Adrenal trauma experience at a major tertiary centre in Sweden: Clinical and radiological findings.

BACKGROUND AND OBJECTIVE: Information on the incidence of adrenal trauma and its association with other injuries is limited. Our objective was to study the incidence of adrenal haemorrhage, its association with other injuries, clinical parameters, and long-term outcomes. PATIENTS AND MEASUREMENTS: All patients treated for severe abdominal trauma (Level 1) at Karolinska University Hospital, Solna, between January 1, 2013 and December 31, 2018 were included. Patients with a radiological picture of adrenal haematoma were selected. The injury severity score (ISS) was analysed in the entire cohort. Data were collected from the electronic medical files. RESULTS: In total, 1.7% (n = 29/1743) was affected by adrenal trauma. Right adrenal trauma (n = 20/29;69%) was more common than left (n = 6/29;21%, p < 0.01), and 10% were bilateral (n = 3/29). There was no difference in volume in right versus left adrenal trauma [(median 13 (interquartile range (IQR) (7-15) versus 8 (5-13)] ml, p = 0.30). ISS was 23.4 (17-43) in adrenal haematoma patients, higher compared with other trauma patients 16 (8-27) (n = 1714)(p < 0.001). Rib fractures, pneumothorax, and liver lacerations were the three most common findings in association with adrenal trauma. The underlying cause in 48% of the cases was falling from height (≥3 m). Biochemical data demonstrated normal sodium and potassium levels while the lowest haemoglobin level was 72 g/l. At follow-up, 4 (2-6) years after the trauma, except for three patients who died as in-patients, all other persons were still living. None seemed to have adrenal insufficiency. CONCLUSIONS: Adrenal trauma is rare and does not seem to be associated with clinical features of adrenal insufficiency, even if the bleeding is bilateral.

Costal cartilage fractures in blunt polytrauma patients - a prospective clinical and radiological follow-up study.

PURPOSE: To assess the healing of costal cartilage fractures (CCFX) in patients with blunt polytrauma with follow-up imaging and clinical examination. Effect on physical performance and quality of life (QoL) was also evaluated. METHODS: The study group comprised twenty-one patients with diagnosed CCFX in trauma CT. All the patients underwent MRI, ultrasound, ultra-low-dose CT examinations, and clinical status control. The patients completed QoL questionnaires. Two radiologists evaluated the images regarding fracture union, dislocation, calcifications, and persistent edema at fracture site. An attending trauma surgeon clinically examined the patients, with emphasis on focal tenderness and ribcage mobility. Trauma registry data were accessed to evaluate injury severity and outcome. RESULTS: The patients were imaged at an average of 34.1 months (median 36, range 15.8-57.7) after the initial trauma. In 15 patients (71.4%), CCFX were considered stable on imaging. Cartilage calcifications were seen on healed fracture sites in all the patients. The fracture dislocation had increased in 5 patients (23.8%), and 1 patient (4.8%) showed signs of a non-stable union. Four patients (19.0%) reported persistent symptoms from CCFX. CONCLUSION: Non-union in CCFX is uncommon but may lead to decreased stability and discomfort. Both clinical and radiological examinations play an important part in the post-traumatic evaluation of CCFX. CT and MRI visualize the healing process, while dynamic ultrasound may reveal instability. No significant difference in QoL was detected between patients with radiologically healed and non-healed CCFX. Post-traumatic disability was mostly due to other non-thoracic injuries.

Deep learning versus iterative image reconstruction algorithm for head CT in trauma.

