Role of Multidetector CT in Blunt Abdominal Trauma

Abstract

Background: Computed Tomographic (CT) evaluation of Abdomen has become the mainstay of management of all types of trauma to abdomen, in particularly blunt trauma abdomen. This change is mainly attributable to the ability of  CT scanning   to produce most detailed images of the areas of study or interest. CT can determine the source of hemorrhage. However CT is not that accurate in detecting all types of injuries for example, mesenteric injuries and small bowel injuries are sometimes detected surgically only and missed in CT imaging. Aims and Objectives: 1.To study with the aid of multi detector CT (MDCT), different traumatic pathologies of abdomen in blunt trauma. 2. To co-relate imaging findings with surgical findings or clinical data. 3. To evaluate the accuracy of CT in detecting various lesions by statistical analysis. Subjects and Methods: The study was conducted in the Department of Radiodiagnosis at A.J Institute of Medical Sciences and Research Center, Mangalore. Patients with history of Road Traffic Accidents, Fall, or assault or other causes where clinically blunt trauma of abdomen is suspected and referred for CT abdomen were studied using Multidetector CT (MDCT) A total of 56 patients with abdominal trauma who underwent Computed Tomography (CT) examination were included. CT findings were compared with surgical findings in 37 operated cases. Results: A total number of 56 cases were selected based on Ultrasound and Clinical inferences for CT evaluation. 37 cases underwent surgery and remaining were managed conservatively. On correlating with surgical findings MDCT has a sensitivity of 80% , specificity of 95% for detecting solid organ injury and the PPV and NPV were 97% and 70%respectively. Meanwhile for detection of Hollow Viscus Injury (HVI) sensitivity and specificity were75% and 96% respectively. Conclusion: MDCT is the gold standard for evaluation of blunt trauma abdomen. Prompt imaging in proper technique and expertise in reporting improves the detection rate and accuracy of all types of abdominal injuries associated with blunt trauma abdomen. While MDCT diagnosis of solid organ injury is highly accurate, the detection rate of hollow viscus injury and bladder injury is not optimal. Bladder injuries particularly extra-peritoneal type should be further analyzed by ascending urethrogram to confirm it as well as to rule out urethral injury.