CT radiation exposure and management of delayed pseudoaneurysms in pediatric liver and spleen injuries: A multicenter study

Abstract

Aim

Minimizing radiation exposure and preventing pseudoaneurysm rupture are crucial for pediatric patients with delayed pseudoaneurysm following blunt liver and/or spleen injuries. However, the radiation exposure from follow-up CT scans in patients managed conservatively or with prophylactic embolization remains unclear. This study aimed to evaluate radiation exposure from CT scans based on these management strategies.

Methods

This research was a secondary analysis of a multicenter, retrospective observational study that included pediatric patients (≤16 years old) who sustained blunt liver and/or spleen injuries at 83 institutions in Japan from 2008 to 2019. Patients diagnosed with delayed pseudoaneurysm, defined as a newly detected pseudoaneurysm on or after the second day post-injury, were included. This descriptive study compared CT-related radiation exposure and rupture rates between patients with and without prophylactic embolization, with radiation exposure assessed using dose length product.

Results

Fifty patients had delayed pseudoaneurysm. Of these, 28 (56%) did not receive prophylactic embolization. The sum of dose length product in patients with delayed pseudoaneurysm not receiving prophylactic embolization was 4203 (1802–7503) mGy·cm, compared with 2492 (1258–4457) mGy·cm in those receiving prophylactic embolization (p = 0.12). Then, pseudoaneurysm rupture occurred in 32% of no prophylactic embolization patients, whereas no ruptures were observed in the embolization group (p = 0.003).

Conclusion

Pediatric patients not receiving prophylactic embolization trended to have high radiation exposure from CT scans and had a higher rate of ruptured delayed pseudoaneurysm compared to those receiving embolization. These findings support further study of strategies to reduce rupture risk and radiation exposure.