Splenic artery embolisation for blunt splenic trauma: 10 years of practice at a trauma centre.

INTRODUCTION: Splenic artery embolisation (SAE) has transformed the management of splenic trauma. The aim of this study was to review the outcomes and postprocedural management of blunt splenic trauma patients treated with SAE at a trauma centre over a 10-year period. METHODS: Details of patients undergoing SAE for blunt trauma between January 2012 and January 2022 were acquired from a prospectively maintained database. Patient records were reviewed for demographic information, splenic injury grades, embolisation efficacy, complications, and associated injuries and mortality. Data relating to Injury Severity Scores (ISS) and postprocedural practice (vaccinations, antibiotic prescribing, follow-up imaging) were also obtained. RESULTS: Thirty-six patients (24 male, 12 female) with a median age of 42.5 years (range 13-97 years) were identified. American Association for the Surgery of Trauma splenic injury grades were III (n = 7), IV (n = 20) and V (n = 9). Seventeen patients had isolated splenic injury and 19 had additional injuries to other organ systems. Median ISS was 18.5 (range 5-50). SAE succeeded first time in 35/36 cases, and upon the second attempt in 1/36 cases. No patients died because of splenic injury or SAE although four patients with polytrauma died owing to other injuries. SAE complications occurred in 4/36 cases. For survivors, vaccinations were administered in 17/32 cases, and long-term antibiotics were initiated in 14/32 cases. Formal follow-up imaging was arranged in 9/32 cases. CONCLUSIONS: These data show that SAE is an effective means of controlling splenic haemorrhage secondary to blunt trauma with no patient requiring subsequent laparotomy. Major complications occurred in 11% of cases. Follow-up practice varied regarding further imaging, antibiotic and vaccination administration.

Minimal gradient encoding for robust estimation of diffusion anisotropy.

This study has investigated the relationship between the noise sensitivity of measurement by magnetic resonance imaging (MRI) of the diffusion tensor (D) of water and the number N of diffusion-weighting (DW) gradient directions, using computer simulations of strongly anisotropic fibers with variable orientation. The DW directions uniformly sampled the diffusion ellipsoid surface. It is shown that the variation of the signal-to-noise ratio (SNR) of three ideally rotationally invariant scalars of D due to variable fiber orientation provides an objective quantitative measure for the diffusion ellipsoid sampling efficiency, which is independent of the SNR value of the baseline signal obtained without DW; the SNR variation decreased asymptotically with increasing N. The minimum number N(0) of DW directions, which minimized the SNR variation of the three scalars of D was determined, thereby achieving the most efficient ellipsoid sampling. The resulting time efficient diffusion tensor imaging (DTI) protocols provide robust estimation of diffusion anisotropy in the presence of noise and can improve the repeatability/reliability of DTI experiments when there is high variability in the orientation of similar anisotropic structures, as for example, in studies which require repeated measurement of one individual, intersubject comparisons or multicenter studies.