Imaging of Blunt Pancreatic Trauma: A Systematic Review

Abstract

<jats:sec><jats:title>Purpose:</jats:title><jats:p> Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures. </jats:p></jats:sec>

Temporal–spatial organ response after blast‐induced experimental blunt abdominal trauma

“…This is of course different in the present AT model, where the defined blast wave was centered on the central upper abdominal region, thereby impacting the pancreas in the depth 33 . However, it is tempting to speculate that pancreatic trauma in humans, although associated with a high morbidity and mortality rate, may still be underestimated, and minor damage detected only on a histological level may be missed by clinical exam or even by advanced imaging (CT scans) with reported sensitivity levels ranging between 30% and 100% 30 . Various injury patterns of abdominal organs have been proposed to be dependent on the trauma source.…”

“…33 However, it is tempting to speculate that pancreatic trauma in humans, although associated with a high morbidity and mortality rate, may still be underestimated, and minor damage detected only on a histological level may be missed by clinical exam or even by advanced imaging (CT scans) with reported sensitivity levels ranging between 30% and 100%. 30 Various injury patterns of abdominal organs have been proposed to be dependent on the trauma source. For example, whole body blast injuries due to terroristic attacks resulted in a unique injury pattern of multiple regions with predominantly hollow organ injuries, 34 which were not dominant in the current isolated AT by an abdominal-centered blast wave.…”

Urgent ultrasonographic diagnostics in acute traumatic abdominal conditions: Urgent ultrasound in abdominal trauma

“…Ultrazvučni pregled pankreasa je teži od pregleda jetre i slezine iz razloga njegove retroperitonealne pozicije, te se ne smatra optimalnom dijagnostičkom metodom za detekciju traumatskih lezija 11 . Dosadašnja istraživanja pokazuju širok spektar senzitivnosti (27-96%) i specifi čnosti (69-100%) u detekciji traume pankreasa 12 . Kontuzije i hematomi pankreasa se ultrazvučno prezentuju kao fokalne hipoehogene promene, dok se laceracija vidi kao linearna hipoehogena promena.…”

“…Indirektni ultrazvučni znaci mogu pomoći u detekciji traume pankreasa, kao što su peripankreatična ili intraperitonealna slobodna tečnost, hiperehogena reakcija peripankreatičnog masnog tkiva i ultrazvučni znaci povrede drugih parenhimskih organa 11,12 . Kompletna laceracija koja prolazi kroz telo pankreasa naziva se transekcija ili fraktura pankreasa.…”

“…Kompletna laceracija koja prolazi kroz telo pankreasa naziva se transekcija ili fraktura pankreasa. Svaka povreda pankreasa koja zahvata najmanje polovinu debljine pankreasa je visoko suspektna za povredu glavnog pankreatičnog kanala, što zahteva hitnu hiruršku intervenciju 11,12 . Kontrolni ultrazvučni pregledi igraju značajnu ulogu u praćenju evolucije traume pankreasa 11 .…”