PURPOSE: To compare the image quality between a deep learning-based image reconstruction algorithm (DLIR) and an adaptive statistical iterative reconstruction algorithm (ASiR-V) in noncontrast trauma head CT. METHODS: Head CT scans from 94 consecutive trauma patients were included. Images were reconstructed with ASiR-V 50% and the DLIR strengths: low (DLIR-L), medium (DLIR-M), and high (DLIR-H). The image quality was assessed quantitatively and qualitatively and compared between the different reconstruction algorithms. Inter-reader agreement was assessed by weighted kappa. RESULTS: DLIR-M and DLIR-H demonstrated lower image noise (p < 0.001 for all pairwise comparisons), higher SNR of up to 82.9% (p < 0.001), and higher CNR of up to 53.3% (p < 0.001) compared to ASiR-V. DLIR-H outperformed other DLIR strengths (p ranging from < 0.001 to 0.016). DLIR-M outperformed DLIR-L (p < 0.001) and ASiR-V (p < 0.001). The distribution of reader scores for DLIR-M and DLIR-H shifted towards higher scores compared to DLIR-L and ASiR-V. There was a tendency towards higher scores with increasing DLIR strengths. There were fewer non-diagnostic CT series for DLIR-M and DLIR-H compared to ASiR-V and DLIR-L. No images were graded as non-diagnostic for DLIR-H regarding intracranial hemorrhage. The inter-reader agreement was fair-good between the second most and the less experienced reader, poor-moderate between the most and the less experienced reader, and poor-fair between the most and the second most experienced reader. CONCLUSION: The image quality of trauma head CT series reconstructed with DLIR outperformed those reconstructed with ASiR-V. In particular, DLIR-M and DLIR-H demonstrated significantly improved image quality and fewer non-diagnostic images. The improvement in qualitative image quality was greater for the second most and the less experienced readers compared to the most experienced reader.

Diagnostic accuracy of dual-energy CT for detection of bone marrow lesions in the subacutely injured knee with MRI as reference method.

BACKGROUND: Dual-energy computer tomography (DECT) can detect post-traumatic bone marrow lesions. Prospective studies of the knee with large numbers of participants and intra-observer agreement assessment are limited. PURPOSE: To investigate the diagnostic accuracy of DECT in detecting bone marrow lesions as well as estimating the bone marrow lesion volume in patients with suspected anterior cruciate ligament trauma with magnetic resonance imaging (MRI) as reference standard. MATERIAL AND METHODS: Forty-eight consecutive patients with suspected anterior cruciate ligament injury were imaged bilaterally with DECT within a mean of 25 days (range 4-55 days) following injury and MRI within seven days of DECT. Two readers analyzed DECT virtual non-calcium-blinded images. Consensus MRI was reference standard. Intra- and inter-observer agreement were determined using weighted kappa statistics. Sensitivity, specificity, and negative and positive predictive values were calculated. Bone marrow lesion volumes were measured; for comparison, intra-class correlation coefficient was used. RESULTS: The 48 patients (26 men, 22 women; mean age 23 years, age range 15-37 years) were imaged bilaterally yielding 52 knees with bone marrow lesions, of which 44 were in the femur and 41 were in the tibia. Intra- and inter-observer agreement to detect bone marrow lesions was moderate and fair to moderate (κ 0.54-0.66, 95% confidence interval [CI] 0.39-0.80 and 0.37-0.41, 95% CI 0.20-0.57) and overall sensitivity and specificity were 70.1% and 69.1%, respectively. Positive and negative predictive values were 72.9% and 66.1%, respectively. Bone marrow lesion volumes showed excellent intra- and inter-observer agreement (0.83-0.91, 95% CI 0.74-0.94 and 0.76-0.78, 95% CI 0.57-0.87). CONCLUSION: The diagnostic performance of DECT to detect bone marrow lesions in the subacutely injured knee was moderate with intra- and inter-observer agreement ranging from moderate to substantial and fair to moderate. Bone marrow lesion volume correlation was excellent.

Diagnostic performance of CT and the use of GI contrast material for detection of hollow viscus injury after penetrating abdominal trauma. Experience from a level 1 Nordic trauma center.

