Contrast enhanced ultrasound (CEUS) in blunt abdominal trauma

Lucio Cagini, Sabrina Gravante, Corrado Maria Malaspina, Elviro Cesarano, Melchiorre Giganti, Alberto Rebonato, Paolo Fonio, Michele Scialpi, Lucio Cagini, Sabrina Gravante, Corrado Maria Malaspina, Elviro Cesarano, Melchiorre Giganti, Alberto Rebonato, Paolo Fonio, Michele Scialpi

Abstract

In the assessment of polytrauma patient, an accurate diagnostic study protocol with high sensitivity and specificity is necessary. Computed Tomography (CT) is the standard reference in the emergency for evaluating the patients with abdominal trauma. Ultrasonography (US) has a high sensitivity in detecting free fluid in the peritoneum, but it does not show as much sensitivity for traumatic parenchymal lesions. The use of Contrast-Enhanced Ultrasound (CEUS) improves the accuracy of the method in the diagnosis and assessment of the extent of parenchymal lesions. Although the CEUS is not feasible as a method of first level in the diagnosis and management of the polytrauma patient, it can be used in the follow-up of traumatic injuries of abdominal parenchymal organs (liver, spleen and kidneys), especially in young people or children.

Figures

Figure 1
Figure 1
Spleen. Contrast-enhanced CT in venous phase (a), US-B-mode (b) and CEUS (c) in a 40 year- male patient with blunt abdominal trauma. CT shows a splenic hypodense parenchymal lacerative area (a) not recocognizable by US B-Mode examination (b). CEUS demonstrate splenic hypoechoic lesion corresponding to that of CT.
Figure 2
Figure 2
Liver. Contrast-enhanced CT in venous phase (a), US-B-mode (b) and CEUS (c) in a 67 year-old male patient with blunt abdominal trauma. CT shows a epatic hypodense intra-parenchymal traumatic area (a) not recocognizable by US B-Mode examination (b). CEUS demonstrate epatic hypoechoic lesion corresponding to that of CT.
Figure 3
Figure 3
Kidney. Contrast-enhanced CT in venous phase (a), US-B-mode (b) and CEUS (c) in a 72 year-old female patient with blunt abdominal trauma. CT shows a renal subcapsular haematoma (a) recocognizable by US B-Mode examination (b).and CEUS corresponding to that of CT.

