Reformatted images of the thoracic and lumbar spine following CT of chest, abdomen, and pelvis in the setting of blunt trauma: are they necessary?

Abstract

Injuries involving the thoracic and lumbar (TL) spine in the setting of blunt trauma are not uncommon. At our institution, CT of the chest, abdomen, and pelvis (CT CAP) with dedicated reformatted images of the thoracolumbar spine (CT TL) is part of the standard work-up of patients following significant blunt trauma. The purpose of this study was to compare the detection rate of TL spine fractures on routine trauma CT CAP with reformatted CT TL spine images and determine whether these reformatted images detect additional fractures and if these altered patient management. The imaging records of 1000 consecutive patients who received blunt trauma protocol CT CAP with CT TL spine reformats were reviewed to determine identification of TL spine fracture in each report. Fracture type and location were documented. Of the 896 patients, 66 (7.4 %) had fractures of the TL spine identified on either CT CAP or CT TL spine. Of these 66 patients, 40 (60.6 %) had fractures identified on both CT CAP and CT TL spine and 24 (36.4 %) had fractures identified on CT TL spine images alone. Fourteen patients required treatment with surgery or bracing, 4 (28.6 %) of which had fractures identified on reformatted TL spine imaging only. In conclusion, a significant number of fractures are detected on TL spine reformats that are not identified on CT CAP alone, altering patient management in a few cases and suggesting that dedicated TL spine reformats should be a standard part of the work-up of blunt trauma patients.

Iterative Model Reconstruction in Lumbar Spine Image Retrieval from Computed Tomography of the Abdomen and Pelvis

“…There is an increasing tendency of generating multiplanar reconstructed spinal images from CTAP examinations, particularly in the trauma setting. 4 This is primarily because they are more sensitive in detecting fractures compared with plain radiographs and avoid subjecting patients to a second CT spine study. 4 Similarly, in a nontrauma setting, especially oncology patients and patients with pyrexia of unknown origin, spinal reconstructions are routinely performed to assist in the detection of bone, paravertebral, and disc pathologies.…”

“…4 This is primarily because they are more sensitive in detecting fractures compared with plain radiographs and avoid subjecting patients to a second CT spine study. 4 Similarly, in a nontrauma setting, especially oncology patients and patients with pyrexia of unknown origin, spinal reconstructions are routinely performed to assist in the detection of bone, paravertebral, and disc pathologies. 20 Image noise levels were significantly higher for reconstructed lumbar spine images from CTAP compared with L-spine CT, when both were reconstructed using SIR.…”

“…Lumbar spine reconstructions from CTAP datasets are frequently requested by emergency physicians for assessment of bony injury or pathology. 4,5 The image quality of the reconstructions is generally inferior to that of dedicated CT of the lumbar spine (L-spine CT). However, the better image quality of L-spine CT is at the expense of higher radiation dose and potentially missing other intraabdominal or pelvic pathology outside the field of view.…”

Injuries to the Rigid Spine: What the Spine Surgeon Wants to Know

“…For patients with advanced DS affecting the facet joints, careful attention must be given to the posterior elements, as a fracture line extending there suggests an unstable injury (Fig 8). Therefore, the spine should be assessed by using spine CT protocols, not bone windows at CT of the neck, chest, abdomen, or pelvis (34). This is true for all rigid spine entities.…”

Achieving Value in Spine Surgery: 10 Major Cost Contributors

“… 5 Additional expense can be avoided by forgoing redundant CT studies; multiple studies have demonstrated the capabilities of reformatted images from abdominal or thoracic multidetector CT studies. 6 , 7 …”