BACKGROUND: Use of gastrointestinal (GI) contrast material for computed tomography (CT) diagnosis of hollow viscus injury (HVI) after penetrating abdominal trauma is still controversial. PURPOSE: To assess the sensitivity of CT and GI contrast material use in detecting HVI after penetrating abdominal trauma. MATERIAL AND METHODS: Retrospective analysis (2013-2016) of patients with penetrating abdominal trauma. Data from the local trauma registry, medical records, and imaging from PACS were reviewed. CT and surgical findings were compared. RESULTS: Of 636 patients with penetrating trauma, 177 (163 men, 14 women) had abdominal trauma (mean age 34 years, age range 16-88 years): 155/177 (85%) were imaged with CT on arrival; 128/155 (83%) were stab wounds and 21/155 (14%) were gunshot wounds; 47/155 (30%) had emergent surgery after CT. Two patients were imaged using oral, rectal and i.v. contrast; 23 with rectal and i.v. contrast; and 22 with i.v. contrast only. Surgery revealed HVI in 26 patients. CT had an overall sensitivity 69.2%, specificity 90.5%, PPV 90.0%, and NPV 70.4%. CT with oral and/or rectal contrast (n = 25) had sensitivity 66.7%, specificity 71.4%, PPV 85.7%, and NPV 45.5%. CT with i.v. contrast only (n = 22) had 75% sensitivity, 100% specificity, PPV 100%, and NPV 87.5%. No statistically significant difference was found between sensitivity of CT with GI contrast material and i.v. contrast only (P = 1). CONCLUSION: Stab wounds were the most common cause of penetrating abdominal trauma. CT had 69.2% sensitivity and 90.5% specificity in detecting HVI. CT with GI contrast had similar sensitivity as CT with i.v. contrast only.

Ultra-low-dose CT for extremities in an acute setting: initial experience with 203 subjects.

OBJECTIVE: The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. MATERIALS AND METHODS: An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. RESULTS: In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 µSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 µSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. CONCLUSIONS: Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.

Contrast-Enhanced Ultrasound for identifying circulatory complications after liver transplants in children.

Our main goal with this study was to share our off-label experience with CEUS for identifying circulatory complications after liver transplantation in children. A total of 74 CEUS examinations performed on 34 pediatric patients who underwent a liver transplant were retrospectively included. About 53% of the examinations were performed on children 2 years old or younger. About 82% of the examinations were performed within 30 days from the transplant. About 62% of patients were transplanted due to a cholestatic disease, 11% due to a metabolic disease, 8% were re-transplanted due to graft failure, and 19% was due to other conditions. BA was the most common reason for transplantation and represented 38% of patients. About 38% of the transplantations were performed with whole grafts from DD, 40% with split liver grafts, and 22% with left lateral segments from LD. For diagnosing arterial circulatory complications, the PPV was 80%. For diagnosing portal vein circulatory complications, the PPV was 66.7%. NPV was 100%. In 28% of the examinations, the examiner could not visualize the normal arterial blood flow without CEUS. CEUS is a non-invasive and safe imaging technique that seems valuable in these patients and further efforts are needed to license its use in the post-transplant setting.

Fibular head avulsion fractures accompanying operative treated medial tibial plateau fractures.

OBJECTIVE: The aims of this work are to determine how frequently medial tibial plateau fractures are accompanied by fibular head avulsion fractures and evaluate the sensitivity of radiographs detecting them, and also to assess if the presence of fibular fracture is correlated with long-term functional outcome and peroneal nerve damage. MATERIALS AND METHODS: A retrospective chart review of operated patients with medial tibial plateau fractures at level I trauma center during 2002-2008 was performed. From 63 patients imaged preoperatively, 59 had CT and radiographs, three had only CT, and one only radiograph. The presence and fragment size of fibular fracture were retrospectively evaluated. Body mass index (BMI) and functional outcome measurements (the Modified Lysholm knee score and WOMAC) were available for 46 patients. RESULTS: Fourteen out of 63 patients (22.2%) had fibular fractures. Of the 59 patients with both CT and radiographs, 12 had fibular fractures, and of these, nine were seen with both modalities and three only in CT. Functional scores were available for ten patients with fibular fracture. Patients with fibular fracture seen on radiographs had a significantly higher score on WOMAC function (26 vs. 7; p = 0.027). The patients with fibular fractures had also higher BMI (p = 0.035). Of the six patients with peroneal nerve damage, 50% had fibular fracture. CONCLUSIONS: In patients with operatively treated medial tibial plateau fracture, the fibular fractures are relatively common. Detecting it is important, as it may be associated with worse functional scores and peroneal nerve paresis. Some fibular fractures may remain undetected on radiographs, hence preoperative CT is recommended.

