Multi-detector row computed tomography and blunt chest trauma

Blunt chest trauma is a significant source of morbidity and mortality in industrialized countries. The clinical presentation of trauma patients varies widely from one individual to another and ranges from minor reports of pain to shock. Knowledge of the mechanism of injury, the time of injury, estimates of motor vehicle accident velocity and deceleration, and evidence of associated injury to other systems are all salient features to provide for an adequate assessment of chest trauma. Multi-detector row computed tomography (MDCT) scanning and MDCT-angiography are being used more frequently in the diagnosis of patients with chest trauma. The high sensitivity of MDCT has increased the recognized spectrum of injuries. This new technology can be regarded as an extremely valuable adjunct to physical examination to recognize suspected and unsuspected blunt chest trauma.     

Multi-detector computed tomography imaging of blunt chest trauma

Background and purpose

Chest trauma is a significant cause of mortality and morbidity, especially in the younger population. The purpose of this study was to evaluate the role of multi-detector computed tomography (MDCT) in the assessment of patients with blunt chest trauma.

Patients and methods

A prospective study was conducted on thirty (30) patients with blunt chest trauma (21 males and 9 females, aged from 6 to 62 years) and 29 control patients presented with any trauma other than blunt chest trauma (23 males and 6 females, aged from 10 to 68 years) at the Emergency Department, Tanta University Hospital, from January 2013 to February 2014. Cases were subjected to clinical evaluation and radiological assessment of the chest using conventional chest X-ray (CXR) and multi-detector computed tomography.

Results

The most common mode of injury was motor vehicle accidents (56.7%). On MDCT scan, the frequency of chest injuries were; chest wall injuries (86.7%), pleural injuries (80%), parenchymal injuries (56.7%), mediastinal injuries (30%) and finally the dorsal spine injuries (16.7%). MDCT is more sensitive, specific, and accurate than CXR in the assessment of blunt chest trauma and management of patients.

Conclusion

MDCT is the modality of choice for rapid assessment of emergency chest trauma patients, when chest X-ray was inconclusive.     

Multidetector computed tomography of spinal trauma: a pictorial review

Spinal trauma is 1 of the major causes of disability that commonly affects young adults, and radiologists play a crucial role in the evaluation of acutely traumatized patients. With the advent of multidetector computed tomography (MDCT), the algorithm of imaging of spinal trauma has changed dramatically and MDCT is now established as the imaging modality of choice for the diagnosis of spinal trauma. The appearance on MDCT of the spinal injury depends on the mechanism of the injury, which also determines the stability of the injury. This pictorial essay describes the MDCT appearances, mechanism, and stability of commonly encountered traumatic spinal injuries.     

Multidetector computed tomography in the diagnosis and management of renal trauma

Renal injuries fall within the broad and complex subject of retroperitoneal trauma. Although their computed tomography (CT) features have been known for a while, the timing, diagnostic approach and management are still debated. In addition, some areas of uncertainty remain regarding timing, indications and imaging modalities to be used in the follow-up of these patients. The purpose of this paper is to review the impact of CT on the management of renal trauma, stressing the importance of this technique and the role of the radiologist in the timing of decisions. Finally, we discuss the diagnostic approach to the follow-up of renal trauma.     

The diagnostic impact of computed tomography in blunt abdominal trauma

Sixty patients with blunt abdominal trauma were investigated by computed tomography, 21 within 48 h of injury, 39 within days and weeks. Organ laceration of the spleen, liver, pancreas and kidney and haematoma formation were comprehensively demonstrated and post-operative complications readily identified. Computed tomography is currently the radiological method of choice to evaluate injuries to abdominal organs.     

Multidetector computed tomography imaging of facial trauma in accidental falls from heights

PURPOSE: To assess multidetector computed tomography (MDCT) findings in facial trauma in adults who accidentally fall from heights. MATERIAL AND METHODS: Of the MDCT scans of 2413 cases requested by emergency-room physicians for suspected facial injury, 155 (age 15.3-76.7, mean 42.0 years; 134 male, 21 female) met the criteria of falling from heights. These were reviewed by two researchers by consensus. RESULTS: Of these 155, 118 (104 male, 14 female) had 247 fractures, while 37 had no fracture. The fractures were classified into 13 categories, the zygomatic complex being the region most frequently involved. Mean falling height, known in 132 of 155 cases, was 5.7 m (range 0.4-25) in all, 6.0 m (0.4-25) in those suffering a fracture, and 5.0 m (range 0.4-13) in those without a fracture. Patients with Le Fort II, Le Fort III, or frontal bone fractures had fallen higher and frequently had associated skull base fractures, but with considerable overlap in falling heights. Zygomatic arch and nasal bone fractures rarely occurred solitarily. CONCLUSION: In a fall-from-height injury, nasal bone and zygomatic arch fractures indicate the presence of more severe fractures. Height cannot solely predict injury probability. Clear sinus sign is a valuable aid in assessing midface trauma in falls from heights.     

