Predictive factors of extravasated visualization in digital subtraction angiogram (DSA) following a positive computed tomography angiogram (CTA)

Abstract

Objective: To analyse the time delay between imaging modalities and several factors which impact the imaging correlation between CTA and DSA. Materials and methods: A retrospective cross-sectional study was conducted on all patients who underwent DSA following a positive contrast blush in CTA for active bleeding from January 2021 to December 2022. Time delay and several factors were compared between positive and negative imaging correlation groups. Results: Ninety-one DSAs were performed in patients with active bleeding following a positive CTA. Forty-one patients had gastrointestinal bleeding. Seventeen patients had liver injury/ruptured liver tumors. Fifteen patients had chest wall/abdominal wall/retroperitoneum bleeding. The median time delay from CTA to DSA was 295 (216–584) minutes, with no significant difference between positive and negative correlation groups. However, we found a significant decrease in positive correlation when performing DSA at 120–239 min compared with those performed at 0–119 min, 30.4% versus 60%, respectively (p value = 0.049). Conclusions: After a positive CTA, DSA should be performed promptly to improve the chance of detecting the bleeding site and enable super-selective embolization.