Whole-Body Magnetic Resonance Tomography and Whole-Body Computed Tomography in Pediatric Polytrauma Diagnostics—A Retrospective Long-Term Two-Center Study

Raimann, Marnie; Ludwig, Johanna; Heumann, Peter; Rechenberg, Ulrike; Goelz, Leonie; Mutze, Sven; Schellerer, Vera; Bakır, Mustafa

doi:10.3390/diagnostics13071218

Cited by 3 publications

(2 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, in an article recently published in the Deutsches Ärzteblatt, Berger et al recommend very conservative determination of the indication for whole-body CT and prefer in most cases a combination of thorough and possibly repeat sonographic examination and an organ-centered diagnostic workup (e. g. isolated head CT) depending on the clinical examination and the injury mechanism [21]. A further alternative, if available, is whole-body MRI with abbreviated protocols adapted to the acute situation [22]. As a rule, the risk of an injury not being diagnosed or being diagnosed too late (delayed diagnosis of injury, DDI) should always be taken into consideration and a necessary CT examination should never be withheld from an injured child.…”

Section: Questionable Benefit Of Whole-body Ct In Injured Childrenmentioning

confidence: 99%

“…B. isoliertes Schädel-CT) in Abhängigkeit der klinischen Untersuchung und des Verletzungsmechanismus [21]. Eine weitere Alternative besteht, sofern verfügbar, in der Ganzkörper-MRT mit an die Akutsituation angepassten, gekürzten Protokollen [22]. Grundsätzlich sollte immer die Gefahr einer nicht oder zu spät diagnostizierten Verletzung (delayed diagnosis of injury, DDI) bedacht werden und keinesfalls eine notwendige CT einem verletzen Kind vorenthalten werden.…”

Section: Dosisreduktion Bei Pädiatrischen Ct-untersuchungenunclassified

See 1 more Smart Citation

CT in pediatric trauma patients

Appelhaus,

Schönberg,

Weis

2024

Rofo

View full text Add to dashboard Cite

The decision as to whether to perform a computed tomography (CT) examination in severe pediatric trauma poses a challenge. The therapeutic benefit of computed tomography in injured children is lower compared to adults, while the potential negative effects of ionizing radiation may be higher. Thus, the threshold for CT should be higher. Centers that less frequently treat pediatric cases tend to conduct more whole-body CT examinations than dedicated pediatric trauma centers, indicating a clinical overestimation of injury severity with subsequently unnecessary imaging due to inexperience. On the other hand, a CT scan that is not performed but is actually necessary can also have negative consequences if an injury is detected with a delay. An injured child presents a challenging situation for all involved healthcare providers, and thus requires a structured approach to decision-making.Selective literature review of the benefits and risks of CT in injured children, as well as indications for whole-body and region-specific CT imaging.This article provides an overview of current guidelines, recent insight into radiation protection and the benefits of CT in injured children, and evidence-based decision criteria for choosing the appropriate modality based on the mechanism of injury and the affected body region.

show abstract

Section: Questionable Benefit Of Whole-body Ct In Injured Childrenmentioning

confidence: 99%

Section: Dosisreduktion Bei Pädiatrischen Ct-untersuchungenunclassified

CT in pediatric trauma patients

Appelhaus,

Schönberg,

Weis

2024

Rofo

View full text Add to dashboard Cite

show abstract

Feasibility and diagnostic accuracy of fast whole-body MRI in slightly to moderately injured trauma patients

