SpringerLink
Log in

Stellenwert der Multidetektor-CT bei Polytrauma

Importance of multidetector CT imaging in multiple trauma

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Klinisches/methodisches Problem

Die Diagnostik komplexer Mehrfachverletzungen ist eine Herausforderung für die moderne radiologische Notfalldiagnostik. Eine umfassend angelegte, frühe und präzise radiologische Diagnostik ist entscheidend für eine prioritätenorientierte und zeitnahe Therapie mit dem Ziel, potenziell lebensbedrohliche Verletzungen frühzeitig zu erkennen und adäquat zu behandeln.

Radiologische Standardverfahren

Die Basisdiagnostik triagiert zur Sofortoperation und besteht unverändert aus einer fokussierten Ultraschalluntersuchung (Focused Assessment with Sonography for Trauma, FAST) und Projektionsradiographie (CR), meist limitiert auf eine einzelne Thoraxaufnahme.

Methodische Innovationen

Die Multidetektor-CT (MDCT) hat sich als standardisierte frühe Ganzkörper-CT („whole-body“, WBCT) etabliert; die Detektionsrate von Verletzungen ist herausragend und die Überlebenswahrscheinlichkeit verbessert sich um 20–25 %. Die räumliche und zeitliche Auflösung wurde verbessert und die Untersuchungszeit erheblich verkürzt. Die Dosisexposition ist auch bei einmaliger Akutanwendung nicht unerheblich, durch moderne Scannertechnologie und Dosisreduktion, einschließlich der iterativen Bildrekonstruktion, konnte eine Dosisreduktion von bis zu 40 % erreicht werden. Die zahlreichen Bilder der WBCT müssen prioritätenorientiert hergestellt, befundet und archiviert werden, zur schnellen Diagnostik bietet sich das „volume image reading“ (VIR) an.

Bewertung/Schlussfolgerung

Die moderne WBCT wir bei Polytrauma früh, umfassend und individuell adaptiert durchgeführt, dabei verbessert die WBCT die Überlebenswahrscheinlichkeit um 20–25 %.

Abstract

Clinical/methodical issue

Diagnostic imaging of complex multiple trauma remains a challenge for any department providing modern emergency radiology (ER) service. An early and comprehensive approach for ER imaging is crucial for a priority-oriented and timely therapy concept with the aim of identifying potentially life-threatening injuries early and initiating appropriate treatment.

Standard radiological methods

The basic diagnostic approach still consists of focused ultrasound using focused assessment with sonography for trauma (FAST) and conventional radiography (CR), usually limited to a single supine chest x-ray for triaging patients undergoing immediate operations.

Methodical innovations

Multidetector computed tomography (MDCT) has become established as early whole body CT (WBCT) as the undisputable diagnostic method. The detection rate of injuries by WBCT is outstanding and it improves the probability of survival by 20–25 % compared with all other previous methods. At the same time, the spatial and temporal resolution of MDCT was improved resulting in considerably shortened examination times but WBCT is still associated with a significant radiation exposure, even in the acute single use setting. Using modern scanner and dose reduction technology, including iterative reconstruction, a dose reduction of up to 40 % could be achieved. The substantial number of images in WBCT is another challenge; images must be processed priority-oriented, read and transferred to the picture archiving and communications system (PACS). For rapid diagnosis, volume image reading (VIR) offers additional options to keep the diagnostic process on time.

Achievements/practical recommendations

Modern WBCT after multiple trauma is performed early, comprehensively and personalized so that WBCT improves the probability of survival by 20–25 %.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Thailand)

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Anderson SW, Varghese JC, Lucey BC et al (2007) Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients. Radiology 243:88–95

    Article  PubMed  Google Scholar 

  2. Baker SP, O’Neill B, Haddon W Jr et al (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196

    Article  PubMed  CAS  Google Scholar 

  3. Boscak AR, Shanmuganathan K, Mirvis SE et al (2013) Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 268:79–88

    Article  PubMed  Google Scholar 

  4. Statistisches Bundesamt (2012) Todesursachenstatistik. Statistisches Bundesamt Fachserie 12. https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Todesursachen

  5. Foster BR, Anderson SW, Uyeda JW et al (2011) Integration of 64-detector lower extremity CT angiography into whole-body trauma imaging: feasibility and early experience. Radiology 261:787–795

