First experiences with multidetector CT in traumatized children

INTRODUCTION: The aim of this study was to describe and discuss first experiences with multidetector CT (MDCT) in the assessment of traumatized children. MATERIAL AND METHODS: Since the implementation of a MDCT scanner in April 2002, 85 children (31 girls, 54 boys with a mean age of 9.2 years) consecutively underwent MDCT (Siemens, Erlangen, Germany) with different protocols depending on age, weight, trauma mechanism and clinical presentation. In all patients in whom pathology was suspected, multiplanar reformations (MPR) in coronal and or sagittal orientation was performed. Examinations were evaluated by two radiologists retrospectively and in consensus. RESULTS: In 55 (65%) children, a MDCT solely of the head was performed, in 46 there was no pathology found. In six (7%), head and facial bones were scanned. Head and abdomen was examined in two (2%), in two (2%) the abdomen only and in one (1%) the pelvis solely. Scans of the spine were obtained in seven (8%) children. A thorax and abdomen examination only was obtained in one (1%) child each. In 11 (13%) children, a polytrauma protocol was performed. In all patients, the time of examination did not exceed 17 min, including setup time. All children survived at the writing of this report. CONCLUSION: MDCT was promising in the management of traumatized children and seems to shorten the necessary time to reach diagnosis and to initiate life-saving treatment.     

Multidetector CT evaluation of abdominal trauma

CT is the imaging modality of choice to evaluate blunt abdominal trauma. With the advent of multidetector CT (MDCT), scanning times have progressively decreased while image resolution has increased owing to thinner collimation and reduced partial volume and motion artifacts. MDCT also allows high quality two-dimensional and three-dimensional multiplanar reformatted images to be obtained, which aid in the diagnosis of the complex multisystem injuries seen in the trauma patient. This article describes the authors' current imaging protocol with 16-detector MDCT, the spectrum of CT findings seen in patients with blunt abdominal injuries, and the role MDCT has in guiding injury management.     

Computed tomography whole body imaging in multi-trauma: 7 years experience

AIM: To assess the impact of the introduction of a computed tomography (CT) imaging protocol for multi-trauma patients on the workload, overall diagnostic yield, and effect on detection of cervical spine injury and pneumothorax. METHOD: Between February 1997 and April 2004, all patients presenting acutely to the Emergency Department (ED) with haemodynamically stable trauma (Abbreviated Injury Scale 3 or more) involving more than two body systems were imaged with a comprehensive pre-set helical CT protocol (including non-contrast head, cervical spine: cranio-cervical and cervico-thoracic junctions; and oral and intravenous contrast-enhanced thoracic, abdomen and pelvis) after initial triage and a standard trauma series of radiographs (chest, lateral C-spine and pelvis). Diagnosis of cervical spine fracture and pneumothorax was noted before and after the CT protocol was carried out and findings from all studies were recorded prospectively. RESULTS: Over the 7-year period 296 multi-trauma CT studies were completed of which 41 (13.8%) were negative. Of the positive cases there were 127 (43%) head injuries; 25 cervical spine fractures (8%); 66 pelvic fractures (22%);48 thoracic or lumbar spine fractures (16%); 97 pneumothoraces (33%); 22 mediastinal injuries (7%) and 49 intra-abdominal injuries (17%) with 19 (6%) splenic tears/ruptures. Positive findings included many unsuspected injuries, including 19 cervical spine fractures which were not demonstrated on the standard lateral radiograph from the resuscitation room. Of the 97 CT detected pneumothoraces, 12 were bilateral, 52 already had a chest drain in situ and 36 were not detected on initial supine chest radiography in the resuscitation room. One undetected case had bilateral tension pneumothoraces that were promptly drained on the CT table. Only three patients did not complete their multi-trauma examination because of deterioration in clinical condition and these were all immediately returned to the resuscitation room. CONCLUSION: Over the 7-year period in a large acute National Health Service (NHS) hospital trust currently averaging 85,000 ED attendances per year only 296 patients fulfilled the stated criteria for an immediate multi-trauma CT study. Although disruptive in the short-term, the overall impact on workload was small. A wide range of significant injuries were demonstrated rapidly, accurately and safely, including 19 cervical spine fractures and 26 pneumothoraces not detected on plain radiographs.     

