Top

La radiologia medica

Published in:

01-02-2015 | Abdominal Radiology

Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT

Authors: Barbara Sessa, Margherita Trinci, Stefania Ianniello, Guendalina Menichini, Michele Galluzzo, Vittorio Miele

Published in: La radiologia medica | Issue 2/2015

Abstract

Purpose

This study was undertaken to evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in the detection and grading of abdominal traumatic lesions in patients with low-energy isolated abdominal trauma in comparison with baseline ultrasound (US) and contrast-enhanced multidetector computed tomography (CE-MDCT), considered the gold standard.

Materials and methods

A total of 256 consecutive patients who arrived in our Emergency Department between January 2006 and December 2012 (159 males and 97 females aged 7–82 years; mean age 41 years), with a history of low-energy isolated abdominal trauma were retrospectively analysed. All patients underwent US, CEUS with the use of a second-generation contrast agent (Sonovue, Bracco, Milan, Italy) and MDCT. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) and overall accuracy for the detection of lesions and free peritoneal fluid on US and CEUS, and sensitivity for the grading of lesions on CEUS were calculated compared with the CT findings, in accordance with the American Association for the Surgery of Trauma criteria.

Results

CE-MDCT identified 84 abdominal traumatic lesions (liver = 28, spleen = 35, kidney = 21) and 45 cases of free intraperitoneal fluid. US depicted 50/84 traumatic lesions and 41/45 cases of free peritoneal fluid; CEUS identified 81/84 traumatic lesions and 41/45 free peritoneal fluid. The sensitivity, specificity, PPV, NPV and overall accuracy for the identification of traumatic abdominal lesions were 59, 99, 98, 83 and 86 %, respectively, for US and 96, 99, 98, 98 and 98 %, respectively, for CEUS. The values for the identification of haemoperitoneum were 91, 99, 95, 98 and 97 %, respectively, for US and 95, 99, 95, 99 and 98 %, respectively, for CEUS. CEUS successfully staged 72/81 traumatic lesions with a sensitivity of 88 %.

Conclusions

In patients with low-energy isolated abdominal trauma US should be replaced by CEUS as the first-line approach, as it shows a high sensitivity both in lesion detection and grading. CE-MDCT must always be performed in CEUS-positive patients to exclude active bleeding and urinomas.

Poletti PA, Wintermark M, Schneyder P et al (2002) Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol 12:969–978CrossRefPubMed

Valentino M, Ansaloni L, Catena F et al (2009) Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Rad Med 114:1080–1093CrossRef

Catalano O, Aiani L, Barozzi L et al (2009) CEUS in abdominal trauma: multi-center study. Abdom Imaging 34:225–234CrossRefPubMed

Clevert DA, Weckbach S, Minaifar N et al (2008) Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma. Clin Hemorheol Microcircul 39:155–169

Lv F, Tang J, Luo Y et al (2011) Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma. Radiol Med 116:1076–1082CrossRefPubMed

Miele V, Buffa V, Stasolla A et al (2004) Contrast-enhanced ultrasound with second generation contrast agent in traumatic liver lesions. Radiol Med 108:82–91PubMed

Regine G, Atzori M, Miele V et al (2007) Second-generation sonographic contrast agents in the evaluation of renal trauma. Radiol Med 112:581–587CrossRefPubMed

Oldenburg A, Hohmann J, Skrok J et al (2004) Imaging of paediatric splenic injury with contrast-enhanced ultrasonography. Pediatric Radiol 34:351–354CrossRef

Cokkinos D, Antypa E, Stefanidis K et al (2012) Contrast-enhanced ultrasound for imaging blunt abdominal trauma—indications, description of the technique and imaging review. Ultraschall Med 33:60–67CrossRefPubMed

10.

Afaq A, Harvey C, Aldin Z et al (2012) Contrast-enhanced ultrasound in abdominal trauma. Eur J Emerg Med 19:140–145CrossRefPubMed

11.

Moore EE, Cogbill TH, Jurkovich GJ et al (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324CrossRefPubMed

12.

Moore EE, Shackford SR, Pachter HL et al (1989) Organ injury scaling: spleen, liver and kidney. J Trauma 29:1664–1666CrossRefPubMed

13.

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 186:1361–1367CrossRefPubMed

14.

Catalano O, Lobianco R, Raso MM, Siani A (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application. J Ultrasound Med 24:299–310PubMed

15.

Catalano O, Cusati B, Nunziata A, Siani A (2006) Active abdominal bleeding: contrast-enhanced sonography. Abdom Imaging 31:9–16CrossRefPubMed

16.

Marmery H, Shanmuganatan K, Mirvis SE et al (2008) Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg 206:685–693CrossRefPubMed

17.

Hamilton JD, Kumaravel M, Censullo ML et al (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28:1603–1616CrossRefPubMed

18.

Valentino M, De Luca C, Galloni SS et al (2010) Contrast-enhanced US evaluation in patients with blunt abdominal trauma. J Ultrasound 13:22–27CrossRefPubMedCentralPubMed

19.

Tang J, Li W, Lv F et al (2009) Comparison of gray-scale contrast-enhanced ultrasonography with contrast-enhanced computed tomography in different grading of blunt hepatic and splenic trauma: an animal experiment. Ultrasound Med Biol 35:566–575CrossRefPubMed

20.

Dietrich CF (2008) Comments and illustrations regarding the guidelines and good clinical practice recommendations for contrast-enhanced ultrasound (CEUS)–update 2008. Ultraschall Med 29(Suppl 4):S188–S202CrossRefPubMed

21.

Clevert DA, Weckbach S, Minaifar N et al (2008) Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma. Clin Hemorheol Microcirc 39:155–169PubMed

22.

Pinto F, Miele V, Scaglione M, Pinto A (2013) The use of contrast-enhanced ultrasound in blunt abdominal trauma: advantages and limitations. Acta Radiol. doi:10.1177/0284185113505517

Title: Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT
Authors: Barbara Sessa
Margherita Trinci
Stefania Ianniello
Guendalina Menichini
Michele Galluzzo
Vittorio Miele
Publication date: 01-02-2015
Publisher: Springer Milan
Published in: La radiologia medica / Issue 2/2015
Print ISSN: 0033-8362
Electronic ISSN: 1826-6983
DOI: https://doi.org/10.1007/s11547-014-0425-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Blunt abdominal trauma: role of contrast-enhanced ultrasound (CEUS) in the detection and staging of abdominal traumatic lesions compared to US and CE-MDCT

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2015

2014 Scientific Referees

Treatment of urological complications in more than 1,000 kidney transplantations: the role of interventional radiology

Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging

Contrast-enhanced MR angiography: does a higher relaxivity MR contrast agent permit a reduction of the dose administered for routine vascular imaging applications?

Radiopharmaceutical study on Iodine-131-labelled hypericin in a canine model of hepatic RFA-induced coagulative necrosis

Role of multidetector CT in the recognition of hyperdense middle cerebral artery sign (HMCAS) in patients with acute cerebral ischaemia: correlation with DWI-MRI sequences and clinical data