References

    1. Cokkinos D, Antypa K, Stefanidis K. et al.Contrast-Enhanced Ultrasound for imaging blunt abdominal trauma – Indication, description of the technique and imaging review. Ultraschall in Med. 2012;5:60–67. doi: 10.1055/s-0031-1273442.
    1. Valentino M, Serra C, Zironi G. et al.Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR. 2006;5:1361–1367. doi: 10.2214/AJR.05.0027.
    1. Korner M, Krotz MM, Degenhart C. et al.Current role of emergency US in patients with major trauma. Radiographics. 2008;5:225–244. doi: 10.1148/rg.281075047.
    1. Thorelius L. Emergency real-time contrast-enhanced ultrasonography for the detection of solid organ injuries. Eur Radiol Suppl. 2007;5:107–112. doi: 10.1007/s10406-007-0235-4.
    1. Catalano O, Aiani L, Barozzi L. et al.CEUS in abdominal trauma: multi-center study. Abdom Imaging. 2009;5:225–234. doi: 10.1007/s00261-008-9452-0.
    1. Valentino M, Serra C, Pavlica P. et al.Contrast-Enhanced Ultrasound for blunt abdominal trauma. Semin Ultrasound CT MR. 2007;5(2):130–140. doi: 10.1053/j.sult.2007.01.008.
    1. Valentino M, Pavlica P, Barozzi L. Ecografia con mezzo di contrasto nei traumi addominali. Diagnostica per immagini del trauma maggiore. Masson. 2010. pp. 211–216.
    1. Bartolotta TV, Midiri M, Scialpi M. et al.Focal nodular hyperplasia in normal and fatty liver: a qualitative and quantitative evaluation with contrast-enhanced ultrasound. Eur Radiol. 2004;5:583–591. doi: 10.1007/s00330-003-2089-z.
    1. Piscaglia F, Nolsoe C, Dietrich CF. et al.The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in Med. 2012;5:33–59. doi: 10.1055/s-0031-1281676.
    1. Claudon M, Cosgrove D, Albrecht T. et al.Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – Update 2008. Ultraschall in Med. 2008;5:28–44. doi: 10.1055/s-2007-963785.
    1. Esposito F, Di Serafino M, Sgambati P, Mercogliano F, Tarantino L, Vallone G, Oresta P. Ultrasound contrast media in paediatric patients: is it an off-label use? Regulatory requirements and radiologist's liability. Radiol Med. 2012;5(1):148–59. doi: 10.1007/s11547-011-0718-1.
    1. Raimondi F, Migliaro F, Sodano A, Umbaldo A, Romano A, Vallone G, Capasso L. Can neonatal lung ultrasound monitor fluid clearance and predict the need of respiratory support? Crit Care. 2012;5(6):R220. doi: 10.1186/cc11865.
    1. Reginelli A, Pezzullo MG, Scaglione M, Scialpi M, Brunese L, Grassi R. Gastrointestinal disorders in elderly patients. Radiol Clin North Am. 2008;5(4):755–71. doi: 10.1016/j.rcl.2008.04.013.
    1. Cosgrove D. Ultrasound contrast agent: an overview. Eur J Radiol. pp. 324–30.
    1. Catalano O, Sandomenico F, Matarazzo I, Siani A. Contrast-Enhanced Sonography of the spleen. AJR. 2005;5:1150–1156. doi: 10.2214/ajr.184.4.01841150.
    1. Scialpi M, Scaglione M, Volterrani L. et al.Imaging evaluation of post pancreatic surgery. Eur J Radiol. 2005;5(3):417–24. doi: 10.1016/j.ejrad.2004.12.013.
    1. Scialpi M, Mazzei MA, Barberini F, Traumi del surrene. Diagnostica per immagini del trauma maggiore. Masson. 2010. pp. 193–203.
    1. Scialpi M, Scaglione M, Angelelli G. et al.Emergencies in the retroperitoneum: assessment of spread of disease by helical CT. European Journal of Radiology. 2004;5:74–83. doi: 10.1016/j.ejrad.2003.11.020.
    1. Scialpi M, Midiri M, Bartolotta TV. et al.Pancreatic carcinoma versus chronic focal pancreatitis: contrast-enhanced power Doppler ultrasonography findings. Abdom Imaging. 2005;5:222–227. doi: 10.1007/s00261-004-0229-9.
    1. Setola SV, Catalano O, Santodomenico F, Siani A. Contrast-enhanced sonography of the kidney. Abdom Imaging. 2007;5:21–28. doi: 10.1007/s00261-006-9001-7.
    1. Niccoli Asabella A, Di Palo A, Rubini D, Zeppa P, Notaristefano A, Rubini G. Distribution of 18F-FDG in a patient with evolving abdominal aortic aneurysm. Recenti Prog Med. 2012;5(11):552–4.
