A review of split-bolus single-pass CT in the assessment of trauma patients

Jeavons, Cassandra; Hacking, Craig; Beenen, Ludo F. M.; Gunn, Martin L.

doi:10.1007/s10140-018-1591-1

Cited by 35 publications

(19 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Before the implementation of systematic screening protocols, overall incidence for BCVI in blunt polytrauma was reported to be at 0.1–1% [2, 12, 13], and is now believed to be at 1–2% [14, 15]. With more efficient and liberal screening, markedly higher detection rates of up to 2.7–9% in blunt polytrauma patients have been reported [3, 13, 14, 16, 17].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, to as much as 30% of the BCVI patients, any of these clinical or radiological risk factors indicating BCVI do not apply, and it has been suggested that more liberal screening protocols are required to detect BCVI in these patients [22–24]. CTA screening of high-energy trauma patients can easily be included into whole-body CT (WBCT) for trauma [4, 13, 16, 25].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

et al. 2019

View full text Add to dashboard Cite

Purpose BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke. Methods Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma. Results 1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke ( p < .0001; OR = 9.77; 95% CI 3.3–28.7). Eleven percent of patients with BCVI would not have met standard screening criteria. Conclusions The increase in detection rate for BCVI justifies more liberal screening protocols.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The rapid acquisition of images in trauma CT has allowed for a minimal delay in definitive management. 32 Although historically angiography and embolization were reserved for patients who were hemodynamically stable, as explained earlier, there is increasing role for intraoperative angioembolization in unstable patients.…”

Section: A Preoperative Evaluationmentioning

confidence: 99%

“…The resultant images are a combination of the arterial phase and the portal venous phase. 32 This technique is noninferior to conventional multiphase techniques in diagnosing traumatic injuries in the spleen but variable results in liver trauma. 34 Hence, for patients who are hemodynamically stable, multiphase CT has emerged as a preferred imaging to asses liver trauma and hemorrhage.…”

Section: A Preoperative Evaluationmentioning

confidence: 99%

Contemporary Management of Hepatic Trauma: What IRs Need to Know

Gilyard

Shinn

Nezami

et al. 2020

Semin intervent Radiol

View full text Add to dashboard Cite

Trauma remains one of the leading causes of death in the United States in patients younger than 45 years. Blunt trauma is most commonly a result of high-speed motor vehicular collisions or high-level fall. The liver and spleen are the most commonly injured organs, with the liver being the most commonly injured organ in adults and the spleen being the most affected in pediatric blunt trauma. Liver injuries incur a high level of morbidity and mortality mostly secondary to hemorrhage. Over the past 20 years, angiographic intervention has become a mainstay of treatment of hepatic trauma. As there is an increasing need for the interventional radiologists to embolize active hemorrhage in the setting of blunt and penetrating hepatic trauma, this article aims to review the current level of evidence and contemporary management of hepatic trauma from the perspective of interventional radiologists. Embolization techniques and associated outcome and complications are also reviewed.

show abstract

“…This dual-phase protocol can be accomplished with discrete CT acquisitions at 30 seconds (arterial) and 90 seconds (portal venous) after administration of a single contrast material bolus. As an alternative, a split-bolus technique can be used instead to achieve both arterial and portal venous phase images in a single CT acquisition after two separate contrast material boluses are administered, which can decrease radiation exposure (Table 2) (26,(29)(30)(31).…”

Section: Ct Protocolsmentioning

confidence: 99%

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

et al. 2019

View full text Add to dashboard Cite

After experiencing blunt or penetrating trauma, patients in unstable condition who are more likely to die of uncorrected shock than of incomplete injury repairs undergo emergency limited exploratory laparotomy, which is also known as damage control surgery (DCS). This surgery is part of a series of resuscitation steps, with the goal of stabilizing the patient's condition, with rapid surgical control of hemorrhage followed by supportive measures in the intensive care unit before definitive repair of injuries. These patients often are imaged with multidetector CT within 24-48 hours of the initial surgery. Knowledge of this treatment plan is critical to CT interpretation, because there are anatomic derangements and foreign bodies that would not be present in patients undergoing surgery for other reasons. Patients may have injuries beyond the surgical field that are only identified at imaging, which can alter the care plan. Abnormalities related to the resuscitation period such as the CT hypoperfusion complex and ongoing hemorrhage can be recognized at CT. Familiarity with these imaging and clinical findings is important, because they can be seen not only in trauma patients after DCS but also in other patients in the critical care setting. The interpretation of imaging studies can be helped by an understanding of the diagnostic challenges of grading organ injuries with surgical materials in place and the awareness of potential artifacts on images in these patients.

show abstract

A review of split-bolus single-pass CT in the assessment of trauma patients

Cited by 35 publications

References 40 publications

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke

Contemporary Management of Hepatic Trauma: What IRs Need to Know

Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic Injuries

Contact Info

Product

Resources

About