Bernard A. Birnbaum, MD, Rendon C. Nelson, MD, Judith L. Chezmar,
MD and Seth N. Glick, MD
PURPOSE: To assess the ability of an extravasation detection
accessory (EDA) to detect clinically important ( 10 mL) extravascular injection
of iodinated contrast material delivered with an automated power injector.
MATERIALS AND METHODS: Five hundred patients referred for contrast
material–enhanced body computed tomography (CT) participated in a prospective,
multiinstitutional, observational study in which the EDA was used to identify
and interrupt any injection associated with clinically important extravasation.
The presence or absence of extravasation was definitively established with helical
CT at the injection site (injection rate, from 1.0 to 5.0 mL/sec; mean, 2.9
mL/sec; median, 3.0 mL/sec).
RESULTS: There were four true-positive (extravasation volumes,
13–18 mL), 484 true-negative, 12 false-positive, and no false-negative
cases. The prevalence of overall and clinically important ( 10 mL) extravasation
was 3.6% (18 of 500 cases) and 0.8% (four of 500 cases), respectively. The EDA
had a sensitivity of 100% (four of four cases; 95% CI: 51%, 100%) and a specificity
of 98% (484 of 496 cases; 95% CI: 96%, 99%) in the detection of clinically important
extravasation.
CONCLUSION: The EDA is easy to use, safe, and accurate in the
monitoring of intravenous injections for extravasation, which could prove especially
useful in high-flow-rate CT applications.
(1) From
the Departments of Radiology, Hospital of the University of Pennsylvania, 3400
Spruce St, Philadelphia, PA 19104 (B.A.B.); Duke University Medical Center,
Durham, NC (R.C.N.); Emory University Hospital, Atlanta, Ga (J.L.C.); and Hahnemann
University Medical Center, Philadelphia, Pa (S.N.G.). Received July 30, 1998;
revision requested September 4; revision received October 29; accepted February
15, 1999.
Address reprint requests to B.A.B. (e-mail: birnbaum@oasis.rad.upenn.edu).