Dual-Energy CT: A Paradigm Shift in Acute Traumatic Abdomen

2020 ◽  
Vol 71 (3) ◽  
pp. 371-387 ◽  
Author(s):  
Saira Hamid ◽  
Savvas Nicolaou ◽  
Faisal Khosa ◽  
Gordon Andrews ◽  
Nicolas Murray ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Abdominal Trauma ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Vascular Injuries ◽  
Intravenous Contrast ◽  
Penetrating Abdominal Trauma ◽  
Portable Ultrasound

Abdominal trauma, one of the leading causes of death under the age of 45, can be broadly classified into blunt and penetrating trauma, based on the mechanism of injury. Blunt abdominal trauma usually results from motor vehicle collisions, fall from heights, assaults, and sports and is more common than penetrating abdominal trauma, which is usually seen in firearm injuries and stab wounds. In both blunt and penetrating abdominal trauma, an optimized imaging approach is mandatory to exclude life-threatening injuries. Easy availability of the portable ultrasound in the emergency department and trauma bay makes it one of the most commonly used screening imaging modalities in the abdominal trauma, especially to exclude hemoperitoneum. Evaluation of the visceral and vascular injuries in a hemodynamically stable patient, however, warrants intravenous contrast-enhanced multidetector computed tomography scan. Dual-energy computed tomography with its postprocessing applications such as iodine selective imaging and virtual monoenergetic imaging can reliably depict the conspicuity of traumatic solid and hollow visceral and vascular injuries.

scholarly journals The role of computerized tomography in penetrating abdominal trauma

2018 ◽  
Vol 45 (1) ◽  
Author(s):  
EDUARDO LOPES MARTINS FILHO ◽  
MELISSA MELLO MAZEPA ◽  
CAMILA ROGINSKI GUETTER ◽  
SILVÂNIA KLUG PIMENTEL
Keyword(s):  
Computed Tomography ◽  
Negative Predictive Value ◽  
Abdominal Trauma ◽  
Predictive Value ◽  
Penetrating Trauma ◽  
Nonoperative Treatment ◽  
Historical Cohort ◽  
Penetrating Abdominal Trauma ◽  
Late Postoperative Period

ABSTRACT Objective: to evaluate the role of abdominal computed tomography in the management of penetrating abdominal trauma. Methods: we conducted a historical cohort study of patients treated for penetrating trauma in the anterior abdomen, dorsum or thoracoabdominal transition, that were submitted to a computed tomography carried out on admission. We evaluated the location of the wound and the presence of tomographic findings, and the management of these patients as for nonoperative treatment or laparotomy. We calculated the sensitivity and specificity of computed tomography according to the evolution of the nonoperative treatment or the surgical findings. Results: we selected 61 patients, 31 with trauma to the anterior abdomen and 30 to the dorsum or thoracoabdominal transition. The mortality rate was 6.5% (n=4), all in the late postoperative period. Eleven patients with trauma to the anterior abdomen were submitted to nonoperative treatment, and 20, to laparotomy. Of the 30 patients with trauma to the dorsum or thoracoabdominal transition, 23 underwent nonoperative treatment and seven, laparotomy. There were three nonoperative treatment failures. In penetrating trauma of the anterior abdomen, the sensitivity of computed tomography was 94.1% and the negative predictive value was 93.3%. In dorsal or thoracoabdominal transition lesions, the sensitivity was 90% and the negative predictive value was 95.5%. In both groups, the specificity and the positive predictive value were 100%. Conclusion: the accuracy of computed tomography was adequate to guide the management of stable patients who could be treated conservatively, avoiding mandatory surgery in 34 patients and reducing the morbidity and mortality of non-therapeutic laparotomies.