Reliability of the evaluation of multidetector computed tomography images from the scanner's console in high-energy blunt-trauma patients

Purpose: To evaluate the reliability of a structured 5-min evaluation of multidetector computed tomography (MDCT) images from the scanner's console in high-energy trauma patients.

Material and Methods: Forty patients were scanned with four-slice MDCT using a standardized trauma protocol. Image evaluation covered the thorax, abdomen, and pelvis. The radiologist scrolled axial images on the scanner's console using three different window settings (lung, soft tissue, and bone) and performed a prospective structured evaluation of the traumatic lesions. The findings were compared to the final radiological diagnosis of the MDCT data made on a PACS workstation, the operative findings, and the clinical follow-up.

Results: Evaluation from the scanner's console enabled the diagnosis of all potential life-threatening injuries, the sensitivity for all injuries being 60% and specificity 98%.

Conclusion: A PACS workstation is needed for the final diagnosis of all injuries, but this rapid screening method can reliably detect all injuries that require instant care.     

Thoracic computed tomography in victims of blunt trauma: changes in utilization after the introduction of helical technology

Purpose: In blunt trauma, CT of the thorax is often performed because of the limitations of plain film chest radiography in accurately depicting injuries to the thoracic aorta. The advent of helical CT has allowed the entire chest to be imaged more expeditiously. We will evaluate the extent to which this ability to rapidly obtain additional images of the thorax has increased the utilization of chest CT in blunt trauma. Methods: The radiologic records of all victims of blunt trauma who underwent total body CT (TBCT), which included abdomen, pelvis, and chest images, in the 10 months before and 10 months after our institution acquired helical CT (HCT), were retrospectively evaluated. Results: In the 10 months before we obtained HCT, 520 conventional CT of the abdomen and pelvis were completed, of which only 11 (2.1 %) included images of the full thorax. After HCT was instituted, 684 abdomen and pelvis CT were performed, of which 59 (8.6 %) were ordered with the entire chest. Of the 11 conventional TBCT, 6 (55 %) showed findings in the chest; in 2 of these cases (18 %) the abnormalities were confined exclusively to the thorax. Similarly, of the 59 helical TBCT, 31 (53 %) depicted traumatic abnormalities in the thorax, and in 23 of these cases (39 %) injuries were only within the chest. In 4 of the latter the injuries were mediastinal hematomas, 1 of which (25 %) was confirmed angiographically to represent an aortic laceration. Conclusion: The speed and ease with which additional images can be obtained by HCT has greatly increased utilization of cross-sectional imaging of the thorax after blunt trauma (approximately four-fold). Over half of these depict traumatic injuries.     

MDCT in emergency radiology: is a standardized chest or abdominal protocol sufficient for evaluation of thoracic and lumbar spine trauma?

OBJECTIVE: The objective of our study was to assess the diagnostic performance of a standardized 4-MDCT trauma protocol for the evaluation of the thoracic and lumbar spine in patients with multiple injuries. MATERIALS AND METHODS: Eighty-two patients with multiple injuries underwent MDCT for the chest and abdomen using a standardized 4-MDCT trauma protocol (collimation, 4 x 2.5 mm). Secondary reconstructions targeted to the spine were performed (slice width, 3 mm; reconstruction interval, 1.5 mm). All spinal fractures were additionally scanned using a collimation of 4 x 1 mm, and these images served as the standard of reference for fracture classification. An additional 50 patients with no spinal fracture served as the control group. A total of 65 major spinal fractures were present in 55 of the patients with multiple injuries. Two observers (observer 1 and observer 2) independently evaluated all CT data for spinal fractures using a 5-point confidence scale, classified the different fracture types, and rated the image quality of spinal structures on axial images and multiplanar reformations. RESULTS: Image quality for axial images was excellent in 80% and in 68% using 4 x 1 mm and 4 x 2.5 mm collimation, respectively. Image quality of the multiplanar reformations was excellent in 75% and good in 65% using 4 x 1 mm and 4 x 2.5 mm collimation, respectively. Spinal fractures were detected by observer 1 and observer 2 with a sensitivity and specificity of 98% and 97% and of 97% and 97%, respectively. Interobserver agreement regarding the confidence scale for fracture detection was substantial (kappa = 0.80), and agreement between the different imaging protocols for fracture classification was excellent for observer 1 (kappa = 0.95) and observer 2 (kappa = 0.97). CONCLUSION: Accurate evaluation of the thoracolumbar spine is possible with targeted image reconstruction based on a standardized 4-MDCT trauma protocol of the chest and abdomen.     

