COMPUTED TOMOGRAPHY IN DIAGNOSTICS AND TREATMENT DECISIONS CONCERNING MULTIPLE TRAUMA AND CRITICALLY ILL PATIENTS, ACTA UNIVERSITATIS OULUENSIS D Medica 1048

Technical improvements in computed tomography (CT) scanners have provided new possibilities to\nexploit the resources of this imaging modality in the evaluation of patients with multiple injuries or\npatients being treated in an intensive care unit (ICU). The purpose of this study was to assess the\nsignificance of multi-detector computed tomography (MDCT) in diagnostics and treatment\ndecisions concerning multiple trauma and critically ill patients.\nFindings of MDCT using a dedicated trauma protocol in 133 patients exposed to high-energy\nblunt trauma were retrospectively evaluated. Diagnostic information about the injuries that would\nenable planning of treatment was sought. The imaging protocol consisted of axial scanning of the\nhead and helical scanning of the facial bones, cervical spine, thorax, abdomen, and pelvis. Ninetynine\nof the patients (74%) had at least one finding consistent with trauma. Nineteen false negative\nfindings and two false positive findings were made. The overall sensitivity of MDCT was 94%,\nspecificity 100%, and accuracy 97%.\nThe reliability of a structured 5-min evaluation of MDCT images from the scanner’s console was\nprospectively evaluated in 40 high-energy trauma patients. The dedicated trauma protocol covering\nthe thorax, abdomen, and pelvis was used in MDCT scanning. The findings were compared with the\nfinal radiological diagnosis of the MDCT data made on a picture archiving and communicating\nsystem (PACS) workstation, the operative findings, and the clinical follow-up. The evaluation from\nthe scanner’s console enabled diagnosis of all potentially life-threatening injuries, the sensitivity for\nall injuries being 60% and specificity 98%.\nThe effects of MDCT on the treatment of patients in a 12-bed medical-surgical ICU were\nobserved prospectively. Sixty-four patients with an ICU stay longer than 48 h had had inconclusive\nfindings with other modalities of radiological imaging. They underwent altogether 82 MDCT\nexaminations. Fifty examinations (61%) resulted in a change in treatment, and 20 (24%) of them\notherwise contributed to or supported clinical decision-making. Twelve examinations (15%) failed\nto provide any additional information relevant to the patient’s treatment. MDCT examination was\nhelpful in general ICU patients, with inconclusive findings with other imaging modalities.\nCT images of 127 mixed medical-surgical ICU patients were retrospectively reviewed for the\npreviously determined findings. Forty-three of these patients underwent open cholecystectomy,\nrevealing eight cases with a normal gallbladder (GB), 26 with an edematous GB, and nine with\nnecrotic acute acalculous cholecystitis (AAC). Abnormal CT findings were present in 96% of all the\nICU patients. Higher bile density in the GB body and subserosal edema were associated with an\nedematous GB. The most specific findings predicting necrotic AAC were gas in the GB wall or\nlumen, lack of GB wall enhancement, and edema around the GB. The frequent prevalence of\nnonspecific abnormal imaging findings in the GB of ICU patients limits the diagnostic value of CT\nscanning.

ISBN-10:
978-951-42-6148-0
Kieli:
eng.
Sivumäärä:
142 s.
Tekijät:
Ahvenjärvi Lauri
Tuotekoodi 013957
20,00 €