    Article  PubMed  Google Scholar 

  6. Geyer LL, Koerner M, Wirth S et al (2013) Polytrauma: optimal imaging and evaluation algorithm. Semin Musculoskelet Radiol 17:371–379

    Article  PubMed  Google Scholar 

  7. Geyer LL, Korner M, Hempel R et al (2013) Evaluation of a dedicated MDCT protocol using iterative image reconstruction after cervical spine trauma. Clin Radiol 68:e391–e396

    Article  PubMed  CAS  Google Scholar 

  8. Geyer LL, Korner M, Linsenmaier U et al (2013) Incidence of delayed and missed diagnoses in whole-body multidetector CT in patients with multiple injuries after trauma. Acta Radiol 54:592–598

    PubMed  Google Scholar 

  9. Harrieder A, Geyer LL, Korner M et al (2012) Evaluation of radiation dose in 64-row whole-body CT of multiple injured patients compared to 4-row CT. Rofo 184:443–449

    Article  PubMed  CAS  Google Scholar 

  10. Holmes JF, Akkinepalli R (2005) Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma 58:902–905

    Article  PubMed  Google Scholar 

  11. Holmes JF, Offerman SR, Chang CH et al (2004) Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries. Ann Emerg Med 43:120–128

    Article  PubMed  Google Scholar 

  12. Huber-Wagner S, Lefering R, Qvick LM et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461

    Article  PubMed  Google Scholar 

  13. Kanz KG, Linsenmaier U, Pfeifer KJ et al (2002) Standardized evaluation of trauma patients: requirements for diagnostic imaging. Radiologe 42:515–521

    Article  PubMed  CAS  Google Scholar 

  14. Kanz KG, Paul AO, Lefering R et al (2010) Trauma management incorporating focused assessment with computed tomography in trauma (FACTT) – potential effect on survival. J Trauma Manag Outcomes 4:4

    Article  PubMed  PubMed Central  Google Scholar 

  15. Korner M, Geyer LL, Wirth S et al (2011) Analysis of responses of radiology personnel to a simulated mass casualty incident after the implementation of an automated alarm system in hospital emergency planning. Emerg Radiol 18:119–126

    Article  PubMed  Google Scholar 

  16. Korner M, Geyer LL, Wirth S et al (2011) 64-MDCT in mass casualty incidents: volume image reading boosts radiological workflow. AJR Am J Roentgenol 197:W399–W404

    Article  PubMed  Google Scholar 

  17. Korner M, Krotz M, Kanz KG et al (2006) Development of an accelerated MSCT protocol (triage MSCT) for mass casualty incidents: comparison to MSCT for single-trauma patients. Emerg Radiol 12:203–209

    Article  PubMed  CAS  Google Scholar 

  18. Korner M, Krotz MM, Degenhart C et al (2008) Current role of emergency US in patients with major trauma. Radiographics 28:225–242

    Article  PubMed  Google Scholar 

  19. Korner M, Krotz MM, Wirth S et al (2009) Evaluation of a CT triage protocol for mass casualty incidents: results from two large-scale exercises. Eur Radiol 19:1867–1874

    Article  PubMed  Google Scholar 

  20. Korner M, Reiser M, Linsenmaier U (2009) Imaging of trauma with multi-detector computed tomography. Radiologe 49:510–515

    Article  PubMed  CAS  Google Scholar 

  21. Krotz M, Bode PJ, Hauser H et al (2002) Interdisciplinary shock room management: personnel, equipment and spatial logistics in 3 trauma centers in Europe. Radiologe 42:522–532

    Article  PubMed  CAS  Google Scholar 

  22. Larson DB, Johnson LW, Schnell BM et al (2011) National trends in CT use in the emergency department: 1995–2007. Radiology 258:164–173

    Article  PubMed  Google Scholar 

  23. Linsenmaier U, Kanz KG, Mutschler W et al (2001) Radiological diagnosis in polytrauma: interdisciplinary management. Rofo 173:485–493

