Abstract
Purpose
The aim of the study was to evaluate the diagnostic capability of contrast-enhanced ultrasonography (CEUS) in a large series of patients with blunt abdominal trauma.
Materials and methods
We studied 133 haemodynamically stable patients with blunt abdominal trauma. Patients were assessed by ultrasonography (US), CEUS and multislice computed tomography (MSCT) with and without administration of a contrast agent. The study was approved by our hospital ethics committee (clinical study no. 1/2004/O).
Results
In the 133 selected patients, CT identified 84 lesions; namely, 48 splenic, 21 hepatic, 13 renal or adrenal and two pancreatic. US identified free fluid or parenchymal alterations in 59/84 patients with positive CT and free fluid in 20/49 patients with negative CT. CEUS detected 81/84 traumatic lesions identified on CT and ruled out traumatic lesions in 48/49 patients with negative CT. The sensitivity, specificity and positive and negative predictive values of US were 70.2%, 59.2%, 74.7% and 53.7%, respectively, whereas those of CEUS were 96.4%, 98%, 98.8% and 94.1%, respectively.
Conclusions
Our study showed that CEUS is an accurate technique for evaluating traumatic lesions of solid abdominal organs. The technique is able to detect active bleeding and vascular lesions, avoids exposure to ionising radiation and is useful for monitoring patients undergoing conservative treatment.
Riassunto
Obiettivo
Scopo di questo lavoro è stato valutare le possibilità diagnostiche dell’ecografia con mezzo di contrasto (CEUS) in un’ampia serie di pazienti con trauma chiuso dell’addome.
Materiali e metodi
Sono stati studiati 133 pazienti con trauma addominale chiuso, emodinamicamente stabili. I pazienti sono stati valutati con ecografia (US), CEUS e tomografia computerizzata (TC) multistrato senza e con mezzo di contrasto (MdC). Lo studio è stato approvato dal comitato etico dell’Ospedale (studio clinico no1/2004/O).
Risultati
Nei 133 pazienti la TC ha identificato 84 lesioni, 48 spleniche, 21 epatiche, 13 renali o surrenaliche e 2 pancreatiche. L’US ha identificato versamento libero o alterazioni parenchimali in 59/84 pazienti positivi alla TC e versamento libero in 20/49 pazienti negativi alla TC. La CEUS ha riconosciuto 81/84 lesioni traumatiche identificate dalla TC e ha escluso lesioni traumatiche in 48/49 pazienti negativi alla TC. Sensibilità, specificità, valore predittivo positivo e negativo per l’US sono stati rispettivamente 70,2%, 59,2%, 74,7% e 53,7%; per la CEUS sono stati 96,4%, 98%, 98,8% e 94,1%.
Conclusioni
Lo studio ha dimostrato che la CEUS è uno strumento accurato nella valutazione delle lesioni traumatiche degli organi solidi addominali. La metodica riconosce il sanguinamento attivo e le lesioni vascolari, evita l’esposizione a radiazioni ionizzanti ed è utile nel monitoraggio dei pazienti con trattamento conservativo.
