AJR:194, February 2010
Nam Kyung Lee, Suk Kim, Chang Won Kim, Jun Woo Lee, Ung Bae Jeon, Dong Soo Suh
OBJECTIVE. This study was designed to evaluate retrospectively the accuracy of MDCT in the identification of bleeding sites in patients with postpartum hemorrhage.
MATERIALS AND METHODS. Twenty-seven consecutively registered patients (mean age, 31.4 years; age range, 24-39 years) with postpartum hemorrhage underwent contrast-en¬hanced MDCT before embolization. CT images were reviewed independently by two radiolo¬gists who were blinded to the angiographic findings. Disagreements were resolved by consen¬sus. The MDCT diagnosis of active bleeding was made when extravasation of contrast material was identified on contrast-enhanced CT scans. The location of bleeding was classified accord¬ing to four anatomic regions: uterine body, cervix, vagina, and paragenital area. Each bleeding location was recorded on the right and left sides. Conventional angiography was used as the ref¬erence standard. The sensitivity, specificity, and accuracy of MDCT in the detection of hemor¬rhage were assessed. We also assessed the presence of additional CT abnormalities that might influence further treatment.
RESULTS. Extravasation of contrast material was depicted on MDCT scans in 24 of 27 patients. The overall location-based sensitivity, specificity, and accuracy of MDCT in the de¬tection of bleeding were 100% (38/38), 96% (171/178), and 97% (209/216). Additional abnor¬malities detected on CT images included rectus sheath hematoma with contrast extravasation (n = 5), extraperitoneal hematoma (n = 6), gestational pancreatitis (n = 2), diffuse liver dis¬ease (n = 2), and abdominal compartment syndrome (n = 1).
CONCLUSION. MDCT may have a role in the detection and localization of postpartum hemorrhage and yield supplementary information on extrauterine abnormalities.