Multidetector computed tomography in acute abdomen

MDCT has become a fundamental tool for determining the causes of acute abdomen. CT is considered the imaging technique of choice in the diagnostic workup of both localized and diffuse acute abdomen, except in patients in whom acute cholecystitis or acute gynecological disease is suspected and in children, adolescents, and pregnant patients, in whom ultrasonography is the imaging technique of choice. Plain-film X-ray examination has been relegated to the initial management of renal colic, suspected foreign bodies, and intestinal obstruction. One of the drawbacks of MDCT is its use of ionizing radiation, which makes it necessary to filter and direct the examinations as well as to ensure that the most appropriate protocols are used. For this reason, low dose protocols have been developed so that diagnostic studies can be performed with doses of radiation between 2 and 3 mSv; these are normally used in the diagnosis of renal colic and can also be used in selected patients with suspected appendicitis and acute diverticulitis.     

Multidetector computed tomography and neuroendocrine pancreaticoduodenal tumors

Purpose: To investigate the accuracy of dedicated pancreatic multidetector computed tomography (MDCT) in the diagnosis of neuroendocrine pancreaticoduodenal tumors (NPTs).

Material and Methods: MDCT and other imaging studies in patients with suspected NPTs were identified. Thirty dedicated MDCT studies were done in 23 patients. Fourteen patients (16 operations) subsequently had surgery. Imaging reports were reviewed and findings compared with surgical findings and findings in other imaging studies.

Results: Patients with surgery: 19 NPTs (16 extrapancreatic gastrinomas and 3 pancreatic NPTs) were identified at surgery. MDCT identified 16 and somatostatin receptor scintigraphy (SRS) 11 out of 19 tumors. Endoscopic ultrasound detected 11 out of 14 NPTs. Patients without surgery: In 4 out of 9 patients, no NPTs were identified at MDCT.

Conclusion: Dedicated MDCT of the pancreas can identify many NPTs, including small duodenal and periduodenal tumors, and the detection rate is better than reported in the older literature on CT.     

Detection of free intraperitoneal air on computed tomography after blunt abdominal trauma

In patients who have sustained blunt abdominal trauma, detection of free intraperitoneal air on computed tomography (CT) is thought to be a fairly specific finding of bowel rupture. We devised a method to determine the accuracy of a radiologist in identifying this important finding on CT scans in patients with blunt abdominal trauma. We retrospectively reviewed 50 CT scans and the radiologist’s report in patients who had undergone diagnostic peritoneal lavage (DPL) before the CT scan. We analyzed the report to see whether either free intraperitoneal air or the possibility of DPL was mentioned. Thirty scans retrospectively demonstrated free intraperitoneal air. The radiologist detected this finding in 25 patients (83%). In 5 patients (17%), the radiologist did not detect the free air or raise the possibility of a previous lavage. The amount of air introduced postlavage was variable, depending on the surgical technique and the time interval between the lavage and the CT scan. Air was most often demonstrated (in order of frequency) anterior to the liver, in the rectus recesses adjacent to the lavage defect, and in the fissures of the liver. In the five patients in whom free air was not identified, the amount or location of the air did not contribute to the error. The findings of this study were reviewed with all of the radiologists at a physician quality assurance meeting. A follow-up study of 25 patients was then obtained, and free air was detected in 25 (100%) of the cases. In summary, (a) free intraperitoneal air was missed in 17% of patients; (b) air preferentially collects beneath the diaphragm and in the rectus recesses; (c) there was no correlation between the amount or location of air and the error rate; (d) the most important variable is the examiner’s experience, and this can be improved markedly through education.     

Multidetector computed tomography in acute joint fractures

Conventional radiography plays an essential diagnostic role in the primary evaluation of acute joint trauma. In complex fractures, however, computed tomography (CT) is an imaging modality often used second to radiography. As a result of technical breakthroughs in the field, multidetector CT (MDCT) allows faster imaging and better temporal, spatial, and contrast resolution compared with conventional single-slice spiral CT. MDCT with multiplanar reformation is helpful in disclosing fracture patterns, particularly in complex joint fractures, where they reveal occult fractures and show the exact number of fracture components and their degree of displacement.     

