Traumatic injuries: imaging of abdominal and pelvic injuries

Abstract

The availability of new imaging modalities has altered the diagnostic approach to patients with abdominal and pelvic trauma. Computed tomography and ultrasound have largely replaced diagnostic peritoneal lavage. Ultrasound is used in most trauma centers as the initial imaging technique for the detection of hemoperitoneum and helps to determine the need for emergency laparotomy. Computed tomography allows for an accurate diagnosis of a wide range of traumatic abdominal and pelvic conditions. The speed of single-detector helical and multi-detector row CT (MDCT) permits a rapid CT examination of the seriously ill patient in the emergency room. In particular, the technology of MDCT permits multiple, sequential CT scans to be quickly obtained in the same patient, which is a great advance in the rapid assessment of the multiple-injured patient. The evolving concepts in trauma care promoting non-operative management of liver and splenic injuries creates the need for follow-up cross-sectional imaging studies in these patients. Computed tomography and, less frequently, MR or ultrasound, are used for this purpose.

Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy?

“…Abandonment of conventional radiographs may reduce the total effective dose by 24.7% as compared to the use of both imaging techniques in combination [3]. Our results further show that thin-slice technique can increase diagnostic accuracy up to 100% and that by use of common thoraco-abdominal CT protocols [2,11], this information can be gained without any additional scanning. A highly interesting approach in this direction has just recently been proposed by Ptak et al, who showed that by the choice of a singlepass continuous whole-body CT protocol, total dose reductions of up to 17% were feasible [23].…”

“…The significant advantage of computed tomography over conventional radiography previously has been demonstrated by others [3,[8][9][10][11][12][13]. With regard to MDCT, surprisingly high sensitivities for unstable thoraco-lumbar fractures, but rather low sensitivities for thoraco-lumbar fractures in general were observed by Wintermark et al [14].…”

“…Thus sensitivity in both the detection of lumbar spine and thoracic spine fractures may be markedly increased by simply reducing the slice thickness. This observation is of particular importance as common MDCT protocols for thoraco-abdominal imaging use collimations that allow for at least 3.0-mm slice thickness, and additional scanning for thin-slice imaging consequently would not be necessary [2,10,11]. It can certainly be argued that our results show rather similar diagnostic accuracy for 3-and 5-mm slices combined with MPR and that the latter thus not only may be sufficient, but also causes less data to be stored.…”

Verletzungen des Beckenrings und der Beckenorgane

“…Parenchymdiagnostik (dafür sind dünne Schichten primär nicht erforderlich) auf den Nachweis von Traumafolgen am Skelett und am Gefäßsystem ankommt und wenn multiplanare und dreidimensionale Darstellungen gefordert werden. [15,26].…”

Role of Multi Detector Computed Tomography in Evaluation of Abdominal Trauma

“…Breath holding may not be possible in trauma CT, and the speed of MDCT scanning further reduces breathing artefact 6,7 .…”