Computed tomography for cervical spine trauma. The impact of MDCT on fracture detection and dose deposition

A multidetector computed tomography (MDCT) was installed in our department. Referral rates, examination protocols and detection rates of abnormal findings in CT examinations for cervical spine trauma 6 months before and 6 months after MDCT installation were compared to look for changes in practice. Retrospective analysis of all CT cervical spine examinations in patients with multiple trauma over two contiguous 6-month periods: from July 2003 to December 2003 (helical CT) and from January 2004 to June 2004 (MDCT). Variables recorded were number of CT examinations performed, scan plane coverage and traumatic abnormalities detected. Phantom dosimetry measurements for cervical spine examination in both helical CT and MDCT were compared. One hundred and fifty four patients underwent cervical spine CT during these periods. Helical CT period: of 91 patients undergoing CT cervical spine examination for trauma, 65 (71%) were complete cervical examinations and 26 (29%) were level-specific examinations. Eight patients (9%) had cervical spine fracture, six of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 24.76, 1.86 and 0.21 mGy, respectively, for complete cervical spine examinations. MDCT period: of 63 patients who underwent CT cervical spine examination for trauma, 61 (97%) were complete examinations and 2 (3%) were level-specific examinations. Six patients (11%) had cervical spine fracture, three of which were apparent on radiographs. Dose estimations for thyroid, lens and breast were 75.8, 9.7 and 0.7 mGy, respectively, for complete cervical spine examinations, which were notably higher than those for helical CT. After installation of MDCT, clinical requests for complete examination of the cervical spine following trauma increased. This changing trend resulted in a significantly higher radiation dose to thyroid, lens and breast.     

Comparison of low-dose with standard-dose multidetector CT in cervical spine trauma

BACKGROUND AND PURPOSE: The purpose of this work was to evaluate the possible use of low-dose multidetector CT (MDCT) in cervical clearance of patients with blunt trauma. MATERIALS AND METHODS: A total of 191 patients underwent cervical spine MDCT with 6- and 16-MDCT: standard-dose (n = 51) and low-dose MDCT with tube current modulation at high (n = 70) and low (n = 70) tube voltage (kilovolts). Effective dose, image noise, and subjective image quality were calculated in all of the patients. RESULTS: MDCT found 18 patients (9.4%) with a cervical spine fracture, 3 in the standard-dose and 15 in the low-dose group, 14 of them with unstable lesions. Tube current modulation reduced the dose by 50%-61% in all of the low-dose examinations. The mean effective dose was 3.75, 1.57, and 1.08 mSv, and mean image noise was 14.82, 17.46, and 19.72 Hounsfield units for standard dose and low dose with high and low kilovolt examinations, respectively. These differences in mean effective dose and image noise were significant between the 3 examination groups (Kruskal-Wallis test: P < .0001 and P = .0001). Evaluation of subjective image quality by 2 radiologists and 2 residents showed no significant difference in image quality score among the 3 examination groups (Kruskal-Wallis tests, P = .61, .32, .18, and .31). All of the reviewers correctly detected 18 fractures, except 1 resident, who missed 3 fractures. CONCLUSION: Low-dose cervical spine MDCT in patients with blunt trauma gives a substantial dose reduction of 61%-71%, compared with standard-dose MDCT, with a small increase in image noise and without difference in subjective image quality evaluation.     