Reichel,

Hahlbohm,

Kromrey

et al. 2024

Eur Radiol

View full text Add to dashboard Cite

Objectives To determine the feasibility and diagnostic accuracy of fast whole-body magnetic resonance imaging (WB-MRI) compared to whole-body computed tomography (WB-CT) in detecting injuries of slightly to moderately injured trauma patients. Materials and methods In a prospective single-center approach, trauma patients from convenience sampling with an expected Abbreviated Injury Scale (AIS) score ≤ 3 at admission, received an indicated contrast-enhanced WB-CT (reference standard) and a plain WB-MRI (index test) voluntarily up to five days after trauma. Two radiologists, blinded to the WB-CT findings, evaluated the absence or presence of injuries with WB-MRI in four body regions: head, torso, axial skeleton, and upper extremity. Diagnostic accuracy was determined using sensitivity, specificity, positive predictive value, and negative predictive value by body region. Results Between June 2019 and July 2021, 40 patients were assessed for eligibility of whom 35 (median age (interquartile range): 50 (32.5) years; 26 men) received WB-MRI. Of 140 body regions (35 patients × 4 regions), 31 true positive, 6 false positive, 94 true negative, and 9 false negative findings were documented with WB-MRI. Thus, plain WB-MRI achieved a total sensitivity of 77.5% (95%-confidence interval (CI): (61.6–89.2%)), specificity of 94% (95%-CI: (87.4–97.8%)), and diagnostic accuracy of 89.3% (95%-CI: (82.9–93.9%)). Across the four regions sensitivity and specificity varied: head (66.7%/93.1%), torso (62.5%/96.3%), axial skeleton (91.3%/75%), upper extremity (33.3%/100%). Both radiologists showed substantial agreement on the WB-MRI reading (Cohen’s Kappa: 0.66, 95%-CI: (0.51–0.81)). Conclusion Regarding injury detection, WB-MRI is feasible in slightly to moderately injured trauma patients, especially in the axial skeleton. Clinical relevance statement Besides offering a radiation-free approach, whole-body MRI detects injuries almost identically to whole-body CT in slightly to moderately injured trauma patients, who comprise a relevant share of all trauma patients. Key Points Whole-body MRI could offer radiation-free injury detection in slightly to moderately injured trauma patients. Whole-body MRI detected injuries almost identically compared to whole-body CT in this population. Whole-body MRI could be a radiation-free approach for slightly to moderately injured young trauma patients.

show abstract

Diagnostic utility of whole-body computed tomography/pan-scan in trauma: a systematic review and meta-analysis study

Fathi,

Mirjafari,

Yaghoobpoor

et al. 2024

Emerg Radiol

View full text Add to dashboard Cite

Trauma is a significant cause of mortality and morbidity. It is crucial to diagnose trauma patients quickly to provide effective treatment interventions in such conditions. Whole-body computed tomography (WBCT)/pan-scan is an imaging technique that enables a faster and more efficient diagnosis for polytrauma patients. The purpose of this systematic review and meta-analysis is to evaluate the efficacy of WBCT in diagnosing injuries in polytrauma patients. We will also assess its impact on the mortality rate and length of hospital stay among trauma centers between patients who underwent WBCT and those who did not (non-WBCT). Twenty-seven studies meeting our inclusion criteria were selected among PubMed, Scopus, Web of Science, and Google Scholar. The criteria were centered on the significance of WBCT/pan-scan application in trauma patients. Stata version 15 was used to perform statistical analysis on the data. The authors have also used I2 statistics to evaluate heterogeneity. Egger and Begg’s tests were performed to rule out any publication bias. Total of twenty-seven studies including 68,838 trauma patients with a mean age of 45.0 ± 24.7 years were selected. Motor vehicle collisions were the most common cause of blunt injuries (80.0%). Head, neck, and face injuries were diagnosed in 44% (95% CI, 0.28–0.60; I2 = 99.8%), 6% (95% CI, 0.02–0.09; I2 = 97.2%), and 9% (95% CI, 0.05–0.13; I2 = 97.1%), respectively. Chest injuries were diagnosed by WBCT in 39% (95% CI, 0.28–0.51; I2 = 99.8%), abdominal injuries in 23% (95% CI, 0.03–0.43; I2 = 99.9%) of cases, spinal injuries 19% (95% CI, 0.11–0.27; I2 = 99.4%), extremity injuries 33% (95% CI, 0.23–0.43; I2 = 99.2%), and pelvic injuries 11% (95% CI, 0.04–0.18; I2 = 97.4%). A mortality odd ratio of 0.94 (95% CI, 0.83–1.06; I2 = 40.1%) was calculated while comparing WBCT and non-WBCT groups. This systematic review and meta-analysis provide insight into the possible safety, efficacy, and efficiency of WBCT/pan-scan as a diagnostic tool for trauma patients with serious injuries, regardless of their hemodynamic status. In patients with serious injuries from trauma, whether or not there are indicators of hemodynamic instability, our recommended approach is to, wherever possible, perform a WBCT without stopping the hemostatic resuscitation. By using this technology, the optimal surgical strategy for these patients can be decided upon without causing any delays in their final care or greatly raising their radiation dose.

show abstract

Whole-Body Magnetic Resonance Tomography and Whole-Body Computed Tomography in Pediatric Polytrauma Diagnostics—A Retrospective Long-Term Two-Center Study

Cited by 3 publications

References 34 publications

CT in pediatric trauma patients

CT in pediatric trauma patients

Feasibility and diagnostic accuracy of fast whole-body MRI in slightly to moderately injured trauma patients

Diagnostic utility of whole-body computed tomography/pan-scan in trauma: a systematic review and meta-analysis study

Contact Info

Product

Resources

About