Contrast-enhanced ultrasound versus MS-CT in blunt abdominal trauma

Issue title: Selected Proceedings of the 14th European Conference for Clinical Hemorheology and Microcirculation, Dresden, Germany, June 27–30, 2007

Article type: Research Article

Authors: Clevert, D.-A.^; | Weckbach, S.^; | Minaifar, N. | Clevert, D.-A. | Stickel, M. | Reiser, M.

Affiliations: Department of Clinical Radiology, University Hospitals – Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany | Medical Clinic for Nephrology and Internal Intensive Care, Charité – Universitätsmedizin Berlin, Berlin, Germany | Department of Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany

Note: [] Corresponding author: Dr. Dirk-André Clevert, Department of Clinical Radiology, University of Munich – Grosshadern Campus, Marchioninistr. 15, 81377 Munich, Germany. Tel.: +49 89 7095 3620; Fax: +49 89 7095 8832; E-mail: Dirk.Clevert@ med.uni-muenchen.de.

Note: [] D.-A. Clevert and S. Weckbach contributed in equal parts to the manuscript.

Abstract: To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) in the diagnosis and characterization of hepatic, renal and splenic traumatic injuries versus conventional ultrasound (US) and multislice computed tomography (MS-CT). Between January 2005 and January 2007, 78 patients (48 males, 30 females, mean age 56 years) with blunt abdominal trauma were examined by conventional US, CEUS and MS-CT. CEUS employed a low-MI technique using 1.2 to 2.4 ml of SonoVue (Bracco, Italy) i.v. and a multifrequency transducer (2–4 MHz, Siemens, Sequoia, Acuson). CT examinations were performed on a 64 detector CT scanner (Somatom Sensation 16 or 64, Siemens Medical Systems, Forchheim, Germany) before and after administration of 120 ml intravenous contrast agent (Solutrast®, Bracco, Milan, Italy) followed by 50 ml saline. The presence of hepatic, renal and splenic injuries was analyzed and the conspicuousness of findings was assessed. In 15 of the 78 patients conventional US identified solid organ injuries: 8 hepatic, 2 renal and 5 splenic injuries. CEUS identified 3 more injuries (2 hepatic and 1 splenic) that had been missed by conventional US. CEUS identified traumatic lesions in 18/78 patients. In one of the 18 patients even active bleeding could be identified by CEUS. In CEUS solid organ injuries appeared hypoechoic. MS-CT identified 18 solid organ injuries in 78 patients, corroborating the CEUS results. CEUS greatly improves the visualization and characterization of hepatic, renal and splenic injuries compared to conventional ultrasound and correlates well with MS-CT. The imaging technique detects even minor blood flow and is able to depict vascular structures in detail. At our institution it is used as an additional examination technique which supplements MS-CT in unclear cases. Owing to its bedside availability, CEUS provides a good alternative to MS-CT, especially in patients with contraindications to CT contrast agents (e.g. due to renal failure or severe allergy) and in hemodynamically compromised patients.

Keywords: Trauma, contrast-enhanced ultrasound, multislice computed tomography

DOI: 10.3233/CH-2008-1080

Journal: Clinical Hemorheology and Microcirculation, vol. 39, no. 1-4, pp. 155-169, 2008