Low-dose MDCT findings of blunt hepatobiliary trauma

This pictorial essay shows low-dose multi-detector computed tomography (MDCT) findings of blunt hepatobiliary trauma, and describes the indications and protocol for MDCT. Given the universal usage of MDCT in assessing the liver in blunt abdominal trauma, reduction of patient dose is essential. The new l0se MDCT protocol presented here can achieve up to 50% dose reduction while maintaining diagnostic image quality and thus facilitate dose sensitive patient management. Our institution’s blunt hepatobiliary MDCT imaging algorithm can help determine which patients require operative therapy. Injury to the liver is graded on various schemes, one being the Organ Injury Scale devised by the American Association for the Surgery of Trauma classification based on the extension of the lesion and bleeding.     

Assessing potential spinal injury in the intubated multitrauma patient: does MRI add value?

The purpose of the study was to determine the role of magnetic resonance imaging (MRI) in intubated multitrauma patients with normal computed tomography (CT) in excluding unstable ligamentous injury to the cervical spine. A retrospective evaluation was done on those multitrauma patients admitted to the intensive care unit of a level 1 trauma centre who had normal single-slice helical CT cervical spine and underwent MRI for cervical spine clearance from 1/1/04 to 30/6/05. Fifty-five patients met the inclusion criteria. Ten of these patients had a discoligamentous injury identified on MRI; however, all these patients had injuries limited to only one of the three columns of the cervical spine. Single-slice helical CT with sagittal reformats had a negative predictive value of 82% for discoligamentous injury and 100% for unstable injury. A normal single-slice helical CT with sagittal reformats of the cervical spine in intubated trauma patients excluded unstable injuries at follow-up cervical spine MR imaging.     

Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal?

PURPOSE: To retrospectively determine what information, if any, magnetic resonance (MR) imaging of the cervical spine in obtunded and/or "unreliable" patients with blunt trauma adds to multi-detector row computed tomography (CT) of the entire cervical spine (including routine multiplanar sagittal and coronal reformations) when the CT findings are normal. MATERIALS AND METHODS: The study was HIPAA compliant and institutional review board approved. Informed consent was not required. From April 2001 to November 2003, 1400 trauma patients underwent MR imaging of the cervical spine to evaluate potential cervical spine injuries. Multi-detector row CT of the cervical spine was performed with a four- or 16-detector row scanner. MR imaging of the cervical spine was performed with transverse gradient-echo, sagittal intermediate-weighted, sagittal short inversion time inversion-recovery, and sagittal T1- and T2-weighted fast spin-echo sequences. Many MR examinations were performed to exclude soft-tissue injuries in the cervical spine of obtunded patients with blunt trauma in whom cervical spine injury could not be excluded with physical examination. Complete cervical spine MR studies were obtained to evaluate soft-tissue injuries in 366 obtunded patients with blunt trauma (281 male and 85 female patients; age range, 13-92 years; mean age, 42.1 years). The patients had previously undergone total cervical spine multi-detector row CT with normal findings. The results obtained with these two modalities were compared. RESULTS: MR images were negative for acute injury in 354 of the 366 patients and negative for cervical spine ligamentous injury in 362. Seven of the 366 patients had cervical cord contusions, four patients had ligamentous injuries, three patients had intervertebral disk edema, and one patient had a cord contusion, a ligamentous injury, and an intervertebral disk injury. Four patients had ligamentous injuries; however, all of these patients had ligament injuries limited to only one of the three columns of cervical spine ligament support. Multi-detector row CT had negative predictive values of 98.9% (362 of 366 patients) for ligament injury and 100% (366 of 366 patients) for unstable cervical spine injury. CONCLUSION: A normal multi-detector row CT scan of the total cervical spine in obtunded and/or "unreliable" patients with blunt trauma enabled the authors to exclude unstable injuries on the basis of findings at follow-up cervical spine MR imaging.     

Local staging of endometrial carcinoma: role of multidetector CT

The purpose was to evaluate the accuracy of multidetector CT (MDCT) on a 16-row CT scanner in local staging of endometrial carcinoma and more specifically in the assessment of the depth of myometrial invasion and presence of cervical infiltration. This prospective study includes 21 women with newly diagnosed endometrial carcinoma. All CT examinations were performed on a 16-row CT scanner, and the protocol included scanning of the abdomen after intravenous administration of iodinated contrast material, during the portal phase, using a detector collimation of 16×0.75 mm and a pitch of 1.2. Sagittal, parasagittal and oblique reformatted images were evaluated for the depth of myometrial invasion, whether superficial or deep, and the presence of cervical infiltration. Imaging findings were correlated with the histopathologic results. The sensitivity, specificity and accuracy of MDCT in evaluating myometrial invasion were 100%, 80% and 95%, respectively, and for assessing cervical infiltration were 78%, 83% and 81%, respectively. In conclusion, MDCT on a 16-row CT scanner proved accurate in local staging of endometrial carcinoma.     

