Contrast-enhanced Computed Tomography Versus Contrast and Non-contrast Enhanced Computed Tomography for Detecting Blunt Abdominal Injury
DOI:
https://doi.org/10.31584/jhsmr.20231003Keywords:
blunt abdominal trauma,, computed tomography, contrast-enhanced computed tomography, non-contrast computed tomography, radiation exposureAbstract
Objective: This study aimed to compare the diagnostic ability of contrast-enhanced computed tomography (CECT) and CECT combined with non-contrast computed tomography (NCT) for intraabdominal organ injury in patients with blunt abdominal injury.
Material and Methods: Overall, 195 adult patients having had blunt abdominal trauma underwent CT at this institution; from 2016 and 2021. All CT images were retrospectively reviewed by two radiologists. The efficacy of detection of organ injuries and the degree of intra-abdominal injury were recorded. The radiologists scored their diagnostic confidence for each CT image dataset on a five-point scale: inter-observer agreement was also calculated.
Results: All included patients underwent CT for blunt abdominal trauma. The most common cause of injury was motorcycle accident (59.5%), with patients being predominantly male: the mean patient age was 44 years. Hemoperitoneum was the most common CT finding, with a significantly higher detection rate on CECT combined with NCT than on CECT alone. There was no statistically significant difference in the diagnostic efficacy of the detected organ injury nor other types of organ injuries between CECT alone and CECT combined with NCT. Nevertheless, the accuracy of CECT in detecting hemoperitoneum may diminish in patients with severe fatty liver disease; especially in the perihepatic region.
Conclusion: CECT alone is a potential tool for detecting abdominal injuries in patients with blunt trauma. NCT provides no additional benefits in detecting organ injury; except in cases of severe fatty liver disease. NCT is recommended as an optional protocol; particularly for patients with obesity.
References
Patcharee P, Thanom P, Janya N, Mayuree M, Walailuk J, Rassamee S. Epidemiological characteristics of traffic and non-traffic injuries and quality of emergency medical services in southern thailand. J Health Sci Med Res 2021;39:273-82.
Jones EL, Stovall RT, Jones TS, Bensard DD, Burlew CC, Johnson JL, et al. Intra-abdominal injury following blunt trauma becomes clinically apparent within 9 hours. J Trauma Acute Care Surg 2014;76:1020-3.
Ledrick D, Payvandi A, Murray AC, Leskovan JJ. Is there a need for abdominal CT scan in trauma patients with a lowrisk mechanism of injury and normal vital signs? Cureus 2020;12:e11628.
Jansen JO, Yule SR, Loudon MA. Investigation of blunt abdominal trauma. BMJ 2008;336:938-42.
Shyu JY, Khurana B, Soto JA, Biffl WL, Camacho MA, Diercks DB, et al. ACR appropriateness criteria® major blunt trauma. J Am Coll Radiol 2020;17:S160-74.
Amy BG, Sarah D. Risk of cancer from diagnostic x-rays estimates for the UK and 14 other countries. Lancet 2004;363:345-51.
Hui CM, MacGregor JH, Tien HC, Kortbeek JB. Radiation dose from initial trauma assessment and resuscitation: review of the literature. Can J Surg 2009;52:147-52.
Stuhlfaut JW, Anderson SW, Soto JA. Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury. Semin Ultrasound CT MRI 2007;28:115-29.
Godt JC, Eken T, Schulz A, Øye K, Hagen T, Dormagen JB. Do we really need the arterial phase on CT in pelvic trauma patients? Emerg Radiol 2021;28:37-46.
Bonatti M, Lombardo F, Vezzali N, Zamboni G, Ferro F, Pernter P, et al. MDCT of blunt renal trauma: imaging findings and therapeutic implications. Insights Imaging 2015;6:261-72.
Hallinan JT, Tan CH, Pua U. The role of multidetector computed tomography versus digital subtraction angiography in triaging care and management in abdominopelvic trauma. Singapore Med J 2016;57:497-502.