Augmenting Denver criteria yields increased BCVI detection, with screening showing markedly increased risk for subsequent ischemic stroke.

PURPOSE: BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke. METHODS: Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma. RESULTS: 1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p < .0001; OR = 9.77; 95% CI 3.3-28.7). Eleven percent of patients with BCVI would not have met standard screening criteria. CONCLUSIONS: The increase in detection rate for BCVI justifies more liberal screening protocols.

Incidence and Imaging Findings of Costal Cartilage Fractures in Patients with Blunt Chest Trauma: A Retrospective Review of 1461 Consecutive Whole-Body CT Examinations for Trauma.

Purpose To assess the incidence of costal cartilage (CC) fractures in whole-body computed tomographic (CT) examinations for blunt trauma and to evaluate distribution of CC fractures, concomitant injuries, mechanism of injury, accuracy of reporting, and the effect on 30-day mortality. Materials and Methods Institutional review board approval was obtained for this retrospective study. All whole-body CT examinations for blunt trauma over 36 months were reviewed retrospectively and chest trauma CT studies were evaluated by a second reader. Of 1461 patients who underwent a whole-body CT examination, 39% (574 of 1461) had signs of thoracic injuries (men, 74.0% [425 of 574]; mean age, 46.6 years; women, 26.0% [149 of 574]; mean age, 48.9 years). χ2 and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Interobserver agreement was calculated by using Cohen kappa values. Results A total of 114 patients (men, 86.8% [99 of 114]; mean age, 48.6 years; women, 13.2% [15 of 114]; mean age, 45.1 years) had 221 CC fractures. The incidence was 7.8% (114 of 1461) in all whole-body CT examinations and 19.9% (114 of 574) in patients with thoracic trauma. Cartilage of rib 7 (21.3%, 47 of 221) was most commonly injured. Bilateral multiple consecutive rib fractures occurred in 36% (41 of 114) versus 14% (64 of 460) in other patients with chest trauma (OR, 3.48; 95% CI: 2.18, 5.53; P < .0001). Hepatic injuries were more common in patients with chest trauma with CC fractures (13%, 15 of 114) versus patients with chest trauma without CC fractures (4%, 18 of 460) (OR, 3.72; 95% CI: 1.81, 7.64; P = .0001), as well as aortic injuries (n = 4 vs n = 0; P = .0015; OR, unavailable). Kappa value for interobserver agreement in detecting CC fractures was 0.65 (substantial agreement). CC fractures were documented in 39.5% (45 of 114) of primary reports. The 30-day mortality of patients with CC fractures was 7.02% (eight of 114) versus 4.78% (22 of 460) of other patients with chest trauma (OR, 1.50; 95% CI: 0.65, 3.47; P = .3371). Conclusion CC fractures are common in high-energy blunt chest trauma and often occur with multiple consecutive rib fractures. Aortic and hepatic injuries were more common in patients with CC fractures than in patients without CC fractures. © RSNA, 2017.

Contrast-enhanced ultrasound using sulfur hexafluoride is safe in the pediatric setting.

Background Contrast-enhanced ultrasound (CEUS) by using sulfur hexafluoride microbubbles is not licensed for use in children, but its off-label use is widespread. Purpose To outline our experience with the off-label use of CEUS in children, specifically with regards to safety. Material and Methods We retrieved all records of 10681 patients aged under 18 years who underwent abdominal ultrasound (US) January 2004 to December 2014. We then identified those who underwent an abdominal CEUS using sulfur hexafluoride microbubbles. Electronic patient charts were used to verify the indication for contrast agent, dose, possible adverse effects as well as information on patient height, weight, and age. Results We identified 173 patients (mean age, 11 years; range, 0.1-18 years) who underwent a total of 287 CEUS exams. Of all exams, 46% were performed on the native liver, 31% on a transplanted liver, and 23% on other organs. The indications were "circulatory status?" (40%), "characterization of lesion?" (40%), and miscellaneous (20%). Mean contrast dose was 2.3 mL (range, 0.1-8.1 mL). No immediate adverse effects were recorded. One patient experienced itching the day after, but this was considered to be a reaction to concomitantly administered fentanyl. Conclusion The use of intravenous ultrasound contrast seems safe in patients aged under 18 years and our results do not support the current practice to restrict the use of CEUS in children.

