma predict hematoma expansion and patient outcomes.

Materials and methods

All patients presented with anticoagulation-related spontaneous IP hematoma or RS hematoma and who underwent contrast-enhanced CT exploration, with injection of a contrast material, from January 2012 to January 2015 in our institution were included in this study. Considering the retrospective nature of our study, our institutional review board judged our study to be exempted from ethical approval and no patient consent was required. Computed tomography (CT) images were retrospectively analyzed blindly of the evolution and treatment of hematomas. The type of muscle involved; the presence of contrast extravasation after contrast injection; the volume of the hematoma, as well as, clinical and biological results (hemoglobin value g/dL); and for each patient, the type of anticoagulation used, patient’s treatment and outcomes were noted. The analyses were conducted using R 3.1.0. All statistical tests were 2-sided, and probability values <0.05 were regarded as significant.

Results

Sixty-eight patients were reviewed. Among 68 patients, 44 (65%) patients presented spontaneous IP hematoma and 24/68 (35%) a RS hematoma. There were 37 men (54%) and 31 (46%) women, ranging from 39 to 93 years with a median age of 75 years. Hemodynamic instability was statistically associated with IP hematomas and large volume of hematoma (p < 0.001). Only 15 patients had follow-up CT, 10 without and with IV contrast, 2 with IV contrast only, and 3 without contrast. Follow-up CT was performed from J0 to J8. Detection of contrast extravasation did not appear related to hemodynamically instability (p = 0.35), to a neurological deficit (p = 1), or to the increase in the volume of the hematoma on follow-up CT (p = 0.81). The different types of anticoagulant were not related to muscular type more than the other (p = 0.9). Among anticoagulant therapy, only vitamin K antagonist therapy was statistically associated with surgery (p = 0.04).

Conclusion

CT extravasation of contrast material in IP and RS hematoma does not appear to be related with clinical criteria of severity, and therefore should not be solely considered as a radiological decision criteria.

     

留置针限速技术在儿童CT增强检查中的应用

目的 探讨留置针限速技术在儿童CT增强检查中的优势。 方法 利用留置针限速技术对431例患儿行腹部CT增强检查。记录全部样本的年龄、体质量、对比剂剂量、注射速率、注射时间和动脉期腹主动脉密度,以及灼热感、呕吐、荨麻疹、过敏反应及对比剂外渗等对比剂不良反应的发生率,进行统计学分析。 结果 321例(74.48%)患儿接受手背静脉穿刺,274例(63.57%)使用24G留置针穿刺。平均对比剂注射速率(1.44±0.50)ml/s。仅1例患儿发生对比剂外渗现象,外渗率为0.23%。 结论 留置针限速技术提高了高压注射器对比剂注射方案在儿童CT增强检查中的安全性,降低了对比剂外渗的发生率,并且动脉期靶血管增强效果可达到诊断要求。     

Massive intraperitoneal bleeding due to hemorrhagic cholecystitis and gallbladder rupture: CT findings

Hemorrhagic cholecystitis with subsequent gallbladder rupture and torrential bleeding is a very rare but life-threatening complication of acute biliary tract diseases. Its clinical presentation may be dubious and therefore Computed Tomography (CT) imaging plays a crucial role in a prompt and accurate diagnosis. We present a case of a 64 year-old male who was admitted to the emergency department with clinical findings of acute cholecystitis. During the following hours the patient became hemodynamically unstable and an emergency abdominal CT scan was performed. CT revealed massive hemoperitoneum containing free gallstones. In addition, active extravasation of iv contrast material inside the gallbladder lumen was demonstrated. Based on these findings hemorrhagic cholecystitis with gallbladder rupture was suspected and the patient underwent urgent laparotomy. We describe specific CT findings of this rare condition, thus emphasizing the role of imaging in facilitating urgent surgical treatment.     

Periaortic contrast medium extravasation on chest CT in traumatic aortic injury: a sign for immediate thoracotomy

Traumatic aortic injury (TAI) after blunt chest trauma is potentially a lethal condition. The injury must be diagnosed promptly and accurately. Evaluation for traumatic aortic injury begins with an assessment of mechanism of injury, a physical examination and chest radiography. In recent years, chest computed tomography (CT) has been advocated as a better screening tool to detect TAI but there is still controversial over the confirmatory diagnostic value of CT. For hemodynamically unstable patients in whom chest CT had shown direct sign of aortic injury and with periaortic contrast medium extravasation, we advocate that these patients should be operated on immediately without aortogram to avoid unnecessary delay. Herein, we describe a case of TAI with direct signs and periaortic contrast extravasation and discuss if chest CT can substitute an aortogram as a diagnostic tool when direct signs of TAI are revealed.     

