The accuracy of multidetector-row CT in detecting blunt splenic vascular injuries

Background: Nonsurgical management of splenic injury has become the standard strategy in hemodynamically stable patients with blunt splenic injury. However the existence of splenic vascular injuries (including extravasations (EXTs), pseudoaneurysms (PSAs), A-V fistula, and vessel truncation) could be a risk factor for nonsurgical management. Although several foreign studies have shown the usefulness of multidetector-row CT (MDCT) in detecting splenic vascular injuries, domestic studies have seldom been seen. To assess accuracy of MDCT in detecting splenic vascular injuries, we compared findings of vascular injuries in MDCT and angiography.<BR>Methods: In patients with blunt splenic injuries managed without surgery between January and December 2007, we retrospectively determined whether vascular injuries demonstrated on angiography had also been apparent on MDCT. In principle, angiography was performed in patients with MDCT findings indicating vascular injuries.<BR>Results: There were nine patients with blunt splenic injuries who were hemodynamically stable and managed without surgery. Ten findings of vascular injury (three EXTs, six PSAs, and one vessel truncation) were detected by MDCT in six cases. Angiography was performed in five of six cases demonstrating MDCT findings of vascular injuries and one patient with severe injury who had not shown MDCT findings of vascular injuries. Five of six cases that underwent angiography required splenic artery embolization. All embolized vascular injuries (3 EXTs, 5 PSAs, and one vessel truncation) were detected on MDCT as well. Especially Multi Planar Reconstruction (MPR) and Maximum Intensity Projection (MIP) images in the arterial phase could detect minute pseudoaneurysms under 5mm and could also detect vessel spasms in another case in which pseudoaneurysm appeared in the lesion on day 4.<BR>Conclusion: MDCT was useful for precisely detecting blunt splenic vascular injuries. MPR and MIP images in arterial phase were especially useful in our cases.