Evaluation of multislice computed tomographic perfusion imaging and computed tomographic angiography on traumatic cerebral infarction

Objective： To evaluate the application value of multislice computed tomographic perfusion imaging （MSCTPI） and multislice computed tomographic angiography （MSCTA） on traumatic cerebral infarction. Methods： MSCTA was performed on 10 patients who were initiailly diagnosed as traumatic cerebral infarction by normal conventional computed tomography （NCCT）, among whom, 3 patients were examined by MSCTPI simultaneously. Reconstructed images of the intracranial artery were made with techniques of maximum intensity projection （MIP） and volume rendering （VR） from MSCTA scanning data. Then the graph of function of four parameters, regional cerebral blood flow （rCBF）, regional cerebral blood volume （rCBV）, mean transit time （MTT）, and time to peak （TTP）, acquired by the perfusing analysis software was obtained. Results： Among the 10 patients with traumatic cerebral infarction, 6 showed complex type on NCCT, which depicted abnormality on MSCTA, and 4 showed simple type on NCCT, which had negative results on MSCTA. Among the 4 patients with abnormal great vessels, 2 suffered from stenosis or occlusion of the middle cerebral artery, 1 from spasm of the anterior cerebral artery, and 1 from spasm of the vertebral-basal artery. The image of MSCTPI of 1 patient with massive cerebral infarction on the right cerebral hemisphere confirmed by CT was smaller than those of the other patients, which showed occlusion of the ipsilateral middle cerebral artery on MSCTA, Among the 6 patients whose MSCTA showed no abnormality, 4 showed simple infarction and 2 showed complex infarction. The infarction focus of 5 patients occurred in the basal ganglia and 1 in the splenium of corpus callosum. Among the 2 cases of small cerebral infarction volume on NCCT, one was normal, the other showed hypoperfusion on MSCTPI and was normal on MSCTA. Conclusion： The combination of MSCTPI and MSCTA is very useful for evaluating the change of intracranial artery in ischemic regions and assessing the cerebral hemodynamic information of traumatic cerebral infarction.

Increased incidence of adrenal gland injury in blunt ab- dominal trauma： a computed tomography-based study from Pakistan

Objective： To determine the frequency of adrenal injuries in patients presenting with blunt abdomi- nal trauma by computed tomography （CT）. Methods： During a 6 month period from January 1, 2011 to June 30, 2011, 82 emergency CT examinations were performed in the setting of major abdominal trauma and ret- rospectively reviewed for adrenal gland injuries. Results： A total of 7 patients were identified as having adrenal gland injuries （6 males and 1 female）. Two patients had isolated adrenal gland injuries. In the other 5 patients with nonisolated injuries, injuries to the liver （1 case）, spleen （1 case）, retroperitoneum （2 cases） and mesentery （4 cases） were identified. Overall 24 cases with liver injuries （29 %）, 11cases with splenic injuries （13%）, 54 cases with mesenteric injuries （65%）, 14 cases （17%） with retroperitoneal injuries and 9 cases with renal injuries were identified. Conclusion： Adrenal gland injury is identified in 7 patients （11.7%） out of a total of 82 patients who underwent CT after major abdominal trauma. Most of these cases were nonisolated injuries. Our experience indicates that adrenal injury resulting from trauma is more common than suggested by other reports. The rise in incidence of adrenal injuries could be attributed to the mode of injury.

Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

Objective：Thoracic injuries are responsible for 25% of deaths of blunt traumas.Chest X-ray （CXR） is the first diagnostic method in patients with blunt trauma.The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy （CT） in hemodynamically stable patients with blunt chest trauma.Methods：Study was conducted at the emergency department of S ina Hospital from March 2011 to March 2012.Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included.All patients underwent the same diagnostic protocol which consisted of physical examination,CXR and CT scan respectively.Results：Two hundreds patients （84% male and 16% female） were included with a mean age of（37.9±13.7） years.Rib fracture was the most common finding of CXR （12.5%） and CT scan （25.5%）.The sensitivity of CXR for hemothorax,thoracolumbar vertebra fractures and rib fractures were 20%,49% and 49%,respectively.Pneumothorax,foreign body,emphysema,pulmonary contusion,liver hematoma and sternum fracture were not diagnosed with CXR alone.Conclusion：Applying CT scan as the first-line diagnostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome.