Uyeda J, Anderson SW, Kertesz J, Soto JA. Pelvic CT angiography: application to blunt trauma using 64MDCT. Emerg Radiol 2010;17:131-7.
Kelly J, Raptopoulos V, Davidoff A, Waite R, Norton P. The value of non-contrast-enhanced CT in blunt abdominal trauma. AJR Am J Roentgenol 1989;152:41-8.
Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR. Scaling system for organ specific injuries [Monograph on the Internet]. Chicago: The American Association for the Surgery of Trauma; [cited 2022 Aug 22]. Available from: https://www.aast.org/Assets/56ef079d-229c-45f2-9b18-c3825e450e65/633867256925730000/injuryscoringtables-pdf
Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg 2018;85:1119-22.
Kulkarni NM, Fung A, Kambadakone AR, Yeh BM. Computed tomography techniques, protocols, advancements, and future directions in liver diseases. Magn Reson Imaging Clin N Am 2021;29:305-20.
Javali RH, Krishnamoorthy, Patil A, Srinivasarangan M, Suraj, Sriharsha. comparison of injury severity score, new injury severity score, revised trauma score and trauma and injury severity score for mortality prediction in elderly trauma patients. Indian J Crit Care Med 2019;23:73-7.
Bolorunduro OB, Villegas C, Oyetunji TA, Haut ER, Stevens KA, Chang DC, et al. Validating the injury severity score (ISS) in different populations: ISS predicts mortality better among hispanics and females. J Surg Res 2011;166:40-4.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012;22:276-82.
Kim SW, Kim JH, Kwak S, Seo M, Ryoo C, Shin CI, et al. The feasibility of deep learning-based synthetic contrast-enhanced CT from nonenhanced CT in emergency department patients with acute abdominal pain. Sci Rep 2021;11:20390.
Federle MP, Jeffrey RB Jr. Hemoperitoneum studied by computed tomography. Radiology 1983;148:187-92.
Lubner M, Menias C, Rucker C, Bhalla S, Peterson CM, Wang L, et al. Blood in the belly: CT findings of hemoperitoneum. Radiographics 2007;27:109-25.
Levine CD, Patel UJ, Silverman PM, Wachsberg RH. Low attenuation of acute traumatic hemoperitoneum on CT scans. AJR Am J Roentgenol 1996;166:1089-93.
Naulet P, Wassel J, Gervaise A, Blum A. Evaluation of the value of abdominopelvic acquisition without contrast injection when performing a whole body CT scan in a patient who may have multiple trauma. Diagn Interv Imaging 2013;94:410-7.
Esposito AA, Zilocchi M, Fasani P, Giannitto C, Maccagnoni S, Maniglio M, et al. The value of precontrast thoracoabdominopelvic CT in polytrauma patients. Eur J Radiol 2015;84:1212-8.
The Royal College of Radiologists. Standards of practice and guidance for trauma radiology in severely injured patients second edition [homepage on the Internet]. London: The Royal College of Radiologists; 2015 [cited 2022 Nov 13]. Available from: https://www.rcr.ac.uk/system/files/publication/field_publication_files/bfcr155_traumaradiol.pdf
Miyakawa K, Kaji T, Ashida H, Kuwabara M, Ishizuka K, Wakabayashi M, et al. Evaluation of non-contrast-enhanced CT in blunt abdominal trauma. Nihon Igaku Hoshasen Gakkai Zasshi 1992;52:300-7.
Holz JA, Alkadhi H, Laukamp KR, Lennartz S, Heneweer C, Püsken M, et al. Quantitative accuracy of virtual non-contrast images derived from spectral detector computed tomography: an abdominal phantom study. Sci Rep 2020;10:21575.
Willemink MJ, Persson M, Pourmorteza A, Pelc NJ, Fleischmann D. Photon-counting CT: Technical principles and clinical prospects. Radiology 2018;289:293-312.
Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, et al. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;14:169:2078-86.
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