Vascular injuries are a major source of morbidity and mortality in patients with blunt pelvic trauma. Digital subtraction angiography (DSA) has traditionally been used to detect pelvic arterial injuries and to treat active arterial hemorrhage. Improvements in the technology of computed tomography (CT) have facilitated the implementation of CT angiography, which is beginning to replace DSA in the evaluation of patients with acute trauma. Pelvic CT angiography can reliably depict various pelvic arterial injuries and can help differentiate arterial hemorrhage from venous hemorrhage on the basis of multiphasic acquisitions, a method that may be used to tailor the subsequent clinical approach. With the use of a 64-channel multidetector CT scanner, multiphasic pelvic CT angiography can be integrated into the evaluation of trauma patients by using 1.25-mm reconstructed section thickness, pitch of 1:0.987, and gantry revolution time of 0.5 second to achieve near-isotropic results. A standard dose of 100 mL intravenous contrast material is injected at a rate of 5 mL/sec, and 30 mL saline solution, also at 5 mL/sec, is injected as a "chasing" bolus to follow the contrast material.
(c) RSNA, 2009.