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Contrast-Enhanced Two- and Three-dimensional Sonography for Evaluation of Intra-abdominal Hemorrhage

Division of Diagnostic Ultrasound, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

Address correspondence and reprint requests to Ji-Bin Liu, MD, Department of Radiology, Thomas Jefferson University Hospital, Seventh Floor, Main Building, 132 S 10th St, Philadelphia, PA 19107.

Objective. To determine whether a contrast agent enhances sonographic detection of bleeding sites in the abdomen and whether contrast-enhanced three-dimensional sonography provides additional information compared with contrast-enhanced two-dimensional sonography. Methods. Bleeding sites were created within the livers (n = 3), spleens (n = 5), and kidneys (n = 3) of 3 dogs. A sonographic contrast agent with vascular and parenchymal enhancement capabilities was administered intravenously at a dose of 0.02 mL/kg. Before and after each contrast agent injection, the bleeding sites were imaged with two- and three-dimensional sonography in gray scale harmonic imaging and color flow modes. Sonographic findings were compared with gross pathologic findings. Results. Non– contrast-enhanced sonography was not able to show the specific location of the active bleeding in any of the organs evaluated. The contrast agent enhanced the sonographic detection of blood flow in normal vessels and extravasated blood from damaged vessels or organs in all cases. Intrasplenic and intrahepatic hematomas were better identified on delayed imaging sequences because there was marked enhancement of the normal parenchyma, whereas the hematomas remained unenhanced. Reconstructed three-dimensional sonography showed spatial relationships of the bleeding sites and surrounding structures. Gross pathologic findings were consistent with the contrast-enhanced sonographic results. Conclusions. Contrast-enhanced sonography improves the detection and evaluation of abdominal bleeding sites. Contrast-enhanced three-dimensional sonography appears to provide additional information when compared with two-dimensional sonography.

Key Words: sonography • contrast agent • intra-abdominal hemorrhage • three-dimensional • gray scale harmonic imaging • color Doppler imaging

Abbreviations: AE, acoustic emission • HI, harmonic imaging • 3D, three-dimensional • 2D, two-dimensional

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