Differences of liver CT perfusion of blunt trauma treated with therapeutic embolization and observation management

Yon-Cheong Wong,Huan-Wu Chen,Cheng-Hsien Wu,Shih-Ching Kang,Yu-Pao Hsu,Being-Chuan Lin,Kuo-Ching Yuan,Li-Jen Wang

doi:10.1038/s41598-020-76618-w

Yon-Cheong Wong, Huan-Wu Chen + Show 6 more

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https://doi.org/10.1038/s41598-020-76618-w

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Abstract

Massive hepatic necrosis after therapeutic embolization has been reported. We employed a 320-detector CT scanner to compare liver perfusion differences between blunt liver trauma patients treated with embolization and observation. This prospective study with informed consent was approved by institution review board. From January 2013 to December 2016, we enrolled 16 major liver trauma patients (6 women, 10 men; mean age 34.9 ± 12.8 years) who fulfilled inclusion criteria. Liver CT perfusion parameters were calculated by a two-input maximum slope model. Of 16 patients, 9 received embolization and 7 received observation. Among 9 patients of embolization group, their arterial perfusion (78.1 ± 69.3 versus 163.1 ± 134.3 mL/min/100 mL, p = 0.011) and portal venous perfusion (74.4 ± 53.0 versus 160.9 ± 140.8 mL/min/100 mL, p = 0.008) were significantly lower at traumatic parenchyma than at non-traumatic parenchyma. Among 7 patients of observation group, only portal venous perfusion was significantly lower at traumatic parenchyma than non-traumatic parenchyma (132.1 ± 127.1 vs. 231.1 ± 174.4 mL/min/100 mL, p = 0.018). The perfusion index between groups did not differ. None had massive hepatic necrosis. They were not different in age, injury severity score and injury grades. Therefore, reduction of both arterial and portal venous perfusion can occur when therapeutic embolization was performed in preexisting major liver trauma, but hepatic perfusion index may not be compromised.

Highlights

IntroductionWe employed a 320-detector CT scanner to compare liver perfusion differences between blunt liver trauma patients treated with embolization and observation
Massive hepatic necrosis after therapeutic embolization has been reported
Massive hepatic necrosis is a major concern among trauma surgeons because the death of a large number of contiguous hepatocytes can contribute to a high morbidity and late m ortality[8,9]

Summary

Introduction

We employed a 320-detector CT scanner to compare liver perfusion differences between blunt liver trauma patients treated with embolization and observation. They were not different in age, injury severity score and injury grades Reduction of both arterial and portal venous perfusion can occur when therapeutic embolization was performed in preexisting major liver trauma, but hepatic perfusion index may not be compromised. Complications of liver devascularization injury can vary from massive hepatic necrosis to a spectrum of liver perfusion defect. These changes in devascularization injury cannot be Scientific Reports | (2020) 10:19612. We perform CTP on major liver trauma to clarify whether or not our hypothesis regarding therapeutic liver embolization alone dose not cause liver devascularization injury is true

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