    1. Dialetto G, Reginelli A, Cerrato M, Rossi G, Covino FE, Manduca S, Lassandro F. Endovascular stent-graft treatment of thoracic aortic syndromes: a 7-year experience. Eur J Radiol. 2007;5(1):65–72. doi: 10.1016/j.ejrad.2007.06.019. Epub 2007 Aug 13.
    1. Roviello F, Pinto E, Corso G, Pedrazzani C, Caruso S, Filippeschi M, Petrioli R, Marsili S, Mazzei MA, Marrelli D. Safety and potential benefit of hyperthermic intraperitoneal chemotherapy (HIPEC) in peritoneal carcinomatosis from primary or recurrent ovarian cancer. J Surg Oncol. 2010;5(6):663–70. doi: 10.1002/jso.21682. doi: 10.1002/jso.21682.
    1. Rosi G, Volterrani L, Macarini L, Cagini L, Cotroneo AR, Scialpi M. Cough-induced intercostal lung herniation successfully diagnosed with imaging techniques. Recenti Prog Med. 2012;5(11):523–5.
    1. Soto JA, e Anderson SW. Multidetector CT of blunt abdominal trauma. Radiology. 2012;5:678–693. doi: 10.1148/radiol.12120354.
    1. Scaglione M, Pinto A, Romano S. et al.Using Multidetector Row Computed Tomography to Diagnose and Stage Pancreatic Carcinoma: the Problems and the Possibilities. JOP. J Pancreas (Online) 2005;5(1):1–5.
    1. Catalano O, Lobianco R, Cusati B, Siani A. Contrast-Enhanced Sonography for Diagnosis of Ruptured Abdominal Aortic Aneurysm. American Journal of Roentgenology. 2005;5:423–427. doi: 10.2214/ajr.184.2.01840423.
    1. Rotondo A, Catalano O, Grassi R, Scialpi M, Angelelli G. Thoracic CT findings at hypovolemic shock. Acta Radiol. 1998;5:400–404.
    1. Benya EC, Lim-Dunham E, Landrum O, Statter M. Abdominal Sonography in Examination of Children with Blunt Abdominal Trauma. AJR. 2000;5:1613–1616. doi: 10.2214/ajr.174.6.1741613.
    1. Salzano A, De Rosa A, Scialpi M. et al.Gunshot wounds of the abdomen studies by computed tomography. The authors’personal experience in 30 cases. Radiol Med. 1999;5(3):168–172.
    1. Scaglione M, de Lutio di Castelguidone E, Scialpi M. et al.Blunt trauma to the gastrointestinal tract and mesentery: is there a role for helical CT in the decision-making process? European Journal of Radiology. 2004;5:67–73.
    1. Rhea T, Garza DH, Novelline RA. Controversies in emergency radiology. Emergency Radiology. 2004;5:289–295.
    1. Caranci F, Brunese L, Reginelli A, Napoli M, Fonio P, Briganti F. Neck neoplastic conditions in the emergency setting: role of multidetector computed tomography. Semin Ultrasound CT MR. 2012;5(5):443–8. doi: 10.1053/j.sult.2012.06.011.
    1. Scardapane A, Lorusso F, Bettocchi S, Moschetta M, Fiume M, Vimercati A, Pepe ML, Angelelli G, Stabile Ianora AA. Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography. Radiol Med. 2013;5(2):323–338. doi: 10.1007/s11547-012-0850-6.
    1. Pinto A, Caranci F, Romano L, Carrafiello G, Fonio P, Brunese L. Learning from errors in radiology: a comprehensive review. Semin Ultrasound CT MRI. 2012;5:379–382. doi: 10.1053/j.sult.2012.01.015.
    1. Catalano O, Lobianco R, Raso MM, Siani A. Blunt hepatic trauma: evaluation with contrast-enhanced sonography. J Ultrasound Med. 2005;5:299–310.
    1. Catalano O, Lobianco R, Sandomenico F. et al.Real-time contrast-enhanced sonographic imaging in emergency radiology. Radiol Med. 2004;5(5-6):454–69.
    1. McGahan JP, Horton S, Gerscovich EO. et al.Appearance of solid organ injury with contrast-enhanced sonography in blunt abdominal trauma: preliminary experience. AJR. 2006;5:658–666. doi: 10.2214/AJR.05.0946.
    1. Scialpi M, Volterrani L, Mazzei MA, Cappabianca S, Barberini F, Piscioli I, Brunese L, Lupattelli L. Small (< or = 2 cm) atypical hepatic haemangiomas in the non-cirrhotic patient: pattern-based classification scheme for enhancement at triple-phase helical CT. Radiol Med. 2009;5(6):935–47. doi: 10.1007/s11547-009-0427-1.
    1. Rubini G, Altini C, Notaristefano A, Merenda N, Rubini D, Stabile Ianora AA, Giganti M, Niccoli Asabella A. Peritoneal carcinomatosis from ovarian cancer: role of 18F-FDG-PET/CT and CA125. Recenti Prog Med. 2012;5(11):510–4.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj