Posttraumatic shock in children: CT findings associated with hemodynamic instability.

Sivit, Carlos J.; Taylor, George A.; Bulas, Dorothy; Kushner, David C.; Potter, Barry M.; Eichelberger, Martin R.

doi:10.1148/radiology.182.3.1535886

Cited by 114 publications

(71 citation statements)

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“…The results of this experimental study have been substantiated in a clinical report on patients with a reduced CO due to hypovolemic shock and systemic hypotension, where CT showed an unusually dense opacification of arteries, bowel walls, and kidneys [15]. Fleischmann et al [24] reported in patients with abdominal aortic aneurysms a correlation between the enhancement in the abdominal aorta and the contrast agent transit time, indicating an increase in vessel enhancement with lower CO.…”

Section: Hemodynamic Parameters and Coronary Opacificationsupporting

confidence: 55%

“…An additional important factor affecting the timing of contrast medium enhancement is cardiac output (CO) [14]. It has been clinically observed that reduced CO results in delayed and increased vascular enhancement [15]. Despite the importance of cardiac function for vessel opacification, to our knowledge, no study has investigated the influence of cardiac hemodynamic parameters on coronary artery attenuation.…”

Section: Introductionmentioning

confidence: 99%

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Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography

et al. 2006

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Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomographyAbstract The purpose of this study was to evaluate the influence of ejection fraction (EF), stroke volume (SV), heart rate, and cardiac output (CO) on coronary artery opacification with 64-slice computed tomography (CT). Sixty patients underwent, retrospectively, electrocardiography-gated 64-slice CT coronary angiography. Left ventricular EF, SV, and CO were calculated with semi-automated software. Attenuation values were measured and contrast-to-noise ratios (CNRs) were calculated in the proximal right coronary artery (RCA) and left main artery (LMA). Mean EF during scanning was 61.5±12.4%, SV was 63.2±15.6 ml, heart rate was 62.5±11.8 beats per minute (bpm), and CO was 3.88±1.06 l/min. There was no significant correlation between the EF and heart rate and the attenuation and CNR in either coronary artery. A significant negative correlation was found in both arteries between SV and attenuation (RCA r=−0.26, P<0.05; LMA r=−0.34, P<0.01) and between SV and CNR (RCA r=−0.26, P<0.05; LMA r=−0.26, P<0.05). Similarly, a significant negative correlation was found between the CO and attenuation (RCA r=−0.42, P<0.05; LMA r=−0.56, P<0.001) and between the CO and CNR (RCA r=−0.39, P<0.05; LMA r=−0.44, P<0.001). The actual hemodynamic status of the patient influences the coronary artery opacification with 64-slice CT, in that vessel opacification decreases as SV and CO increase.

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Section: Hemodynamic Parameters and Coronary Opacificationsupporting

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography

et al. 2006

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“…body mass index (BMI), body surface area (BSA)) [9][10][11] or by contrast bolus dilution depending on cardiac output (CO) [12][13][14]. Coronary calcifications are known to influence image quality by their blooming and beam-hardening artifacts [1,4,7].…”

Section: Introductionmentioning

confidence: 99%

Determinants of vessel contrast in BMI-adapted low dose CT coronary angiography with prospective ECG-triggering

Herzog

Husmann

Valenta

et al. 2009

Int J Cardiovasc Imaging

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Methods: Seventy patients underwent low-dose CTCA using BMI-adapted tube parameters and a fixed contrast material bolus. Contrast to noise ratio (CNR) was calculated from contrast (between coronaries and perivascular tissue) and image noise (standard deviation of aortic attenuation). Cardiac output (CO) was calculated from gated 99m Tc-tetrofosmin-SPECT.Results: Mean radiation dose was 2.13 0.69mSv. Image noise was not affected by BMI (r=0.1, P=0.36), while CNR was inversely related to body surface area (BSA) (r= -0.5, P<0.001) and CO (r= -0.49, P<0.001). Conclusions:After successfully overcoming the impact of BMI on image noise by adapting tube parameters, CNR mainly depends on coronary vessel contrast. The latter reflects the dilution of the contrast material by blood volume and CO, which are both correlated to BSA. Therefore, BSA adapted contrast administration may help to compensate for this effect.

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“…Computed tomography (CT) is the most common imaging examination performed in patients with acute abdominal pain, and imaging signs of acute adrenal ischemia, usually consisting of an enlarged hypodense adrenal without significant enhancement after IV contrast material injection, have to be considered in order to promptly diagnose this condition [5][6][7][8][9][10][11]. In case of suspected acute adrenal ischemia, the distinction between non-traumatic adrenal hemorrhage and hypovolemic shock needs to be made in order to preserve adrenal function by implementing rapid and correct treatment, although shock can also be a cause of adrenal ischemia and infarction if not promptly treated [5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Value of the CT “capsular sign” as a potential indicator of acute adrenal ischemia

et al. 2015

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Acute adrenal ischemia represents a rare cause of adrenal insufficiency which should be promptly diagnosed in order to preserve adrenal vitality and function. Our study aims to retrospectively evaluate the diagnostic accuracy of the CT capsular sign as an indicator of adrenal ischemia and its association with vascular involvement. Between January 2013 and January 2014, 69 consecutive patients (47 men, 22 women; mean age 46; range 22-67) with suspected adrenal insufficiency based on clinical and biochemical data underwent 320-row CT examination in our Emergency Department. Written informed consent was obtained for the CT examinations, and the institutional review board approval was obtained for our retrospective study. CT multi-planar images were retrospectively and independently analyzed by two radiologists searching for the patency of adrenal vessels, enlarged adrenals, the presence of the "capsular sign" represented by a peripheral subtle hyperdense line around a hypodense enlarged adrenal, and the presence of any periadrenal inflammatory changes. All CT findings were then compared with the surgical findings (n = 5), follow-up examinations (n = 20), or autopsy (n = 4). Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV) were calculated for the "capsular sign" and were further evaluated by ROC analysis. Acute adrenal ischemia occurred in 29/69 patients (42 %), unilateral in 20, and bilateral in 9. Forty of sixty-nine patients (58 %) had no evidence of adrenal disease on CT. Thrombosis of the main adrenal vein was found in 20/29 (69 %) and non-venous ischemia in 9/29 (31 %). The capsular sign was found in 24/29 patients (83 %). Sensitivity, specificity, DA, PPV, and NPV values of 83, 100, 93, 100, and 89 %, respectively, were obtained. The capsular sign represents a CT indicator of acute adrenal ischemia, with a specificity of 100 % and leading to a prompt diagnosis in the early phase of the disease.

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Posttraumatic shock in children: CT findings associated with hemodynamic instability.

Cited by 114 publications

References 0 publications

Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography

Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography

Determinants of vessel contrast in BMI-adapted low dose CT coronary angiography with prospective ECG-triggering

Value of the CT “capsular sign” as a potential indicator of acute adrenal ischemia

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