High intensity focused ultrasound (HIFU) in tumor therapy.

HIFU (high intensity focused ultrasound) is a method in which high-frequency ultrasound is focused on a tissue in order to achieve a thermal effect and the subsequent percutaneously ablation, or tissue modulation. HIFU is non-invasive and results in an immediate tissue destruction effect corresponding to surgery, either percutaneously or through body cavities. HIFU can be utilized in the treatment of both benign and malignant tumors. In neurological diseases, focused HIFU can be used in the treatment of disorders of the basal ganglia.

Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma.

OBJECTIVE: To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. MATERIALS AND METHODS: At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. RESULTS: A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79% and 100%, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. CONCLUSION: DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon.

[Hips have a hard time in ice hockey goalkeeper's butterfly technique]. / Lonkat kovilla jääkiekkomaa1ivahdin perhostorjunnassa.

Hip problems have increased especially among young ice hockey goalkeepers and those using the butterfly technique. Femoroacetabular impingement (FAI) is a common cause of the symptoms. Although hip impingement may also be symptomless, it may later predispose to joint damages, especially in case of goalkeepers who are loading their hip. Diagnosis of the impingement is important in order to lessen any harmful effects. Magnetic resonance imaging is the most important investigation in addition to the elucidation of patient history and clinical condition. Conservative treatment includes changing the exercise, and making use of exercises supporting the hip. If secondary joint damages have already developed, surgical treatment is required.

MDCT findings after elbow dislocation: a retrospective study of 140 patients.

OBJECTIVE: To assess the number and anatomical location of fractures associated with elbow dislocation, to study the correlation between the direction of dislocation and the trauma energy, and to assess radiographs' diagnostic performance characteristics for fractures using MDCT as a reference standard. MATERIALS AND METHODS: A retrospective study was performed at a level 1 trauma center, finding a total of 140 patients who had sustained an elbow dislocation and who had undergone a subsequent MDCT examination. The CT and radiographs of the patient were reviewed by two musculoskeletal radiologists. CT images were analyzed for the site and size of the fracture fragments. In addition, the primary direction of the dislocation, patients' age, and gender were recorded. Trauma energy was also assessed. RESULTS: One hundred and thirty-four out of 140 patients (96%) had a fracture that was seen on the correlative CT examination. The most common anatomical fracture locations were the coronoid process of the ulna 84 out of 140 (60%), the radial head 75 out of 140 (54%), and the humeral capitellum 57 out of 140 (41%). Multiple fractures were seen in 71 out of 134 (53%) patients with fractures. The left elbow was more commonly dislocated than the right one. The overall sensitivity of the radiographs was 62% and the specificity 96%. CONCLUSION: Small fractures and impaction fractures are almost invariably present in elbow dislocations, and half of the patients have more than one fracture. Radiographs have a sensitivity of only 62%. MDCT is an invaluable method for determining the extent of bony injury and revealing occult fractures.

The reverse Segond fracture: not associated with knee dislocation and rarely with posterior cruciate ligament tear.

The aims of this study were to assess the incidence of reverse Segond fracture, to examine the associated ligamentous injuries, and to examine how often reverse Segond fracture coexists with a knee dislocation. At a level 1 trauma center, an 11-year period of emergency department multidetector-row computed tomography (MDCT) examinations for knee trauma was evaluated for reverse Segond and Segond fractures. Surgical findings served as the reference standard for intra-articular injuries. The hospital discharge register was searched for the diagnosis of knee dislocation from August 2000 through the end of August 2011. A total of 1,553 knee MDCT examinations were evaluated. Ten patients with a reverse Segond fracture were found, comprising 0.64 % of emergency room acute knee trauma MDCT examinations. Seven patients who had a reverse Segond fracture were operated: Three had an avulsion fracture of the anterior cruciate ligament, one had an avulsion fracture of posterior cruciate ligament, two had a lateral meniscal tear, and two had a medial collateral ligament tear. The ratio of reverse Segond fractures to Segond fractures was 1:4. None of the 71 knee dislocation patients had a reverse Segond fracture. Reverse Segond fracture is a rare finding even in a level 1 trauma center. Cruciate ligament injuries appear to be associated with avulsion fracture, but every patient does not have PCL injury, as previously reported. Our results do not support the association of knee dislocation with reverse Segond fracture.

