Martin Mack MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: To evaluate the potential of a standardized MDCT protocol for the initial diagnostic work up of patients with severe multiple injuries. Methods and Materials: 485 patients (329 male, 156 female, mean age 39,8 years, median age 35.8 years) with severe multiple injuries were examined between January 2002 and February 2003. The diagnostic work-up was done with a standardized CT protocol using a 4- or 16 row MDCT (Somatom Volume Zoom or Sensation 16, Siemens, Erlangen). Routine work up included a non contrast standard CT scan of the brain and a spiral CT-scan of the cervical spine using a 4 x 1 mm collimation or a 16 x 0.75 mm collimation (reconstruction in bony and soft tissue window with 1.2 mm slice thickness and 0.7 mm increment). The data set of the cervical spine was also used for MPR reconstruction of the bony structures of the face. After administration of 120 ml of contrast medium (delay 85 seconds) one spiral CT scan of the thorax and abdomen was performed using the 4 x 2.5 mm collimation at the Volume zoom scanner or the 16 x 1.5 mm collimation at the Sensation 16. Reconstruction were done in soft tissue window (5 mm slice thickness, 5 mm increment), lung window (5 mm slice thickness, 5 mm increment) and bony window (3 mm slice thickness, 1.5 mm increment). MPR reconstruction were done routinely for the assessment of the cervical, thoracic and lumbar spine. Results: The above mentioned MDCT protocol could be performed in all cases. 11.5% were injured during work, 8.8% during leisure-time activity, 7.8 % were injured as a result of violence, 9.7% had a motor bile accident, 15.7% were injured due a fall, 4.6% were injured due to a suicide, 38.7 were injured by a car accident, and in 3.2% the reason for injury was unknown. MPR reconstruction of the cervical, thoracic and lumbar spine is essential in evaluating slight impression fractures or intervertebral disc fractures. Contrast enhanced scans are mandatory to evaluate injuries of the vessels and solid organs as liver, spleen, kidneys, and pancreas. The high incidence of additional findings beside the clinically obvious injuries in patients with multiple injuries limited CT scans cannot be recommended. The Injury Severity Score (ISS) was as follows: <9 in 16%, 9-16 in 14%, 16-25 in 8%, 25-41 in 13%, 41-75 in 5%. The initial ISS score couldn't be assessed in 44% of the cases. Conclusion: A standardized protocol for MDCT is extremely helpful in the diagnostic work-up of patients with severe multiple injuries and should be routinely be performed in all cases.       Questions about this event email: M.Mack@em.uni-frankfurt.de

Mack MD, M, Experience with a Standardized Multidetector CT (MDCT) Protocol for the Evaluation of Patients with Severe Multiple Injuries: Experience in 485 Cases.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3107563.html