Diagnostic value of CT contrast extravasation for major arterial injury after pelvic fracture: A meta-analysis

Am J Emerg Med. 2020 Nov;38(11):2335-2342. doi: 10.1016/j.ajem.2019.11.038. Epub 2019 Nov 28.


Purpose: We conducted a meta-analysis to determine diagnostic performance of CT intravenous contrast extravasation (CE) as a sign of angiographic bleeding and need for angioembolization after pelvic fractures.

Materials and methods: A systematic literature search combining the concepts of contrast extravasation, pelvic trauma, and CT yielded 206 potentially eligible studies. 23 studies provided accuracy data or sufficient descriptive data to allow 2x2 contingency table construction and provided 3855 patients for meta-analysis. Methodologic quality was assessed using the QUADAS-2 tool. Sensitivity and specificity were synthesized using bivariate mixed-effects logistic regression. Heterogeneity was assessed using the I2-statistic. Sources of heterogeneity explored included generation of scanner (64 row CT versus lower detector row) and use of multiphasic versus single phase scanning protocols.

Results: Overall sensitivity and specificity were 80% (95% CI: 66-90%, I2 = 92.65%) and 93% (CI: 90-96, I2 = 89.34%), respectively. Subgroup analysis showed pooled sensitivity and specificity of 94% and 89% for 64- row CT compared to 69% and 95% with older generation scanners. CE had pooled sensitivity and specificity of 95% and 92% with the use of multiphasic protocols, compared to 74% and 94% with single-phase protocols.

Conclusion: The pooled sensitivity and specificity of 64-row CT was 94 and 89%. 64 row CT improves sensitivity of CE, which was 69% using lower detector row scanners. High specificity (92%) can be maintained by incorporating multiphasic scan protocols.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Systematic Review

MeSH terms

  • Adult
  • Arteries / injuries*
  • Computed Tomography Angiography / methods
  • Extravasation of Diagnostic and Therapeutic Materials / diagnostic imaging
  • Fractures, Bone / complications*
  • Hemorrhage / diagnosis
  • Hemorrhage / etiology*
  • Humans
  • Middle Aged
  • Pelvic Bones / injuries*
  • Pelvis / blood supply
  • Sensitivity and Specificity