Treatment of lower part of glenoid fractures through a novel axillary approach: A case report

BACKGROUNDBased on the location and size of the fracture block, open reduction and internal fixation can be employed or assisted for shoulder arthroscopy in the treatment of glenoid fractures. However, the treatment of lower part of glenoid fractures through a novel axillary approach has not been reported so far. CASE SUMMARYA 22-year-old right-handed man was transferred to our outpatient clinic because of right shoulder injury during a traffic accident. X-ray examination after admission suggested the fracture of the lower part of the right glenoid and an ipiselial proximal humeral fracture. Three-dimensional (3D) computed tomography (CT) further suggested that the size of the fracture block of the lower part of the right glenoid was 3.4 mm × 16.2 mm. The patient was diagnosed as the fracture of the lower part of the glenoid, also known as bony Bankart lesion without shoulder dislocation. After general anesthesia, the patient was surgically treated with the open reduction internal fixation through a novel axillary approach. 3D CT and shoulder joint function were reexamined at 12 mo of follow-up, showing acceptable recovery.CONCLUSIONThis case report describes a novel axillary approach adopted in an open reduction with cannulated screw and wire anchor internal fixation. After a follow-up for more than 12 mo, 3D CT and shoulder joint function examinations display a good recovery.     

Postural headache and cerebrospinal fluid leak: believing is seeing

A 33-year-old woman developed persistent postural headache following epidural anesthesia (L2-L3 level). Iohexol myelography (L5-S1 puncture) demonstrated no epidural extravasation of contrast material (Figure A), but subsequent computed tomography (CT) axial images (B, C) revealed leakage of dye through the needle track of the L5-S1 puncture (arrows). No leakage of contrast medium was found at the site of the L2-L3 epidural puncture.     

Blunt pancreatic trauma: a difficult injury

The diagnosis and initial management of hemodynamically stable blunt pancreatic trauma should include a high index of suspicion when a patient has sustained a severe force vector in the anterior-posterior direction of the abdominal cavity. Patients who are hemodynamically stable should have physical examination, computed tomography (CT) of the abdomen, and serial determinations of serum amylase levels. If CT shows any suggestion of injury to the pancreas, such as fluid between the splenic vein and the posterior border of the pancreas, follow-up endoscopic retrograde pancreatography (ERP) should be done. In patients with a significant retroperitoneal hematoma, ERP should be followed by noncontrast CT for the evaluation of extravasation of contrast material. If ERP shows ductal disruption or follow-up CT shows extravasation of contrast, operative management is indicated. The astute physician should always remember that the most difficult aspect of pancreatic injury is timely diagnosis.     

多种膀胱准备技术在64排螺旋CT盆腔增强扫描中的应用研究

目的:研究一套完整规范的静脉膀胱造影准备技术对CT盆腔增强扫描的技术方案。方法:选取2019年6月—2020年8月我院200例行盆腔增强CT的患者,其中160例增强前分组对其静脉注射非离子型造影剂碘佛醇(350mL I/mg),每组40例,分别为A组3mL、B组5 mL、C组7 mL、D组10 mL,饮水300 mL后有尿意时,上检查床翻滚两圈后行盆腔增强扫描;测定各组之间的膀胱腔内不同区域液体密度的CT值,对膀胱显示图像进行评分,统计分析结果。结果:B组图像膀胱显示明显优于A、C、D组。另取E组40例检查前饮水300mL,有尿意时,上检查床翻滚两圈后行盆腔增强扫描,与B组相比较分析。结果:B组图像膀胱显示明显优于E组。结论:盆腔增强CT膀胱准备技术中以增强前静脉注射非离子型造影剂5 mL并饮水300 mL后有尿意时,上检查床翻滚两圈后扫描,膀胱充盈好,造影剂混合均匀,CT密度最佳。     

Intra-vascular blood velocity and volumetric flow rate calculated from dynamic 4D CT angiography using a time of flight technique

We examine a time of flight (TOF) approach for the analysis of contrast enhanced 4D volumetric CT angiography scans to derive and display blood velocity in arteries. Software was written to divide blood vessels into a series of cross sections and to track contrast bolus TOF along the central vessel axis, which was defined by a user, from 4D CT source data. Time density curves at each vessel cross section were fit with quadratic, Gaussian, and gamma variate functions to determine bolus time to peak (TTP). A straight line was used to plot TTP versus vessel path length for all three functions and the slope used to calculate intraluminal velocity. Software was validated in a simulated square channel and non-pulsatile flow phantom prior to the calculation of blood velocity in the major cerebral arteries of 8 normal patients. The TOF algorithm correctly calculates intra-luminal fluid velocity in eight flow conditions of the CT flow phantom where quadratic functions were used. Across all conditions, in phantoms and in vivo, the success of calculations depended strongly on having a sufficiently long path length to make measurements and avoiding venous contamination. Total blood flow into the brain was approximately 17 % of a normal 5 L cardiac output. The technique was explored in vivo in a patient with subclavian steal syndrome, in the pulmonary arteries and in the iliac artery from clinical 4D CT source data.  Intravascular blood velocity and flow may be calculated from 4D CT angiography using a TOF approach.     