Application of imaging guidelines in patients with suspected cervical spine trauma: retrospective analysis and literature review

Safe and efficient clearance of cervical spine injury in blunt trauma patients has been a controversial topic among health professionals. The increased availability of CT scanners in major trauma centers seems to be a factor that has led to increased number of unnecessary cervical spine imaging using this imaging modality. The objective of this study was to investigate the applicability and efficacy of a pre-test clinical criterion in order to stratify post-blunt trauma victims based on their risk of sustaining cervical spine injury and in turn recommend an appropriate imaging modality accordingly. Goergen's criteria (Australas Radiol 48(3):287, 2004), a pre-investigation diagnostic algorithm was retrospectively applied to 106 blunt trauma victims who presented to a level?1 trauma center in Sydney, Australia, and had a CT scan of cervical spine as part of their initial management. Overall, nine (8.5%) of patients sustained a significant cervical spine injury. All nine patients would be classified as high-risk victims according to the algorithm investigated in this study, warranting CT scanning. No patients with low-risk injuries were demonstrated to have a significant cervical spine injury. There was a statistically significant greater proportion of acute cervical spine injuries detected in the high-risk group (p value?=?0.0024). Hence, using Goergen's diagnostic algorithm could reduce the number of unnecessary cervical spine CT scans ordered, while not compromising the quality of care in post-blunt trauma victims.     

MDCT in the evaluation of skeletal trauma: principles, protocols, and clinical applications

Multidetector computed tomography (MDCT) scanners have made volume imaging possible and are used extensively to study polytrauma patients, especially in the evaluation of the spine and peripheral skeleton. An MDCT scanner coupled with a modern workstation has become an essential diagnostic tool for any emergency department. Familiarity with the basic physical principles of MDCT such as projection data, section collimation, and beam collimation is important to achieve high-quality imaging while keeping unnecessary radiation to a minimum. After a polytrauma MDCT examination, images can be reconstructed to obtain different slice thickness, slice interval, fields of view, or reconstruction kernels. No additional scanning is needed for imaging the thoracolumbar spine or bony pelvis. High-quality multiplanar reformation (MPR) and three-dimensional (3-D) images can be created at the workstation using the volumetric data. However, MDCT is a high-dose examination, and care should be taken to use as low a dose as possible. In the musculoskeletal system, MDCT has long been used for evaluation of spinal and pelvic trauma; however, the frequency of its use in extremity trauma has been low. In the extremities, radiography seems to underestimate the extent and severity of injury, especially in complex areas such as the shoulder, elbow, wrist, knee, and ankle. MDCT in the extremities is helpful in fracture detection, evaluation, characterization, and treatment planning. The MPR images give excellent structural detail, and the 3-D images help in understanding the spatial relations, which is important for fracture classification and for preoperative planning. MDCT is also helpful in the follow-up of postoperative results, even in the presence of hardware. Tendon injuries can also be evaluated with MDCT.     

Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening

OBJECTIVE: We aimed to validate the routine use of a clinical decision rule to direct diagnostic imaging of adult blunt trauma patients at high risk for cervical spine injury. MATERIALS AND METHODS: We previously developed and have since routinely used a prediction rule based on six clinical parameters to identify patients at greater than 5% risk of cervical spine injury to undergo screening helical CT of the cervical spine. During a 6-month period, 4285 screening imaging studies of the cervical spine were performed in adult blunt trauma patients. Six hundred one patients (398 males, 203 females; age range, 16-100 years; median age, 38 years) underwent helical CT, and the remainder underwent 3684 conventional radiographic examinations. Clinical and report data were extracted from the radiology department database, medical records, and the hospital trauma registry. Abnormal findings were independently confirmed by additional imaging studies, autopsy results, or clinical outcome. RESULTS: The true-positive cervical spine injury rates in helical CT- and conventional radiography-screened patients who presented directly to our trauma center were 40 (8.7%) of 462 and seven (0.2%) of 3684, respectively. The cervical spine injury rate in patients who were transferred from outside institutions to our trauma center and who underwent helical CT was 37 (26.6%) of 139. This figure included 20 patients already known to have cervical spine fracture. CONCLUSION: The clinical decision rule can distinguish patients at high and low risk of cervical spine injury, thus supporting its validity.     