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References/Bibliografia
Meislin H, Criss E, Judkins D et al (1997) Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources. J Trauma 43:433–440
Shuman WP (1997) CT of blunt abdominal trauma in adults. Radiology 205:297–306
Weishaupt D, Grozaj AM, Willmann JK et al (2003) Traumatic injuries: imaging of abdominal and pelvic injuries. In: Baert AL, Gourtsoyannis N (eds) Categorical course ECR. European Congress of Radiology, Vienna, pp 123–139
ACEP Clinical Policies Committee (2004) Clinical Policies Subcommittee on Acute Blunt Abdominal Trauma. Clinical policy: critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. Ann Emerg Med 43:278–290
Poletti PA, Wintermark M., Schnyder P, Becker CD (2002) Traumatic injuries: role of imaging in the management of polytrauma victim (conservative expectation). Eur Radiol 12:969–978
Kretschmer K, Bohndorf K, Pohlenz O (1997) The role of sonography in abdominal trauma: the european experience. Emerg Rad 4:62–67
Brown MA, Casola G, Sirlin CB et al (2001) Blunt abdominal trauma: screening US in 2693 patients. Radiology 218:352–358
Richards JR, Schelper NH, Woo BD et al (2002) Sonographic assessment of blunt abdominal trauma: a 4 year prospective study. J Clin Ultrasound 30:59–67
Brown M, Sirlin C, Hoyt D, Casola G (2003) Screening ultrasound in blunt abdominal trauma. J Int Care Med 18:253–260
Gruessner R, Mentges B, Duber CH et al (1989) Sonography versus peritoneal lavage in blunt abdominal trauma. J Trauma 29:242–244
Liu M, Lee CH, Peng FK (1993) Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 35:267–270
McKenney M, Lentz K, Nunez D et al (1994) Can ultrasound replace diagnostic peritoneal lavage in the assessment of blunt trauma? J Trauma 37:439–441
Ma OJ, Mateer JR, Ogata M et al (1995) Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 38:879–885
Boulanger BR, Brenneman FD, McLellan BA et al (1995) A prospective study of emergent abdominal sonography after blunt trauma. J Trauma 39:325–330
Rozycki GS, Ochsner MG, Schmidt JA et al (1995) A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma 39:492–500
Lingawi SS, Buckley AR (2000) Focused abdominal US in patients with trauma. Radiology 217:426–429
Rothlin MA, Naef R, Amgwerd M et al (1993) Ultrasound in blunt abdominal and thoracic trauma. J Trauma 34:488–495
Brown M, Casola G, Sirlin C, Hoyt D (2001) Importance of evaluating organ parenchyma during screening abdominal ultrasonography after blunt trauma. J Ultrasound Med 20:577–583
Poletti P, Kinkel K, Vermeulen B et al (2003) Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology 227:95–103
American College of Surgeons Committee on Trauma (2002) Advanced Trauma Life Support for Doctors, Student Course Manual (ATLS). American College of Surgeons, Chicago
Catalano O, Lobianco R, Mattace Raso M, et al (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography. J Ultrasound Med 24:299–310
Miele V, Buffa V, Stasolla A et al (2004) Contrast enhanced ultrasound with second generation contrast agent in traumatic liver lesions. Radiol Med 107:82–91
Valentino M, Serra, C, Zironi G et al (2006) Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol 186:1361–1367
McGahan JP, Horton S, Gerscovich EO et al (2006) Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma: preliminary experience. AJR Am J Roentgenol 187:658–666
Catalano O, Aiani L, Barozzi L et al (2009) CEUS in abdominal trauma: multi-center study. Abdom Imaging 34:225–232
Moore EE, Cogbill TH, Malangoni MA et al (1995) Organ injury scaling. Surg Clin North Am 75:293–303
Shanmuganathan K, Mirvis SE, Boyd-Kranis R et al (2000) Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology 217:75–82
Albrecth T, Blombley M, Bolondi L et al (2004) Guidelines for the use of contrast agents in Ultrasound. Ultrashall Med 25:249–256
Valentino M, Serra C, Pavlica P et al (2008) Blunt abdominal trauma: diagnostic performance of contrast-enhanced US in children-initial experience. Radiology 246:903–909
Rutledge R, Hunt JP, Lentz CW et al (1995) A statewide, population-based time-series analysis of the increasing frequencies of nonoperative management of abdominal solid organ injury. Ann Surg 222:311–326
Brown MA, Sirlin CB, Farahmand N et al (2005) Screening sonography in pregnant patients with blunt abdominal trauma. J Ultrasound Med 24:175–181
Catalano O, Lobianco R, Sandomenico F et al (2004) Real-time contrast-enhanced sonographic imaging in emergency radiology. Radiol Med 108:454–469
Gorg C, Bert T (2006) Second-generation sonographic contrast agent for differential diagnosis of perisplenic lesions. AJR Am J Roentgenol 186:621–626
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Valentino, M., Ansaloni, L., Catena, F. et al. Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol med 114, 1080–1093 (2009). https://doi.org/10.1007/s11547-009-0444-0
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DOI: https://doi.org/10.1007/s11547-009-0444-0