MDCT in emergency radiology: is a standardized chest or abdominal protocol sufficient for evaluation of thoracic and lumbar spine trauma?

OBJECTIVE The objective of our study was to assess the diagnostic performance of a standardized 4-MDCT trauma protocol for the evaluation of the thoracic and lumbar spine in patients with multiple injuries. MATERIALS AND METHODS Eighty-two patients with multiple injuries underwent MDCT for the chest and abdomen using a standardized 4-MDCT trauma protocol (collimation, 4 x 2.5 mm). Secondary reconstructions targeted to the spine were performed (slice width, 3 mm; reconstruction interval, 1.5 mm). All spinal fractures were additionally scanned using a collimation of 4 x 1 mm, and these images served as the standard of reference for fracture classification. An additional 50 patients with no spinal fracture served as the control group. A total of 65 major spinal fractures were present in 55 of the patients with multiple injuries. Two observers (observer 1 and observer 2) independently evaluated all CT data for spinal fractures using a 5-point confidence scale, classified the different fracture types, and rated the image quality of spinal structures on axial images and multiplanar reformations. RESULTS Image quality for axial images was excellent in 80% and in 68% using 4 x 1 mm and 4 x 2.5 mm collimation, respectively. Image quality of the multiplanar reformations was excellent in 75% and good in 65% using 4 x 1 mm and 4 x 2.5 mm collimation, respectively. Spinal fractures were detected by observer 1 and observer 2 with a sensitivity and specificity of 98% and 97% and of 97% and 97%, respectively. Interobserver agreement regarding the confidence scale for fracture detection was substantial (kappa = 0.80), and agreement between the different imaging protocols for fracture classification was excellent for observer 1 (kappa = 0.95) and observer 2 (kappa = 0.97). CONCLUSION Accurate evaluation of the thoracolumbar spine is possible with targeted image reconstruction based on a standardized 4-MDCT trauma protocol of the chest and abdomen.

[1]  W A Kalender,et al.  Technical advances in multi-slice spiral CT. , 2000, European journal of radiology.

[2]  B E Fredrickson,et al.  The value of computed tomography in thoracolumbar fractures. An analysis of one hundred consecutive cases and a new classification. , 1983, The Journal of bone and joint surgery. American volume.

[3]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[4]  R. Daffner,et al.  Thoracic fractures and dislocations in motorcyclists , 2004, Skeletal Radiology.

[5]  M. Federle.  Abdominal trauma: the role and impact of computed tomography. , 1981, Investigative radiology.

[6]  E. Van Beek,et al.  Upper thoracic spinal fractures in trauma patients - a diagnostic pitfall. , 2000, Injury.

[7]  P. Aspelin,et al.  Standardized CT examination of the multitraumatized patient , 1998, European Radiology.

[8]  R A Novelline,et al.  Helical CT in emergency radiology. , 1999, Radiology.

[9]  M. Wintermark,et al.  Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. , 2003, Radiology.

[10]  M. Aebi,et al.  A comprehensive classification of thoracic and lumbar injuries , 2005, European Spine Journal.

[11]  H. Häuser,et al.  Radiological emergency management of multiple trauma patients , 1999, Emergency Radiology.

[12]  T. Ptak,et al.  Experience with a continuous, single-pass whole-body multidetector CT protocol for trauma: the three-minute multiple trauma CT scan , 2001, Emergency Radiology.

[13]  N. Müller,et al.  CT in blunt chest trauma: indications and limitations. , 1998, Radiographics : a review publication of the Radiological Society of North America, Inc.

[14]  Kaye Jj,et al.  Thoracic and lumbar spine trauma. , 1990 .

[15]  R. Patten,et al.  Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. , 2000, Radiology.

[16]  F Denis,et al.  The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries , 1983, Spine.

[17]  R. Jeffrey,et al.  Evaluation of abdominal trauma by computed tomography. , 1981, Radiology.

[18]  el-Khoury Gy,et al.  Thoracic and lumbar spine trauma , 1997 .

[19]  R. Novelline,et al.  Helical CT of abdominal trauma. , 1999, Radiologic clinics of North America.

[20]  M. Biros,et al.  Delayed diagnosis of thoracolumbar fractures in multiple-trauma patients. , 1996, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[21]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[22]  M. Reiser,et al.  Whole-body computed tomography in polytrauma: techniques and management , 2002, European Radiology.

[23]  R. Sheridan,et al.  Can chest and abdominal trauma CT eliminate the need for plain films of the spine? – Experience with 329 multiple trauma patients , 2001, Emergency Radiology.

[24]  D. Finlay,et al.  Computerized tomography of injury to the thoracolumbar spine. , 1987, Injury.

[25]  P. Bossuyt,et al.  Empirical evidence of design-related bias in studies of diagnostic tests. , 1999, JAMA.

[26]  R. Novelline,et al.  The frequency and significance of thoracic injuries detected on abdominal CT scans of multiple trauma patients. , 1989, The Journal of trauma.