Can independent coronal multiplanar reformatted images obtained using state-of-the-art MDCT scanners be used for primary interpretation of MDCT of the abdomen and pelvis? A feasibility study

PURPOSE: To evaluate if coronal reformatted images can be used for primary interpretation of MDCT of the abdomen and pelvis using 64-slice MDCT. MATERIALS AND METHODS: IRB approval was obtained. We reviewed MDCT studies of the abdomen and pelvis of 220 consecutive patients performed with 64 row MDCT with constant scanning parameters. Based on a 0.625mm raw data set, transverse images were reconstructed at 5mm and coronal images at 3mm using standard reconstruction algorithms. Reader familiarity was achieved by simultaneous evaluation of transverse and coronal reformats in an initial group of 20 separate cases for findings in consensus. Two subsequent phases of image analysis were then performed in two groups of 100 patients each. In the first phase two radiologists evaluated the added utility of simultaneous review of MDCT of transverse and coronal reformatted images over transverse images alone in 100 consecutive patients referred for MDCT of the abdomen and pelvis. In the second phase, the same radiologists evaluated whether coronal multiplanar reformats could be used for primary interpretation of MDCT of the abdomen and pelvis in a separate but similar cohort of 100 consecutive abdominopelvic MDCT studies. The number of lesion(s), their location, size of smallest lesion, presence of artifacts and likely diagnosis were noted at each image interpretation. Image quality and confidence for interpretation was evaluated using five-point and three-point scale, respectively. The time required for primary interpretation of coronal reformats and transverse images were recorded. Statistical analysis was performed using Wilcoxon signed rank test. RESULTS: Both readers detected additional findings (n=37, 35), respectively, on simultaneous review of transverse and coronal reformats as compared with transverse images alone (p<0.001). Excellent interobserver agreement was noted (r=0.94-0.96). Both readers detected additional findings (n=62, 53), respectively, on independent review of coronal reformats as compared with transverse images alone (p<0.001). Readers' confidence was also found to be higher on coronal evaluations as compared to axial images (p<0.01). There was good interobserver agreement between the two readers. CONCLUSION: Independent coronal multiplanar reformatted images obtained using state-of-the-art MDCT scanners show promise as the preferred orientation and can be useful for primary interpretation of MDCT of the abdomen and pelvis.     

Screening US for blunt abdominal trauma: objective predictors of false-negative findings and missed injuries

PURPOSE: To determine the risk for missed injury in patients with blunt abdominal trauma and negative findings at screening ultrasonography (US) and with coexistent hematuria or fracture of the sixth through 12th ribs, lumbar spine, or pelvis. MATERIALS AND METHODS: From a database of 4,000 patients screened with US for blunt abdominal trauma at a level 1 trauma center, the 3,679 patients with negative US findings were retrospectively classified by consensus of two authors into high-risk (n = 494) and low-risk (n = 3,185) groups based on the presence of hypothetical predictors of missed injury: hematuria (n = 96) or fracture of the sixth through 12th ribs (n = 216), lumbar spine (n = 105), or pelvis (n = 174). Outcome in each patient was determined by the same two authors consensually after retrospective review of the trauma registry and all radiologic, surgical, and autopsy reports. The risk for missed abdominal injury was determined for each patient risk group and for each hypothetical predictor. Risks were statistically compared by using the Pearson chi2, Fisher exact, or Fisher-Freeman-Halton exact test, depending on expected frequencies. RESULTS: High-risk patients were 24 times more likely to have abdominal injuries after negative US findings (30 [6.1%] of 494) than were low-risk patients (eight [0.25%] of 3,185) (P <.001). Among high-risk patients, the absolute risks for missed abdominal injury associated with specific predictors were 15.6% (15 of 96 patients) for hematuria, 6.0% (13 of 216) for lower rib fractures, 7.6% (eight of 105) for lumbar spine fractures, and 5.2% (nine of 174) for pelvic fractures. Each of these risks was significantly higher for patients in the high-risk group than for those in the low-risk group (P <.001). CONCLUSION: Hematuria and fracture of the lower ribs, lumbar spine, or pelvis are objective predictors of missed abdominal injury in patients with blunt abdominal trauma and negative US findings, and such patients may benefit from additional screening with computed tomography.     