Is computed tomography cystography indicated in children with pelvic fractures?

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional images.Methods: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher’s exact test. Ap value of less than 0.05 was considered statistically significant.Results: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

Accuracy of the AAST organ injury scale for CT evaluation of traumatic liver and spleen injuries

Objective： Detection of abdominal in- jury is a very important component in trauma management, so a precise assessment of liver and spleen injuries includ- ing their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists＇ performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale （OIS） drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objec- tive trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment. Methods： Fifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by differ- ent radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with theintraoperative findings gathered from the surgery report. Results： Regarding the original CT report we found a mean divergence of 0.68±0.8 （r=-0.45） to the OIS finding in the surgery report for liver injuries （0.69±1.17 for spleen injuries; r=-0.69）. In comparison with the structured approach, where we detected a divergence of 0.8±0.68; r=-0.63 （0.47±0.77 for spleen injuries; r=0.91）, there was no significant difference. However we detected a lower rate of over-diag- nosis in structured approaches. Conclusion： Our study shows that a structured ap- proach to triage abdominal trauma using an imaging check- list does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of over- diagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.

Diagnostic value of fluid attenuated inversion recovery versus T_2-weighted image in diffuse axonal injury

BACKGROUND：At present, the most common examination modality for diffuse axonal injury （DAI） is CT or MRI. However, both methods exhibit low sensitivity in the diagnosis of DAI lesions. OBJECTIVE： To investigate the value of fluid attenuated inversion recovery （FLAIR） in the clinical diagnosis of DAI, and to compare with T2-weighted images. DESIGN, TIME AND SETTING： This prospective study was based on imaging analysis, and was performed in the First Affiliated Hospital of Chongqing Medical University （Chongqing, China） between October 2002 and April 2004. PARTICIPANTS： Sixty-three patients with craniocerebral injury were admitted to the Department of Neurosurgery at the First Affiliated Hospital of Chongqing Medical University, including 50 males and 13 females. The patients were included in the experiment and were divided into DAI （n=24） and non-DAI （n=39） groups, according to the emergent CT findings and clinical manifestations. METHODS： Both groups underwent MR examinations, including axial and sagittal T1 weighted images （TR = 450 ms, TE = 8-9 ms）, T2-weighted images （TR = 3 600 ms, TE = 100 ms）, and FLAIR （TR = 10 000 ms, TI = 2 500 ms, TE = 40 ms）, 8-mm thick and 2-mm wide, using a GE Sigma MRI device. MAIN OUTCOME MEASURES： The DAI diagnostic rate and lesion-detecting rate of T2-weighted images and FLAIR were determined. RESULTS： All 63 patients were included in the final analysis. The DAI diagnosis rates of FLAIR and T2-weighted images were 88% （21/24） and 62% （15/24）, respectively, of which the difference was statistically significant （P 〈 0.05）. T2-weighted images and FLAIR detected lesions located in the gray matter-white matter junction in parasagittal areas, the corpus callosum, deep periventricular white matter, basal ganglia, internal capsule, hippocampus, cerebellum, and brain stem, with a detailed amount of 123 and 256, respectively. FLAIR was significantly greater than T2-weighted images （P 〈 0.01）. CONCLUSION： FLAIR is superior to T2-weighted images for improving the DAI diagnostic rate and lesion-detecting rate, as well as revealing the extent and severity of DAI.

Clinical studies on diffuse axonal injury in patients with severe closed head injury

OBJECTIVE: To discuss the clinical criteria for diagnosing diffuse axonal injury (DAI). METHODS: Clinical and computed tomographic features of 117 patients with severe closed head injury were analyzed. The authors preliminarily put forward CT diagnostic criteria of DAI, that is, 1) single or multiple small intraparenchymal hemorrhages in the cerebral hemispheres (

