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Detection of Bleeding in Injured Femoral Arteries With Contrast-Enhanced Sonography

Department of Bioengineering (W.L., V.Z., L.C., S.V.), Center for Industrial and Medical Ultrasound, Applied Physics Laboratory (S.C., L.C.), and Department of Radiology (S.C.), University of Washington, Seattle, Washington USA

Address correspondence to Wenbo Luo, MSE, Department of Bioengineering, University of Washington, Box 355061, Seattle, WA 98195 USA. E-mail: wenbo{at}u.washington.edu

Objective. The purpose of this study was to investigate the feasibility of detecting acute arterial bleeding by means of contrast-enhanced sonography. Methods. Puncture injury was produced transcutaneously with an 18-gauge needle in 26 femoral arteries (13 in the control group and 13 in the contrast-enhanced group) of rabbits. A sonographic contrast agent (Optison; Mallinckrodt Inc, St Louis, MO) was administered intravenously at a dose of 0.06 to 0.07 mL/kg. Sonography of the femoral arteries was performed before and after injury, both before and after injection of Optison, with B-mode imaging, color Doppler imaging, and pulse inversion harmonic imaging (PIHI). Results. The specific location of active bleeding could not be visualized in B-mode and PIHI scans in the control group (no Optison injection). After administration of Optison, the bleeding site was visualized because of the increased echogenicity of the extravasated blood at the puncture site in both B-mode imaging and PIHI. In color Doppler images, bleeding sites were localized successfully in 84.6% of the cases in the presence of Optison and in 30.8% of the cases without Optison. Histologic examination (light microscopy) of the hematoma confirmed the presence of contrast agent microbubbles in the extravascular space surrounding the artery. Conclusions. Contrast-enhanced sonography may provide an effective method for detecting arterial bleeding.

Key Words: bleeding detection • Optison • pulse inversion harmonic imaging • sonography

Abbreviations: CT, computed tomography • FAST, focused abdominal sonography for trauma • MI, mechanical index • PIHI, pulse inversion harmonic imaging

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				W. Luo, V. Zderic, F. A. Mann, and S. Vaezy Color and Pulsed Doppler Sonography for Arterial Bleeding Detection J. Ultrasound Med., August 1, 2007; 26(8): 1019 - 1029. [Abstract] [Full Text] [PDF]