A CLINICAL STUDY OF PENETRATING ABDOMINAL TRAUMA WITH SPECIAL REFERENCE TO ITS MANAGEMENT : AN INDIAN SCENARIO

2021 ◽  
pp. 1-3
Author(s):  
Saumya Singh ◽  
Anindya Halder ◽  
Niru Das
Keyword(s):  
Data Collection ◽  
Hospital Stay ◽  
Abdominal Trauma ◽  
Surgical Techniques ◽  
Penetrating Trauma ◽  
Diagnostic Methods ◽  
Gunshot Injury ◽  
Abdominal Injuries ◽  
Average Hospital ◽  
Penetrating Abdominal Trauma

Introduction: The incidence of penetrating abdominal injuries has been on the rise. The common availability of rearms, the lack of proper law, armed conicts, civil violence and road trafc accidents are the major causes of penetrating abdominal injuries. As patient with penetrating abdominal trauma are at risk of harbouring life threatening injuries, early diagnosis and timely intervention is the most important steps to reduce its morbidity as well as mortality. Recently due to improvement of the present healthcare system, the outcome of these injuries is improving. Materials And Methods: A descriptive observational study was carried out on 60 cases of penetrating abdominal injuries. A predesigned pretested schedule was used for data collection. Interview of the study subject and evaluation of all clinical reports was done to obtain the history, clinical ndings, management, complications, mortality and follow up. Before data collection, informed consent was obtained from each and every study subjects. Results: The overall incidence of penetrating abdominal trauma was found to be 2.30% of the total admission of 6217 patients in the department of surgery. The most common cause of penetrating abdominal injury found in this study is stab injury by sharp objects which is followed by gunshot injury. The commonest age group affected was 20 to 30 years which comprises about 41.67%. In this study we found a male preponderance in cases of penetrating injury to the abdomen. In most of the cases the mode is homicidal stab or gunshot injury followed by accidental injuries. Pain, abdominal distension and bleeding from the wound are the main presenting symptom. After initial evaluation with USG (FAST),CTscan abdomen is the most valuable investigation so far. In this series, it is found that the small intestine is the most commonly involved viscera followed by colon, omentum, mesentery and liver respectively. Most common complications after operative intervention was wound infection. The average hospital stay was 6 to 15 days. It has been observed that the post-operative complications, associated injuries and multiple organ injuries are the cause of increased hospital stay. Conclusion: Penetrating trauma can be serious because it can damage internal organs and presents a risk of shock and infection. In the present year, due to overall improvement in the communication and transportation, better monitoring systems and resuscitative measures, improvised diagnostic methods, better availability of blood and blood products, better medications and more skilful surgical techniques, the outcomes of these injuries are improving.

Advanced Computed Tomography Techniques: Overview of Dual-Energy CT

2017 ◽  
Vol 16 (02) ◽  
pp. 061-071
Author(s):  
Reza Forghani
Keyword(s):  
Computed Tomography ◽  
Head And Neck ◽  
Material Characterization ◽  
Dual Energy ◽  
Energy Spectra ◽  
Dual Energy Ct ◽  
Tissue Analysis ◽  
Organ Systems ◽  
Head And Neck Imaging ◽  
Potential Applications

AbstractDual-energy computed tomography (DECT) is an advanced form of computed tomography (CT), in which image acquisition is performed at two different energy spectra, instead of a single-energy spectrum using conventional single-energy CT (SECT). This enables the creation of different reconstructions and quantitative spectral tissue analysis beyond what is possible with SECT. In adults, there are increasing clinical applications of DECT for all organ systems, including neuroimaging and head and neck imaging. However, there are relatively few studies evaluating applications of DECT for pediatric imaging and little to none in neuroimaging or head and neck imaging. The purpose of this article is to provide an overview and familiarize the readers with DECT. This article will review the fundamental principles behind DECT, including different DECT acquisition systems and principles of DECT material characterization. This will be followed by a review of potential applications of DECT, many based on imaging the head and neck. The objectives are to familiarize the readers with this exciting technology and hopefully serve as a primer for investigations and applications of DECT for pediatric neuro and head and neck imaging.

