Nonsurgical management of blunt splenic injury: Use of CT criteria to select patients for splenic arteriography and potential endovascular therapy

PURPOSE: To determine if contrast material-enhanced spiral computed tomogra phy (CT) can be used to select patients with blunt splenic injuries to unde rgo arteriographic embolization. MATERIALS AND METHODS: During a 15-month period, 78 patients who were hemod ynamically stable and required no immediate surgery underwent contrast-enha nced spiral CT followed by splenic arteriography. CT scans were assessed fo r splenic vascular contrast material extravasation or posttraumatic splenic vascular lesions. Medical records were reviewed for splenic arteriographic results and clinical outcome. RESULTS: There were 25 grade I, 12 grade II, 27 grade III, 12 grade IV, and two grade V splenic injuries. CT showed active contrast material extravasa tion in seven patients and splenic vascular lesions in 19 patients. At CT, splenic vascular contrast material extravasation was 100% (seven of seven p atients) and a posttraumatic splenic vascular lesion was 83% (10 of 12 pati ents) sensitive on the basis of arteriographic or surgical outcome in predi cting the need for transcatheter embolization or splenic surgery. Overall, CT had a sensitivity of 81% (17 of 21 patients), a specificity of 84% (48 o f 57 patients), negative and positive predictive values of 92% (48 of 52 pa tients) and 65% (17 of 26 patients), respectively,and an accuracy of 83% (6 5 of 78 patients) in predicting the need for splenic injury treatment. CONCLUSION: Contrast-enhanced spiral CT plays a valuable role in selecting hemodynamically stable patients with splenic vascular injury who may be tre ated with transcatheter therapy and potentially improves the success rate o f nonsurgical management.