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Solid Organ Injuries: Contrast-Enhanced US versus CT

March 4, 2008
Written by: , Filed in: Abdominal Imaging, Pediatric Radiology
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The objective of a recent study was to compare the sensitivity and specificity of routine ultrasound with that of contrast-enhanced ultrasound to depict solid organ injuries in children with blunt abdominal trauma using contrast-enhanced CT scanning as a Reference standard.

The study has concluded that as a noninvasive modality, contrast-enhanced ultrasound approaches contrast-enhanced CT in diagnostic performance in depicting solid organ injuries in children.

Methodology
Over a three-year period, 27 hemodynamically stable patients with moderate or severe injuries were initially evaluated with routine ultrasound and subsequently by contrast-enhanced ultrasound and CT. Each of the three imaging techniques was performed by three respective individuals, who later interpreted the results while blinded to the results of the other examinations.

Routine ultrasound was performed to detect free fluid, consisting of prolonged scanning in all four quadrants with concentrations in the epigastrium, pericardial space, and right and left colic gutters. Contrast-enhanced ultrasound was performed immediately after using a second-generation blood pool contrast agent. The agent was injected as a bolus with a 22-gauge catheter.

The complete contrast-enhanced exam lasted no more than six minutes. Un-enhanced and contrast-enhanced CT examinations were performed immediately after ultrasound. Subsequent statistical analysis was employed.

Related CME:
NEW FOR 2009
Abdominal & Thoracic CT/MR/US: Optimizing Practice
The University of California, San Francisco School of Medicine
Evolving technology improves radiological practice through improved image quality for anatomical interpretation and generation of functional data. The use of MDCT and fast, multi-phase imaging sequences also translates to a tremendous increase in data that requires review and handling and greater need for contrast and radiation safety awareness. This activity targets the community radiologist involved in body and cardiovascular imaging with a focus on developing an efficient workflow practice in the modern imaging environment.
Read more or order: Abdominal & Thoracic CT/MR/US: Optimizing Practice

CT/MRI of the Abdomen and Pelvis
University of California San Francisco Department of Radiology and Biomedical Imaging
Provides an updated review on the use of helical (single and multidetector-row) CT and MRI for imaging of the abdomen and pelvis. Participants will learn the current approach and uses of CT/MRI in the examination of the abdomen and pelvis including advances in abdominal MRI techniques, genitourinary applications of CT/MRI, CT colonoscopy, CT/MR angiography, and CT cholangiography.
Earn up to 12 AMA PRA Category 1 Credits™.
Abdominal Imaging CME

Results of the Study
44% of the 27 patients had 14 injuries that were demonstrated on contrast-enhanced CT images. Routine ultrasound was positive in 10 patients, rendering routine ultrasound 57.1% sensitive and 86.7% specific.

On the other hand, contrast-enhanced ultrasound depicted 13 of 14 lesions, with only a right adrenal gland contusion missed. All 15 patients who had no organ injuries depicted on CT also had normal contrast-enhanced ultrasound.

On contrast-enhanced ultrasound images, organ injuries appeared as strongly hypoechoic areas adjacent to hyperechoic parenchyma. Microbubbles within the lesion indicated active bleeding. The sensitivity and specificity of contrast-enhanced ultrasound was calculated to be 92.9% and 100%, respectively.

Reviewer’s Comments
This is a very interesting article showing that, when used in experienced hands, contrast-enhanced ultrasound accuracy approaches contrast-enhanced CT scanning when depicting solid organ injuries in children.

The authors do not comment on the importance of excluding other types of injuries, for which ultrasound may not be useful, such as osseous or vascular injuries. In practical terms, it may not be worth performing a contrast-enhanced ultrasound in a child only to delay the inevitable CT, which will most likely be used to complete the injury profile.

Author: Basil Hubbi, MD

Reference
Valentino M, Serra C, et al. Blunt Abdominal Trauma: Diagnostic Performance of Contrast-Enhanced US in Children–Initial Experience.
Radiology;
2008; 246 (March): 903-909.

Related CME:
NEW FOR 2009
Abdominal & Thoracic CT/MR/US: Optimizing Practice
The University of California, San Francisco School of Medicine
Evolving technology improves radiological practice through improved image quality for anatomical interpretation and generation of functional data. The use of MDCT and fast, multi-phase imaging sequences also translates to a tremendous increase in data that requires review and handling and greater need for contrast and radiation safety awareness. This activity targets the community radiologist involved in body and cardiovascular imaging with a focus on developing an efficient workflow practice in the modern imaging environment.
Read more or order: Abdominal & Thoracic CT/MR/US: Optimizing Practice

CT/MRI of the Abdomen and Pelvis
University of California San Francisco Department of Radiology and Biomedical Imaging
Provides an updated review on the use of helical (single and multidetector-row) CT and MRI for imaging of the abdomen and pelvis. Participants will learn the current approach and uses of CT/MRI in the examination of the abdomen and pelvis including advances in abdominal MRI techniques, genitourinary applications of CT/MRI, CT colonoscopy, CT/MR angiography, and CT cholangiography.
Earn up to 12 AMA PRA Category 1 Credits™.
Abdominal Imaging CME
.

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