Diagnostic value of the helical CT scan for traumatic aortic injury: correlation with mortality and early rupture

To evaluate the value of helical computed tomography of the thorax (HCTT) as a definitive tool for diagnosing traumatic aortic injury, this study retrospectively examined 53 patients with blunt thoracic injuries and HCTT during a 5-year period. All CT scans were reviewed for direct signs of aortic injury and correlated with aortography or surgery. Correlations between clinical parameters, as well as combinations of direct signs and individual signs, and mortality were analyzed in all traumatic aortic injury (TAI) cases. Direct signs were seen on the HCTT in 25 cases and 22 had TAI. All false positive results came from the group with only a single direct sign depicted on HCTT. Among individual direct signs examined, intimal flap and luminal thrombus were the most specific (100%), whereas irregular aortic contour was the most sensitive (100%). A combination of > or = 3 direct signs (p = 0.006) and periaortic contrast material extravasation significantly correlated with early rupture and mortality (p = 0.002). In conclusion, intimal flap on HCTT is both the most specific and sensitive sign for TAI. TAI patients with > or = 3 direct signs, including periaortic contrast material extravasation, may not require aortography before immediate surgery.     

双能量CT对急性缺血性脑卒中支架取栓术后颅内出血的早期诊断及预测

目的研究双能量CT(DECT)在急性缺血性脑卒中Solitaire支架取栓术后早期诊断颅内出血以及预测患者出血转化/出血增多风险的临床价值。方法收集急性缺血性卒中接受Solitaire支架取栓术的病例,术中造影均采用浓度为370 mg I/ml的碘对比剂,于术后1 h内行双能量CT扫描,重组获得线性融合图像、虚拟平扫及碘图,经综合分析确定诊断。术后24 h行常规CT平扫作为确诊标准,评价DECT早期诊断颅内出血的敏感度、特异度、阳性预测值、阴性预测值和符合率。在碘图上测量颅内病灶的碘浓度,以后续随访结果为标准,采用ROC曲线分析,获取发生出血转化或出血增多的阈值,并评价其特异度、准确度及曲线下面积。结果共44例病例被纳入本研究,其中DECT综合分析诊断单纯碘对比剂外渗25例,合并颅内出血19例,与术后24 h CT随访对照,2例DECT诊断为单纯碘对比剂外渗的患者出现颅内出血,其余23例均诊断准确,19例诊断为碘对比剂外渗合并出血均诊断准确,DECT早期诊断术后颅内出血的敏感度为90.5%、特异度为100%、阳性预测率为100%、阴性预测率为92.0%、符合率为95.5%。44例患者共86个颅内病灶进行了碘浓度测量,在后续随访中,其中19个病灶出现出血转化/出血增多,平均碘浓度为(3.5±1.6)mg I/ml,67个病灶无出血转化/出血增多,平均碘浓度为(1.4±0.9)mg I/ml,两组具有显著差异,即高碘外渗区域更易出现出血转化/出血增多,ROC分析两组之间的Cut-off值为2.7 mg/ml,DECT预测支架取栓术后出现出血转化/出血增多的敏感度、特异度分别为73.7%、92.5%。结论双能量CT在急性缺血性脑卒中Solitaire支架取栓术后早期诊断及预测颅内出血具有重要的临床价值。     

CT and MRI diagnosis]

This section surveys the clinical usefulness of spiral-computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of thrombotic arteriovenous diseases. Spiral CT is useful to detect arterial occlusive disease by using 3D rendering, so call, "CT angiography (CTA)". 3D rendering techniques have been predominantly applied to CTA are the shaded surface display (SSD) and the maximum intensity projection (MIP). These renderings have the lacks that in an MIP no depth cues are inherent and SSD lose the majority of the scan data. The volume rendering (VR) makes up for this loss by rendering what is effectively a binary image of pixel values above the threshold. As the application of MRI in the evaluation of vascular diseases, MR angiography using time-of-flight or phase contrast techniques was performed in the past. However, according to the progress in high speed imaging method, contrast-enhanced 3D MR angiography is now used routinely and will be still more important in the diagnosis of various vascular diseases.     