Local Differences in Mineral Content in Vertebral Trabecular Bone Measured by Dual-Energy Computed Tomography

1989 ◽  
Vol 30 (4) ◽  
pp. 369-371 ◽  
Author(s):  
J. Nepper-Rasmussen ◽  
L. Mosekilde
Keyword(s):  
Computed Tomography ◽  
Central Region ◽  
Mineral Content ◽  
Anterior Part ◽  
Posterior Part ◽  
Region Of Interest ◽  
Calcium Content ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Vertebral Bodies

Twelve lumbar vertebral bodies from cadavers were examined with dual-energy CT, to measure the calcium content in a big central region of interest (ROI). In each of five vertebrae the calcium content was also measured in six small ROI. After completed scanning, six small cylinders were drilled out from each vertebra, and the ash-density of each cylinder was measured. The dual-energy CT measurements correlated well with the ash-density. Both ash-density and dual-energy CT showed a significantly higher mineral content in the posterior part of the vertebrae than in the anterior part, and this difference might be responsible for problems encountered with the reproducibility of dual-energy CT.

scholarly journals Utility of single-energy and dual-energy computed tomography in clot characterization: An in-vitro study

2017 ◽  
Vol 23 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Waleed Brinjikji ◽  
Gregory Michalak ◽  
Ramanathan Kadirvel ◽  
Daying Dai ◽  
Michael Gilvarry ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Area Under The Curve ◽  
In Vitro Study ◽  
Dual Energy ◽  
Dual Energy Ct

Background and purpose Because computed tomography (CT) is the most commonly used imaging modality for the evaluation of acute ischemic stroke patients, developing CT-based techniques for improving clot characterization could prove useful. The purpose of this in-vitro study was to determine which single-energy or dual-energy CT techniques provided optimum discrimination between red blood cell (RBC) and fibrin-rich clots. Materials and methods Seven clot types with varying fibrin and RBC densities were made (90% RBC, 99% RBC, 63% RBC, 36% RBC, 18% RBC and 0% RBC with high and low fibrin density) and their composition was verified histologically. Ten of each clot type were created and scanned with a second generation dual source scanner using three single (80 kV, 100 kV, 120 kV) and two dual-energy protocols (80/Sn 140 kV and 100/Sn 140 kV). A region of interest (ROI) was placed over each clot and mean attenuation was measured. Receiver operating characteristic curves were calculated at each energy level to determine the accuracy at differentiating RBC-rich clots from fibrin-rich clots. Results Clot attenuation increased with RBC content at all energy levels. Single-energy at 80 kV and 120 kV and dual-energy 80/Sn 140 kV protocols allowed for distinguishing between all clot types, with the exception of 36% RBC and 18% RBC. On receiver operating characteristic curve analysis, the 80/Sn 140 kV dual-energy protocol had the highest area under the curve for distinguishing between fibrin-rich and RBC-rich clots (area under the curve 0.99). Conclusions Dual-energy CT with 80/Sn 140 kV had the highest accuracy for differentiating RBC-rich and fibrin-rich in-vitro thrombi. Further studies are needed to study the utility of non-contrast dual-energy CT in thrombus characterization in acute ischemic stroke.

scholarly journals A simulation study on proton computed tomography (CT) stopping power accuracy using dual energy CT scans as benchmark

2015 ◽  
Vol 54 (9) ◽  
pp. 1638-1642 ◽  
Author(s):  
David C. Hansen ◽  
Joao Seco ◽  
Thomas Sangild Sørensen ◽  
Jørgen Breede Baltzer Petersen ◽  
Joachim E. Wildberger ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Simulation Study ◽  
Dual Energy ◽  
Stopping Power ◽  
Ct Scans ◽  
Dual Energy Ct ◽  
Proton Computed Tomography

scholarly journals Dual-Energy Computed Tomography Lung in patients of Pulmonary Tuberculosis