Screening for cervical spine trauma with helical CT: experience with 676 cases

Purpose: CT scanners with helical capability are commonplace. Evaluation of multiple trauma patients using this technique is fast, and easily performed as part of the radiological evaluation. Our purpose was to ascertain the clinical effectiveness of cervical spine screening with helical CT in a large sample population of multitrauma patients. Materials and methods: A retrospective review was carried out using screening helical CT scans from multitrauma patients referred to the Massachusetts General Hospital emergency department. The radiographic diagnosis was evaluated and tallied along with the clinical diagnosis and outcome for each patient included in the study. Results: Six hundred seventy-six patients conformed to the inclusion criteria. In this series, 59 true-positive, 616 true-negative, 1 false-negative, and no false-positive findings were encountered. These data result in a sensitivity of 98.3 %, a specificity of 100 %, and an accuracy of 99.9 %. Conclusions: Screening helical CT in the evaluation of trauma patients has a high diagnostic accuracy, and is sensitive and specific in diagnosing clinically relevant fractures of the cervical spine.     

Evaluation of blunt abdominal trauma using PACS-based 2D and 3D MDCT reformations of the lumbar spine and pelvis

OBJECTIVE: The purpose of this study was to show the value of 2D and 3D reformations of CT data from abdominal and pelvic CT performed immediately at the workstation using a PACS-based software program to evaluate the lumbar spine and pelvis in patients with blunt abdominal trauma. MATERIALS AND METHODS: We reviewed the abdominopelvic CT scans and conventional radiographs of the lumbar spine or pelvis of 156 consecutive patients with blunt abdominal trauma. The CT data were compared with the radiographic findings and also with the findings of dedicated repeat CT of the spine or pelvis, when performed. RESULTS: CT depicted 80 fractures of the lumbar spine and 178 pelvic fractures. Radiography showed 40 fractures of the lumbar spine and 138 pelvic fractures. No additional fractures were identified on dedicated repeat CT. CONCLUSION: Conventional radiographs to clear the lumbar spine are no longer required when abdominopelvic CT data are available. CT and reformatted CT data show more fractures than radiography and miss no fractures compared with dedicated CT of the lumbar spine or pelvis. Having these images immediately available through the PACS workstation saves time for the trauma team in the management of critically ill patients.     

Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method: initial experience

Radiation dose data were collected from a calibrated multi-detector row computed tomographic (CT) scanner during trauma CT. One protocol (used with 10 case subjects) involved a single-pass continuous whole-body acquisition from cranial vertex to symphysis pubis, while the other, conventional protocol (used with 10 control subjects) involved scouting and scanning body segments (head, cervical spine, chest, abdomen, and pelvis) individually. Technical factors were kept constant within each body segment for the single-pass and the segmented protocols. Statistics included univariate analysis, two-tailed t testing to evaluate statistical significance of the summary statistic, and power and subject population contingency tables. The mean dose length product (DLP) with the single-pass protocol was 17% lower than the sum of the DLPs of each of the individual body segment scans (P <.001). Analysis of power and subject population by using a difference in mean of 500 mGy. cm and an alpha of.05 revealed a (1-beta) of higher than 0.90 for a sample of 10 patients. Thus, a whole-body single-pass trauma protocol, compared with a typical segmented acquisition protocol matched for imaging technique, resulted in reduced total radiation dose. The reduction in radiation dose is thought to represent a reduction in redundant imaging at overlap zones between body segments scanned in the segmental protocol but not in the continuous acquisition.