Value of Delayed Imaging in MDCT of the Abdomen and Pelvis

Department of Radiology, Stanford University, 300 Pasteur Dr., Stanford, CA 94305-5105, USA.
American Journal of Roentgenology (Impact Factor: 2.73). 08/2006; 187(1):154-63. DOI: 10.2214/AJR.05.0148
Source: PubMed


OBJECTIVE: Our objective was to illustrate the benefits of obtaining delayed CT images. CONCLUSION: There are several clinical scenarios in which delayed CT images may improve diagnostic specificity.

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    ABSTRACT: Imaging plays a critical role in the evaluation of patients with blunt abdominal trauma. In most institutions, computed tomography (CT) is the modality of choice when evaluating such patients. The purpose of this review is to highlight current techniques in trauma imaging and to review CT findings associated with solid organ, bowel, mesenteric, and diaphragmatic injury. In particular, emphasis is placed on the use of multidetector CT technology (MDCT), especially 64-row detector CT. The role of various techniques, including the use of oral and intravenous contrast, as well as the potential benefit of delayed imaging, is discussed.
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    ABSTRACT: This study was designed to evaluate retrospectively the accuracy of MDCT in the identification of bleeding sites in patients with postpartum hemorrhage. Twenty-seven consecutively registered patients (mean age, 31.4 years; age range, 24-39 years) with postpartum hemorrhage underwent contrast-enhanced MDCT before embolization. CT images were reviewed independently by two radiologists who were blinded to the angiographic findings. Disagreements were resolved by consensus. The MDCT diagnosis of active bleeding was made when extravasation of contrast material was identified on contrast-enhanced CT scans. The location of bleeding was classified according to four anatomic regions: uterine body, cervix, vagina, and paragenital area. Each bleeding location was recorded on the right and left sides. Conventional angiography was used as the reference standard. The sensitivity, specificity, and accuracy of MDCT in the detection of hemorrhage were assessed. We also assessed the presence of additional CT abnormalities that might influence further treatment. Extravasation of contrast material was depicted on MDCT scans in 24 of 27 patients. The overall location-based sensitivity, specificity, and accuracy of MDCT in the detection of bleeding were 100% (38/38), 96% (171/178), and 97% (209/216). Additional abnormalities detected on CT images included rectus sheath hematoma with contrast extravasation (n = 5), extraperitoneal hematoma (n = 6), gestational pancreatitis (n = 2), diffuse liver disease (n = 2), and abdominal compartment syndrome (n = 1). MDCT may have a role in the detection and localization of postpartum hemorrhage and yield supplementary information on extrauterine abnormalities.
    Preview · Article · Feb 2010 · American Journal of Roentgenology
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    ABSTRACT: Purpose The purpose of this study was to analyze the multidetector computed tomography (MDCT) morphologic characteristics of non-aortic acute vascular injuries (AVI) in patients with blunt abdominopelvic trauma that predict treatment. Methods CT scans of 65 trauma patients with non-aortic AVI were reviewed. AVI morphology was categorized as linear or round. The organ of involvement, location of hemorrhage, initial size of hematoma, and hemodynamic status were recorded. Expansion rates of the hematoma were calculated in 40 patients who had delayed imaging. Multivariate regression was used to analyze the morphologic features of AVI and treatment. Results Patients with linear AVI were four times more likely to require aggressive treatment (surgery or embolization) than those with a round morphology, independent of the hemodynamic status. There was no main effect of the organ involved, location of hemorrhage, initial bleed size, or expansion rate on the probability of aggressive treatment. Conclusion The location, initial size, and expansion rate of AVI are not significant predictors of aggressive treatment with surgery or embolization. Linear morphology of AVI, however, is more likely to require aggressive treatment than round AVI, independent of the hemodynamic status. Linear AVI likely reflects a spurting jet of active extravasation, whereas round AVI likely represents a pseudoaneurysm or slow bleed.
    No preview · Article · Oct 2011 · European Journal of Trauma and Emergency Surgery
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