2020 ◽  
Vol 10 ◽  
pp. 39
Author(s):  
Ahmad Umar Khan ◽  
Sachin Khanduri ◽  
Zikra Tarin ◽  
Syed Zain Abbas ◽  
Mushahid Husain ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Imaging Techniques ◽  
Ground Glass Opacity ◽  
Signs And Symptoms ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
High Resolution Computed Tomography ◽  
Cross Sectional ◽  
Pulmonary Tb

Objectives: The objective of this study was to characterize findings of high-resolution computed tomography (HRCT) and dual-energy CT (DECT) (80 keV, 140 keV, and mixed) in pulmonary tuberculosis (TB) patients and to compare and correlate HRCT and DECT findings. Material and Methods: This cross-sectional study was conducted on 67 patients of 18–65 years of age who were suspected cases of pulmonary TB with signs and symptoms of cough, fever, hemoptysis, sputum, night sweats, and weight loss with positive sputum AFB examinations/bronchoalveolar lavage. All the patients subjected to HRCT scan and followed with DECT scan. Comparison of various imaging techniques (DECT 80 keV, DECT 140 keV, and DECT mixed) with HRCT was done for detecting lung findings and data so obtained were subjected to statistical analysis. Results: On comparing the various imaging techniques with HRCT for detecting consolidation, tree in bud pattern, cavitary lesions, ground-glass opacity, bronchiectasis, atelectasis, nodules, granuloma, peribronchial thickening, and fibrosis, the maximum agreement of HRCT was found with DECT 80 keV and minimum agreement was found with DECT 140 keV. Conclusion: The study concluded that DECT 80 keV monochromatic reconstructions among 80 keV, mixed, and 140 keV monochromatic reconstructions in lung parenchyma window settings are a faster and better analytical tool for the assessment of findings of pulmonary TB when compared with HRCT.

scholarly journals Laparoscopy and Penetrating Abdominal Trauma: A Systematic Review

2019 ◽  
Vol 4 (7) ◽  
pp. 217-231
Author(s):  
Bráulio Filgueira Magalhães ◽  
Pedro De Sousa Leite ◽  
Pedro Hugo Bezerra Maia Filho ◽  
George Wallisson Severo de Sá ◽  
Whallyson Pinheiro Mascarenhas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Abdominal Trauma ◽  
Retrieval System ◽  
Penetrating Trauma ◽  
Laparoscopic Approach ◽  
Final Analysis ◽  
Penetrating Abdominal Trauma ◽  
Penetrating Wound ◽  
Definition Of

This article aims to evaluate the effectiveness and use of laparoscopy in penetrating abdominal trauma, thus providing a better definition of the role of laparoscopic approach in patients with PAD.  A systematic review was performed by searching indexed articles in the Virtual Health Library and the Medical Literature Analysis and Retrieval System Online database (MEDLINE / PubMed), in which analysis after final analysis included 07 articles.  In this study we identified seven articles that evaluated the use and contributions of the laparoscopic approach in patients with TAP, in which it was identified that the use as a diagnostic approach is widely used due to its benefits and safety.  Regarding its therapeutic approach it was determined that in the largest of the studies there is indication, usefulness, reliability and accuracy of its use, however, for better results is essential experience of the surgical team in laparoscopic technique.Keywords: Abdominal trauma;  Laparoscopy and Penetrating Trauma;  Abdominal injury;  Laparoscopy;  Penetrating wound.

scholarly journals Role of Diagnostic Laparoscopy in Penetrating Abdominal Trauma

2021 ◽  
Vol 15 (10) ◽  
pp. 3514-3516
Author(s):  
Fatima Abbasi ◽  
Muhammad Khurram Zia ◽  
Farhan Siddique ◽  
Ali Adnan ◽  
Hina Tahseen
Keyword(s):  
Abdominal Trauma ◽  
Diagnostic Laparoscopy ◽  
Bowel Perforation ◽  
Penetrating Trauma ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Missed Injury ◽  
Operative Findings ◽  
Intraabdominal Injury