The spectrum of facial fractures in motor vehicle accidents: an MDCT study of 374 patients.

Road traffic accidents are a major health problem worldwide resulting frequently in maxillofacial injuries. The purpose of the study was to assess the incidence and spectrum of facial fractures in patients involved in a motor vehicle accident (MVA). Using picture archiving and communication system, all requests for suspected facial trauma were retrieved during a 62-month period; 374 met the inclusion criteria. Two researchers interpreted the multidetector computed tomography images by consensus. The motor vehicles involved were divided into two groups: those involving a passenger car or a larger vehicle and those involving a motorized two-wheeler. Furthermore, the motor vehicle accidents were divided into collisions and run-off-road accidents. Of the 374 patients (aged 15-80, mean 34), 271 (72 %) were male and 103 (28 %) female. Of all patients, 262 (70 %) had a facial or skull base fracture; of these, multiple separate fractures were present in 56 %. Nasal fractures were the most common fractures followed by orbital, skull base, and maxillary fractures. Frontal bone, LeFort, and zygomatic arch fractures were always accompanied by other fractures. Fractures were more frequent in the group of collisions compared with run-off-road accidents. In the two-wheeled group, only 15 % did not have facial or skull base fractures. Fractures often occur in multitudes as 39 % of all patients have multiple facial or skull bone fractures, and thus, emergency radiologists should be familiar with the complexity of the injuries. Negative clear sinus sign and low-energy sentinel injuries should be trusted as indications of undetected injuries in MVA victims.

The prevalence of early contained vascular injury of spleen.

Contained vascular injuries (CVI) of spleen include pseudoaneurysms (PSA) and arterio-venous fistulae (AV-fistulae), and their reported prevalence varies. Our purpose was to assess the prevalence of early splenic CVI seen on admission CT in patients with splenic trauma admitted to a single level 1 trauma center in 2013-2021, and its detection in different CT protocols. A retrospective, single-center longitudinal cohort study. Nine-year data (2013-2021) of all patients with suspected or manifest abdominal trauma were retrieved. All patients, > 15 years with an ICD code for splenic trauma (S36.0XX) were included. CT and angiographic examinations were identified. Reports and images were reviewed. Splenic CVI CT criterion was a focal collection of vascular contrast that decreases in attenuation with delayed imaging. Number of CVIs and treatment was based on medical records and/or available angioembolization data. Of 2805 patients with abdominal trauma, 313 patients (313/2805; 11.2%) fulfilled the study entry criteria. 256 patients (256/313; 81.8%) had a CT examination. Sixteen patients had splenectomy before CT, and the final study group included 240 patients (240/313; 76.7%). Median New Injury Severity Score (NISS) was 27 and 87.5% of patients had NISS > 15. Splenic CVI was found in 20 patients, which yields a prevalence of 8.3% (20/240; 95% CI 5.2-12.6%). In those cases with both late arterial and venous phase images available, CVI was seen in 14.5% of cases (18/124, 95% CI 8.6-22.0%). None of the patients with CVI died within 30 days of the injury. The prevalence of early splenic CVI in patients with a splenic trauma was 8.3-14.5% (95% CI 5.2-22.0%). Our data suggests that both arterial and venous phase are needed for CT diagnosis. The 30-day outcome in terms of mortality was good.

Weight-bearing CT imaging of the lower extremity.

OBJECTIVE: The purpose of this article is to describe weight-bearing CT of the lower extremity joints using a novel portable imager utilizing cone-beam CT technology. CONCLUSION: Cone-beam CT technology with new design and flexible gantry movements allows both supine and weight-bearing imaging of the lower extremities, with a reasonable radiation dose and excellent image quality. Weight-bearing CT of joints can provide important new clinical information in musculoskeletal radiology.