CT radiation exposure and management of delayed pseudoaneurysms in pediatric liver and spleen injuries: A multicenter study.

Minimizing radiation exposure and preventing pseudoaneurysm rupture are crucial for pediatric patients with delayed pseudoaneurysm following blunt liver and/or spleen injuries. However, the radiation exposure from follow-up CT scans in patients managed conservatively or with prophylactic embolization remains unclear. This study aimed to evaluate radiation exposure from CT scans based on these management strategies. This research was a secondary analysis of a multicenter, retrospective observational study that included pediatric patients (≤16 years old) who sustained blunt liver and/or spleen injuries at 83 institutions in Japan from 2008 to 2019. Patients diagnosed with delayed pseudoaneurysm, defined as a newly detected pseudoaneurysm on or after the second day post-injury, were included. This descriptive study compared CT-related radiation exposure and rupture rates between patients with and without prophylactic embolization, with radiation exposure assessed using dose length product. Fifty patients had delayed pseudoaneurysm. Of these, 28 (56%) did not receive prophylactic embolization. The sum of dose length product in patients with delayed pseudoaneurysm not receiving prophylactic embolization was 4203 (1802-7503) mGy·cm, compared with 2492 (1258-4457) mGy·cm in those receiving prophylactic embolization (p = 0.12). Then, pseudoaneurysm rupture occurred in 32% of no prophylactic embolization patients, whereas no ruptures were observed in the embolization group (p = 0.003). Pediatric patients not receiving prophylactic embolization trended to have high radiation exposure from CT scans and had a higher rate of ruptured delayed pseudoaneurysm compared to those receiving embolization. These findings support further study of strategies to reduce rupture risk and radiation exposure.