In blunt splenic injury, delayed-phase CT helps differentiate patients with active splenic hemorrhage from those with contained vascular injuries, researchers have found.
In a recent retrospective study published in Radiology (2007;243:88-95.), Dr. Stephan W. Anderson and colleagues from the department of radiology at the Boston University Medical Center evaluated the use of delayed phase CT in the differentiation of active splenic hemorrhage from that of contained vascular injuries.

The team retrospectively evaluated 47 patients with blunt splenic injury diagnosed at CT post blunt abdominal trauma. Dual-Phase abdominal pelvic CT was performed and scans were then reviewed in agreement by two radiologists. The splenic injuries were graded using the American Association for the Surgery of Trauma Splenic Injury Scale.

Researchers categorized the patients into two groups. Patients with intrasplenic hyperattenuating foci on portal venous phase images were classified as having active splenic hemorrhage and placed in group 1. Patients with a contained vascular injury on the basis of delayed-phase imaging findings were placed in group 2. Findings that were suggestive of active hemorrhage included areas that remained hyperattenuating or increased in size on delayed-phase images.

The study states that the clinical outcome of these patients was determined by reviewing their medical records. Anderson and his team also add that “Relationships between several factors were tested with the Fisher exact test that included the presence or absence of hyperattenuating foci and management, and the presence of contained vascular injury or active extravasation and management”.

Results showed that portal venous phase CT revealed a focal high-attenuation parenchymal contrast material collection in 19 patients. Nine of these patients were classified as group 1 and ten were classified as group 2. The study states all patients in group 1 underwent emergent splenectomy, and all patients in group 2 were initially treated without surgery.

Researchers also noted considerable differences in management on whether hyperattenuating foci were seen on portal venous phase images and whether hyperattenuating foci seen at portal venous phase imaging were further characterized as active splenic hemorrhage or a contained vascular injury at delayed-phase CT.