Contrast-enhanced US evaluation in patients with blunt abdominal trauma

Abstract

KEYWORDSUltrasonography; Contrast agent; Abdominal trauma.Abstract Introduction: To evaluate the use of contrast-enhanced ultrasonography (CEUS) in patients with blunt abdominal trauma. Materials and methods: A total of 133 hemodynamically stable patients were evaluated using ultrasonography (US), CEUS and multislice Computer Tomography (CT) da eliminare. Results: In 133 patients, CT identified 84 lesions: 48 cases of splenic injury, 21 of liver injury, 13 of kidney or adrenal gland injury and 2 of pancreatic injury. US identified free fluid or parenchymal abnormalities in 59/84 patients positive at CT and free fluid in 20/49 patients negative at CT. CEUS revealed 81/84 traumatic injuries identified at CT and ruled out traumatic injuries in 48/49 negative at CT. Sensitivity, specificity, positive and negative predictive values for US were 70.2%, 59.2%, 74.7% and 53.7%, respectively; for CEUS the values were 96.4%, 98%, 98.8% and 94.1%, respectively. Conclusions: The study showed that CEUS is more accurate than US and nearly as accurate as CT, and CEUS can therefore be proposed for the initial evaluation of patients with blunt abdominal trauma.Sommario Introduzione: Descrivere l'impiego dell'ecografia con mezzo di contrasto (CEUS) nella valutazione dei pazienti con trauma chiuso dell'addome. Materiali e Metodi: 133 pazienti con trauma addominale chiuso emodinamicamente stabile sono stati esaminati con ecografia (US), CEUS e Tomografia Computerizzata multistrato (TC) da eliminare. Risultati: I 133 pazienti avevano alla TC 84 lesioni, di cui 48 spleniche, 21 epatiche, 13 renali o dei surreni e 2 del pancreas. L'US ha identificato versamento libero o alterazioni parenchimali in 59/84 pazienti positivi alla TC e versamento libero in 20/49 pazienti negativi alla TC. La CEUS ha riconosciuto 81/84 lesioni traumatiche identificate dalla TC e ha escluso lesioni traumatiche in 48/49 pazienti negativi alla TC. Sensibilità, specificità, valore predittivo positivo e negativo per l'US sono stati rispettivamente 70.2%, 59.2%, 74.7% e 53.7%; per la CEUS sono stati 96.4%, 98%, 98.8% e 94.1%. Conclusioni: Lo studio ha dimostrato che la CEUS ha una accuratezza diagnostica maggiore dell'US e quasi sovrapponibile alla TC e può quindi essere proposta nella valutazione iniziale del paziente traumatizzato. ª

Clinical Applications of Contrast-Enhanced Ultrasound in the Pediatric Work-Up of Focal Liver Lesions and Blunt Abdominal Trauma: A Systematic Review

“…It has been argued that CEUS can be considered in the triage of hemodynamically stable children with blunt abdominal trauma [18]. Several studies applying CEUS in blunt abdominal trauma in adults have shown similar results with CEUS outperforming conventional US and comparable to the performance of contrast-enhanced CT [27][28][29][30]. It is in agreement with these findings that CEUS could supersede contrast-enhanced CT in the follow-up of trauma and become the main imaging modality in traumas of minor or moderate severity.…”

Management of Hepatic Trauma: An Update

“…42 CEUS can be considered as first-line imaging in centers where ultrasound is part of the initial trauma screening protocol. 43,44 More importantly, it is especially useful for serial monitoring for conservatively managed patients without exposing them to further radiation. 41…”

Abdominal Trauma

“…The use of CEUS signifi cantly increases the sensitivity in detecting the parenchymal lesions, and perirenal hematoma, even if very small [ 9 ].…”

“…In the follow-up, US allows to evaluate the possible development of pancreatic pseudocysts and/or abscesses and to monitor its progress [ 9 ].…”

“…Lesions are usually asymptomatic, so their detection is accidental. US technique has low sensitivity in detecting traumatic adrenal lesions especially for their association with multiorgan lesions, rib fractures, and pneumothorax [ 9 ].…”