Burr-hole craniotomy treating chronic subdural hematoma： a report of 398 cases

Objective： To investigate the treatment of chronic subdural hematoma （CSDH） with burr-hole craniotomy in our hospital. Methods： From January 2004 to December 2009, 398 patients with CSDH, 338 males and 60 females （male/ female=5.63/1）, received burr-hole craniotomy in our hospital. The median age was 60 years with the mean age of （58.1± 18.1） years, （65.0±14.5） years for females and （57.0± 8.2） years for males. Trauma history was determined in 275 patients （69.1%）. Burr-hole craniotomy was performed under local anesthesia in 368 patients and general anesthesia in 30 patients. CSDH was classified into 3 groups according to the density on CT scan. Clinical data concerning etiologies, symptoms and signs, concomitant diseases, diagnosis, therapies and outcomes were investigated retrospectively. Patients＇ neu- rological status on admission and at discharge was also classified to judge the outcomes. Results： Generally, trauma history showed few dif- ferences between those over 60 years old and under 60 years old, but showed obvious differences when gender was taken into account. Totally 123 male patients （60.0% of 204 cases） suffering from head injuries were under 60 years, whereas 35 female patients （85.4% of 41 cases） with trauma histories were over 60 years. The duration from trauma to appearance of clinical symptoms was （84.0±61.7） days （range, 0-1493 days）. Traumatic accident was the leading etiology, other accompanying diseases such as cerebral vascular disease, hypertension, etc, were also predisposing factors. Commonly, the elderly presented with hemiplegia/ hemidysesthesia/hemiataxia and the young with headache. Most CSDH patients （95.6%） treated with burr-hole cran- iotomy successfully recovered. However, postoperative complications occurred in 17 cases, including recurrence of CSDH in 15 cases, subdural abscess in 1 case and pneumonia in 3 cases. Conclusion： Burr-hole craniotomy is an easy, efficient and reliable way to treat CSDH.

New scoring system for intra-abdominal injury diagno- sis after blunt trauma

Objective： An accurate scoring system for intra-abdominal injury （IAI） based on clinical manifesta- tion and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is de- signed to provide a new scoring system for a better diagno- sis of IAI after blunt trauma. Methods： This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma （BAT） admitted to the emergency department （ED） of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient＇s history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi- square test and logistic regression were done. Factors with significant relationship with CT scan were imported in multi- variate regression models, where a coefficient （13） was given based on the contribution of each of them. Scoring systemwas developed based on the obtained total [3 of each factor. Results： Altogether 261 patients （80.1% male） were enrolled （48 cases of IAI）. A 24-point blunt abdominal trauma scoring system （BATSS） was developed. Patients were di- vided into three groups including low （score〈8）, moderate （8≤score〈12） and high risk （score≥ 12）. In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans （specificity 100%）. Conversely, all high risk patients had positive CT-scan findings （sensitivity 100%）. The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS （sensitivity=99.3%）. Conclusion： The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.

Clinical predictors of abnormal chest CT scan findings following blunt chest trauma: A cross-sectional study

Purpose:Some surgeons believe that chest computed tomography(CT)scan should be used more prudently in management of blunt chest trauma patients.This study aimed to evaluate the clinical predictors of abnormal chest CT scan findings in trauma patients.Methods:This cross-sectional study was conducted on blunt chest trauma patients aged18 years who were referred to the emergency departments of two educational hospitals and underwent chest CT scan.These patients were enrolled in the study using a non-probability sampling method.The exclusion criteria included:class III or IV hemodynamic shock,need for immediate surgical or neurosurgical interventions,penetrating trauma,lack of required information,and pregnancy.Demographic factors,accident details,trauma mechanism,vital signs,and level of consciousness in predicting abnormal chest CT scan findings were evaluated.Analysis was performed using IBM SPSS statistics 21.Results:A total of 977 patients(male 51.5%,female 48.5%)with the mean age of(41.71±14.24)years,range 18e88 years were studied;34.2% of them with high energy trauma mechanism.With 334(34.2%)patients had abnormal findings on chest X-ray(CXR)and 332(34.0%)cases had an abnormal findings on chest CT scan(agreement rate was 99.4%).There was a significant correlation between male gender(p<0.0001),GCS<15(p<0.0001),high energy trauma mechanism(p<0.0001),unstable hemodynamics(p<0.01),and clinical signs and symptoms(p<0.0001)with chest CT findings.Chest wall deformity(odds=8;p<0.0001),generalized tenderness(odds=6.6,p<0.0001),and decreased cardiac sound(odds=3.8,p<0.0001)were the important and independent clinical predictors of abnormal chest CT scan findings.Conclusion:Based on the findings,chest wall deformity,generalized tenderness,decreased cardiac sound,distracting pain,chest wall tenderness,high energy trauma mechanism,male gender,respiratory rate>20 breathes/min,decreased pulmonary sound,and chest wall crepitation were independent clinical predictors of abnormal chest CT scan findings following blunt trauma.