Multidetector computed tomography imaging of the spine

This article discusses applications of multidetector computed tomography imaging of the spine as they were presented at the "Advances in Multidetector CT" meeting held in Washington, DC, September 13-14, 2003. These include imaging the spine in the setting of trauma, postoperative fusion, chronic pain, radiculopathy, or bony lesions and performing image-guided biopsies.     

Multidetector computed tomography imaging of aortoenteric fistula

Three case reports illustrating multidetector computed tomography (CT) imaging findings of secondary aortoenteric fistula (AEF) are described and presented in axial sections, multiplanar reformats, and 3-dimensional reconstruction. Fistulae occurred in the early and late postgrafting period and involved both end-to-end and end-to-side aortic graft anastomoses. Multidetector CT is quick and accurate in the diagnosis of bleeding AEF.     

Multidetector computed tomography angiography of the abdomen

Multidetector computed tomography (MDCT) angiography has provided excellent opportunities for advancement of computed tomography (CT) technology and clinical applications. It has a wide range of applications in the abdomen including vascular pathologies either occlusive or aneurysmal; enables the radiologist to produce vascular mapping that clearly show tumor invasion of vasculature and the relationship of vessels to mass lesions. MDCTA can be used in preoperative planning for hepatic resection, preoperative evaluation and planning for liver transplantation. MDCTA can also provide extremely valuable information in the evaluation of ischemic bowel disease, active Crohn disease, the extent and location of collateral vessels in cirrhosis.     

Criteria for the selective use of chest computed tomography in blunt trauma patients

Purpose

The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury.

Methods

This observational study prospectively included consecutive patients (≥16 years old) who underwent multidetector CT of the chest after a high-energy mechanism of blunt trauma in one trauma centre.

Results

We included 1,047 patients (median age, 37; 70% male), of whom 508 had chest injuries identified by CT. Using logistic regression, we identified nine predictors of chest injury presence on CT (age ≥55 years, abnormal chest physical examination, altered sensorium, abnormal thoracic spine physical examination, abnormal chest conventional radiography (CR), abnormal thoracic spine CR, abnormal pelvic CR or abdominal ultrasound, base excess <?3 mmol/l and haemoglobin <6 mmol/l). Of 855 patients with ≥1 positive predictors, 484 had injury on CT (95% of all 508 patients with injury). Of all 192 patients with no positive predictor, 24 (13%) had chest injury, of whom 4 (2%) had injuries that were considered clinically relevant.

Conclusion

Omission of CT in patients without any positive predictor could reduce imaging frequency by 18%, while most clinically relevant chest injuries remain adequately detected.     

Multidetector computed tomography of pediatric lateral condylar fractures

OBJECTIVE: The objective of this study was to compare lateral condylar fracture characterization using radiographs and multidetector computed tomography (MDCT) of the elbow and to evaluate outcomes in a group of children managed based on MDCT findings. METHODS: Unenhanced MDCT of the elbow with sagittal and coronal reformations was prospectively performed without sedation in 10 children between 1 and 16 years of age with lateral condylar fractures identified on frontal and lateral radiographs of the elbow. Two blinded readers reviewed all radiographs and MDCT images independently and in consensus. For the radiographs and MDCT images, readers graded the displacement of the lateral condyle fracture fragment and classified the fractures according to the Milch classification. Articular and epiphyseal cartilage integrity was assessed on MDCT. Patients were managed based on the consensus interpretation of the MDCT study. The frequency of interobserver agreement, discordant grading of fracture displacement and fracture classification between radiographs and MDCT images, and altered management based on the MDCT findings were determined. RESULTS: Individual readers agreed on fracture displacement in 9 patients (90%) on radiographs and in all 10 patients (100%) on MDCT. Individual readers agreed on fracture classification in 4 patients (40%) on radiographs and in 9 patients (90%) on MDCT. In 4 patients (40%), grading of fracture displacement differed between the consensus interpretation of the radiographs and MDCT images. In 6 patients (60%), fracture classification differed between the consensus interpretation of the radiographs and MDCT images. All 3 patients with fracture displacement greater than 5 mm and 1 patient with fracture displacement between 2 and 5 mm demonstrated disruption of the articular and epiphyseal cartilage on MDCT. Two patients (20%) with fracture displacement near the surgical threshold of 2 mm had altered management based on the MDCT findings. All patients progressed to complete fracture healing, with no delayed displacement or other complications. CONCLUSIONS: Multidetector computed tomography is a highly reproducible means of characterizing pediatric lateral condylar fractures and frequently demonstrates disruption of the epiphyseal and articular cartilage in patients with fracture displacement greater than 2 mm. The findings of MDCT may lead to altered treatment in patients with fracture displacement near the surgical threshold of 2 mm.