Evaluation of Blunt Abdominal Trauma Using PACS-Based 2D and 3D MDCT Reformations of the Lumbar Spine and Pelvis

Brian C. Lucey; Joshua W. Stuhlfaut; Aaron R. Hochberg; Jose C. Varghese; Jorge A. Soto

Disclosures

Am J Roentgenol. 2005;185(6):1435-1440. 

In This Article

Abstract and Introduction

Objective: The purpose of this study was to show the value of 2D and 3D reformations of CT data from abdominal and pelvic CT performed immediately at the workstation using a PACS-based software program to evaluate the lumbar spine and pelvis in patients with blunt abdominal trauma.
Materials and Methods: We reviewed the abdominopelvic CT scans and conventional radiographs of the lumbar spine or pelvis of 156 consecutive patients with blunt abdominal trauma. The CT data were compared with the radiographic findings and also with the findings of dedicated repeat CT of the spine or pelvis, when performed.
Results: CT depicted 80 fractures of the lumbar spine and 178 pelvic fractures. Radiography showed 40 fractures of the lumbar spine and 138 pelvic fractures. No additional fractures were identified on dedicated repeat CT.
Conclusion: Conventional radiographs to clear the lumbar spine are no longer required when abdominopelvic CT data are available. CT and reformatted CT data show more fractures than radiography and miss no fractures compared with dedicated CT of the lumbar spine or pelvis. Having these images immediately available through the PACS workstation saves time for the trauma team in the management of critically ill patients.

In the United States, CT is the investigation of choice for the evaluation of intraabdominal injury from blunt abdominal trauma.[1,2,3,4] Early evaluation of the spine is of paramount importance in the trauma patient both to decrease patient morbidity and to decrease the length of time that the patient is on spinal precautions. It has already been established that evaluation of the cervical spine in trauma patients is better with dedicated cervical spine CT than with conventional radiography.[5,6,7,8,9,10,11] Indeed, in patients who have a fracture of the lumbar vertebral bodies or pelvis identified on radiography, a dedicated CT scan through the area of interest with thin collimation (≤ 2 mm) is traditionally requested by the orthopedic surgeons. CT through the area of interest has frequently been requested after the initial abdominal or pelvic CT examination. This is because the coronal and sagittal reformations produced by incremental CT and single-detector CT were insufficient for accurate evaluation of bone fragments in the spinal canal or hip joint.

With the near ubiquitous use of MDCT in the emergency department for the evaluation of the abdomen and pelvis, a large number of thinly collimated CT images of the regions that include the lumbar spine and pelvis are generated. These images are ideally suited for multiplanar reformations and 3D volume rendering. There have been reports of using abdominal CT data to evaluate the lumbar spine.[12,13,14] At our institution, we routinely use MDCT images of the abdomen and pelvis to generate immediate online multiplanar and 3D reformations of the lumbar spine and pelvis at the PACS workstations.

The purpose of this study was to determine whether the diagnostic performance of this approach is sufficiently high to eliminate the need for radiography of the lumbar spine and pelvis from the initial workup of multiple-trauma patients and to eliminate the need for repeat dedicated CT scans through the fracture site.

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