Background and Objective: Trauma remains the major cause of mortality and disability among young people across the world with penetrating trauma being a very common cause. Traditionally, penetrating abdominal trauma was managed with exploration. But now with the advent of minimally access surgery and advancements in laparoscopic expertise, more patients can be managed with minimally invasive methods. This approach can save many unnecessary laparotomies and large midline incisions. The role of laparoscopy in blunt abdominal trauma is well established. The aim of this study was to evaluate the role of diagnostic laparoscopy in penetrating abdominal injuries. Methods: All the penetrating abdominal trauma patients presenting to the emergency department of Rawal Medical and Dental hospital from January 2019 till December 2020 for a period of 2years (a total of 102 patients) and who were hemodynamically stable, between the ages of 20 to 50 years of either gender were included in the study. All these patients had equivocal abdominal findings with no signs to suggest serious intraabdominal injury. These patients were prepared as standard for general anesthesia and diagnostic laparoscopy was performed. A predesigned performa was used for entering the patients’ details and operative findings. All patients gave written informed consent in urdu. Main outcome measures were the conversion rate, missed injuries leading to reexploration. Results: 85%of the patients were males with only 15% females. Mean age of the population was 38.7 years .Conversion to open was required in only 6.12 % of the cases .Laparoscopy alone was sufficient for all other patients. In about 36% of the patients no intraabdominal injury was found. In rest 58% patients the surgeons were able to repair the injuries laparoscopically.18 patients had minor liver injury,10 patients had minor hemoperitoneum<100 ml without any significant injury and 2 patients had single small bowel perforation which was repaired laparoscopically and cavity was irrigated. No patient had post operative complications of peritonitis due to missed injury or bleeding leading to re exploration. Conclusion: Laparoscopy is a very effective procedure to deal with penetrating abdominal trauma patients who are stable and with equivocal abdominal findings without increasing risk of missed injury with minimal rates of conversion to open laparotomy if patients are selected vigilantly. Keywords: Penetrating, Diagnostic Laparoscopy, Abdominal Trauma

Iodine concentration of healthy lymph nodes of neck, axilla, and groin in dual-energy computed tomography

2020 ◽  
Vol 61 (11) ◽  
pp. 1505-1511 ◽  
Author(s):  
Andreas P Sauter ◽  
Sophie Ostmeier ◽  
Jonathan Nadjiri ◽  
Dominik Deniffel ◽  
Ernst J Rummeny ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lymph Nodes ◽  
Iodine Concentration ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Imaging Data ◽  
Mean Values ◽  
Portal Venous Phase ◽  
Morphological Criteria ◽  
Standard Values

Background Lymph nodes (LN) are examined in every computed tomography (CT) scan. Until now, an evaluation is only possible based on morphological criteria. With dual-energy CT (DECT) systems, iodine concentration (IC) can be measured which could conduct in an improved diagnostic evaluation of LNs. Purpose To define standard values for IC of cervical, axillary, and inguinal LNs in DECT. Material and Methods Imaging data of 297 patients who received a DECT scan of the neck, thorax, abdomen–pelvis, or a combination of those in a portal-venous phase were retrospectively collected from the institutional PACS. No present history of malignancy, inflammation, or trauma in the examined region was present. For each examined region, the data of 99 patients were used. The IC of the three largest LNs, the main artery, the main vein, and a local muscle of the examined area was measured, respectively. Results Normalization of the IC of LNs to the artery, vein, muscle, or a combination of those did not lead to a decreased value-range. The smallest range and confidence interval (CI) of IC was found when using absolute values of IC for each region. Hereby, mean values (95% CI) for IC of LN were found: 2.09 mg/mL (2.00–2.18 mg/mL) for neck, 1.24 mg/mL (1.16–1.33 mg/mL) for axilla, and 1.11 mg/mL (1.04–1.17 mg/mL) for groin. Conclusion The present study suggests standard values for IC of LNs in dual-layer CT could be used to differentiate between healthy and pathological lymph nodes, considering the used contrast injection protocol.

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