Trochlear calcification and intraorbital foreign body in ocular trauma patients

Objective： To distinguish trochlear calcification and intraorbital foreign body after eye injury in order to avoid misdiagnosis as well as mistreatment. Methods： The orbital CT images of 403 patients, who visited the Eye Hospital or the Second Affiliated Hospital of Wenzhou Medical College during May 2005-April 2007, were reviewed. The diagnosis of trochlear calcification and intraorbital foreign body was made together by a skilled radiologist as well as an ophthalmologist. General information and CT characteristics in the patients with trochlear calcification were collected. Results： Using CT scan images, 27 among 403 patients （6.69%） were identified with trochlear calcification. Three patients （3/27, 11.11%） were misdiagnosed by radiologists as intraorbital foreign body. Among the 27 patients with trochlear calcification, 23 （85.19%） were male and 4 （ 14.81% ）were female, with an unilateral calcification in 7 patients （7/27, 25.93%） and bilateral in 20 （74.07%）. The highest occurrence of trochlear calcification was in 31-40 years old group （13/403, 3.23%） which reached to 12.87% （13/101） after age-correction. There were 3 types of trochlear calcification on the basis of CT images： commas, dot and inverted ＂U＂. Conclusions： The trochlear calcification is not an uncommon phenomenon and should not be diagnosed as intraorbital foreign body, especially when it co-exists with eye injury in 31-40 years old group. Injury history and our classification method on the basis of CT images could help to avoid misdiagnosis.

Comparison of stress distribution of thoracolumbar vertebrae under forces with CT value

To provide a new method to estimate the effectiveness of thoracolumbar vertebral finite element model. Methods: A mechanical model of human thoracolumbar vertebrae motion segment was made using three-dimensional finite element method and the stress distribution of vertically compressed thoracolumbar vertebrae was analyzed, meanwhile, 20 patients with burst fracture of thoracolumbar vertebrae were tested by CT to calculated average CT value at ascertained different points of thoracolumbar vertebrae. The calculated results and effective stress at the same position were analyzed with straight line correlation. Results: The stress level of different position of thoracolumbar vertebrae under vertical compressive force was positively correlated with the correlative CT value, and the regressive style, Y= 214.028 + 45.268 X, r= 0.7386 , P< 0.05 (n=8) showed a statistical significance.Conclusions: To study mechanism of thoracolumbar vertebrae injuries under different forces has clinical significance.

Diagnosis and treatment of penetrating craniocerebral injury

Objective: To evaluate the clinical characteristics and present the experience in the treatment of patients with penetrating craniocerebral injury (PCCI). Methods: The data of 7 cases with PCCI by foreign body were retrospectively studied and compared with associated literatures. The strategies of diagnosis and treatment of PCCI were analyzed. In this series, 3 cases underwent emergency debridements and 4 cases underwent craniotomies. All patients received surgical intervention within 3 hours after admission. Results: Outcomes were good in 3 cases, moderate disability was in 2 cases, severe disability in 1 case and persistent vegetative state in 1 case. One case developed wound and intracranial infection, but made good recovery after treatment. During the follow-up period, one patient died one month after discharge and other six patients (range from 8 months to 3 years) recovered well and no epilepsy, leakage of cerebrospinal fluid (CSF), or traumatic vascular disease occurred. Conclusions: Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of PCCI. CT scans are the mainstay in evaluating PCCI and three dimensional (3D) images reconstructed from spiral CT scans provide more information. Efficient debridement should be performed as early as possible. Minimizing the degree of surgical management of PCCI is preferred when there is no indication for aggressive operation. It is important to stress the rapid and effective management of CSF leakage in early stage of PCCI. Use of prophylactic broad-spectrum antibiotics is recommended for patients with PCCI. Traumatic vascular injury should be paid attention to after PCCI.