Crohn disease of small bowel: multidetector row CT with CT enteroclysis, dynamic contrast enhancement, CT angiography, and 3D imaging

Background CT could be used to evaluate abnormalities in the bowel wall, mesentery, adjacent structures, vasculature, and even the activity of Crohn disease (CD). To our knowledge, few direct comparisons of CD characterization using multidetector row CT with dynamic contrast enhancement, 3D imaging, CT angiography (CTA), and CT-enteroclysis (CT-E) on the same cohort of patients. The purpose of this study was to evaluate the diagnostic value of CD using multidetector helical CT with CT-E, dynamic contrast enhancement, 3D imaging, and CTA. Methods Twenty-eight patients known or suspected CD underwent CT-E, dynamic contract enhancement, CTA, and 3D imaging. The multidetector CT series images were performed on eight-slice CT scanner. All the examinations were performed when water was used as an oral contrast starting 25 s after 140 mL of intravenous contrast agent was administered, followed by portal venous phase (60 s), and a 60–70 s delay, then sending 1.25-mm slices to the 3D workstation, CT angiograms and 3D images were reconstructed. All the images were reviewed to detect abnormalities of CD. The abnormalities of the bowel wall, mucosal and submucosal ulceration, prominent perienteric vasculature, sinus tracts or fistulae, abscess were evaluated. Results Crohn disease was diagnosed in 28 patients by CT images, and 54 inflammatory segments were revealed. In active inflammatory cases, the diseased bowel wall thickened and the enhancement of diseased bowel wall increased significantly in 34 inflammatory segments of 22 cases, the enhancement of diseased bowel wall increased significantly but without the wall thickened in three patients. Prominent vasculature was found in CTA and 3D images in 21 patients with active diseases. In 16 patients, the sharp interface between bowel and mesentery was lost and the attenuation of fat increased. Sinus tracts or fistulae were observed in eight patients, four of 28 patients demonstrated abscesses, all were active inflammatory patients. In three chronic inflammatory patients, normal bowel, bowel lumen stricture, and the normal enhancement of the wall were displayed. Conclusion The abnormalities of CD and its complications can be identified by multidetector CT with CT-E, dynamic enhancement, CTA, and 3D imaging, and they are important methods in diagnosing CD. Complications of CD can be shown better when CT-E is performed.     

The role of computed tomography in diagnosis of blunt intestinal and mesenteric trauma (BIMT)

Blunt intestinal mesenteric trauma (BIMT) is a rare injury with a high morbidity and mortality. It is a diagnostic dilemma for Trauma Surgeons and Emergency Physicians. This study was undertaken to assess the role of computed tomography (CT) in BIMT. Data were analyzed from 1995 to 2002. Thirty-six cases of BIMT were identified: 16 isolated and 20 non-isolated injuries. Initial CT scan was abnormal in 74% (17 out of 23), and 83% on retrospect (2 additional cases). CT scans were abnormal (initial and repeat) in 96% (22 out of 23). The most common abnormalities were free fluid (78%), mesenteric stranding or edema (39%), bowel wall hematoma, or edema (30%). Free air was seen in 31% and oral contrast extravasation in 15% of cases of bowel perforation. CT scan findings in BIMT can be subtle and non-specific. Suspicion of BIMT warrants close observation and probably further diagnostic testing.     

KARL-3D迭代重建及MAC重建技术在CT检查中去金属植入物伪影的临床应用价值

目的探讨KARL-3D迭代重建及去金属伪影(MAC)重建技术在CT检查中去金属植入物伪影的临床应用价值。方法收集105例体内有金属植入物患者的CT扫描数据,对扫描图像进行FBP常规重建、KARL-3D迭代重建及MAC重建。以金属伪影影响最严重的区域作为感兴趣区(ROI),比较三组ROI的CT值、噪声值(SD)、信噪比(SNR)、对比噪声比(CNR)和主观评分。结果三组图像的CT值、SD、SNR、CNR和主观评分比较,差异均具有统计学意义(P<0.05),其中SD值(SD1与SD2)的排序为FBP组>KARL-3D迭代组>MAC组;余三项指标(SNR1,SNR2和CNR)排序均为FBP组相似文献   

增强CT扫描对腹部外伤诊断价值探讨

目的 探讨增强CT扫描检查对腹部钝性损伤的诊断价值。方法 回顾性分析80例经手术、血管造影或CT随访证实为腹部钝性损伤病人的平扫及增强CT表现征象,并比较分析各种征象的作用。结果 本组70例中,10例平扫无明显异常,增强CT扫描呈明显的低密度改变;11例器官内或周围斑点状增强,提示为活动性出血;部分病例增强CT扫描后清楚显示裂伤部位;1例膀胱损伤增强CT表现为造影剂进入膀胱左前方。结论 增强CT检查对肝肾损伤的诊断明显优于平扫,还可以判断有无活动性出血等情况,对损伤程度的判断和治疗方案的制定较平扫更有价值。