    Article  PubMed  CAS  Google Scholar 

  24. Linsenmaier U, Kanz KG, Rieger J et al (2002) Structured radiologic diagnosis in polytrauma. Radiologe 42:533–540

    Article  PubMed  CAS  Google Scholar 

  25. Linsenmaier U, Krotz M, Hauser H et al (2002) Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740

    Article  PubMed  Google Scholar 

  26. Linsenmaier U, Reiser M (2009) Multislice computed tomography in emergency radiology. Radiologe 49:479–480

    Article  PubMed  CAS  Google Scholar 

  27. Scaglione M, Linsenmaier U, Schueller G (2012) Emergency radiology of the abdomen. Springer, Berlin Heidelberg New York

  28. Reiser MF, Becker CR, Nikolaou K, Glazer G (2010) Multislice CT. Springer, Berlin Heidelberg New York

  29. Mutschler W, Kanz KG (2002) Interdisciplinary shock room management: responsibilities of the radiologist from the trauma surgery viewpoint. Radiologe 42:506–514

    Article  PubMed  CAS  Google Scholar 

  30. Ringl H, Stiassny F, Schima W et al (2013) Intracranial hematomas at a glance: advanced visualization for fast and easy detection. Radiology 267:522–530

    Article  PubMed  Google Scholar 

  31. Scaglione M, Pinto A, Pedrosa I et al (2008) Multi-detector row computed tomography and blunt chest trauma. Eur J Radiol 65:377–388

    Article  PubMed  Google Scholar 

  32. Shanmuganathan K, Mirvis SE, Chiu WC et al (2004) Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury – a prospective study in 200 patients. Radiology 231:775–784

    Article  PubMed  CAS  Google Scholar 

  33. Sliker CW, Mirvis SE (2007) Imaging of blunt cerebrovascular injuries. Eur J Radiol 64:3–14

    Article  PubMed  Google Scholar 

  34. Sliker CW, Shanmuganathan K, Mirvis SE (2008) Diagnosis of blunt cerebrovascular injuries with 16-MDCT: accuracy of whole-body MDCT compared with neck MDCT angiography. AJR Am J Roentgenol 190:790–799

    Article  PubMed  Google Scholar 

  35. Stuhlfaut JW, Anderson SW, Soto JA (2007) Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel, and mesenteric injury. Semin Ultrasound CT MR 28:115–129

    Article  PubMed  Google Scholar 

  36. Traub M, Stevenson M, McEvoy S et al (2007) The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury 38:43–47

    Article  PubMed  Google Scholar 

  37. Tscherne H, Regel G, Sturm JA et al (1987) Degree of severity and priorities in multiple injuries. Chirurg 58:631–640

    PubMed  CAS  Google Scholar 

  38. Vogel T, Ockert B, Krotz M et al (2008) Progredient intracranial bleeding after traumatic brain injury. When is a control CCT necessary? Unfallchirurg 111:898–904

    Article  PubMed  CAS  Google Scholar 

  39. Wei SC, Ulmer S, Lev MH et al (2010) Value of coronal reformations in the CT evaluation of acute head trauma. AJNR Am J Neuroradiol 31:334–339

    Article  PubMed  CAS  Google Scholar 

  40. Wirth S, Korner M, Treitl M et al (2009) Computed tomography during cardiopulmonary resuscitation using automated chest compression devices – an initial study. Eur Radiol 19:1857–1866

    Article  PubMed  Google Scholar 

  41. Yaniv G, Portnoy O, Simon D et al (2013) Revised protocol for whole-body CT for multi-trauma patients applying triphasic injection followed by a single-pass scan on a 64-MDCT. Clin Radiol 68:668–675

    Article  PubMed  CAS  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Linsenmaier, L.L Geyer, M. Körner, M. Reiser, S. Wirth geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Institut für Diagnostische und Interventionelle Radiologie, HELIOS Kliniken München West, HELIOS Klinik München Perlach, Steinerweg 5, 81241, München, Deutschland

    U. Linsenmaier

  2. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität, München, Deutschland

    L.L. Geyer, M. Reiser & S. Wirth

  3. Radiologie Mühleninsel, Landshut, Deutschland

    M. Körner

Authors
  1. U. Linsenmaier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L.L. Geyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Körner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Wirth
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. Linsenmaier.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Linsenmaier, U., Geyer, L., Körner, M. et al. Stellenwert der Multidetektor-CT bei Polytrauma. Radiologe 54, 861–871 (2014). https://doi.org/10.1007/s00117-013-2634-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-013-2634-y

Schlüsselwörter

Keywords

Search

Navigation