Skip to main content
SpringerLink
Log in

Multidetektor-CT zur Diagnostik traumatologischer Notfälle

Imaging of trauma with multi-detector computed tomography

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Die Diagnostik traumatischer Verletzungen ist eine der Kernaufgaben der modernen Radiologie. Eine frühe und umfassende bildgebende Diagnostik ist entscheidend für eine zeitnahe und v. a. zielgerichtete Therapie potenziell lebensbedrohlicher Verletzungen. Etablierte Untersuchungsverfahren wie die Projektionsradiographie (CR) und die Sonographie (US) stellen nach wie vor die Basisdiagnostik dar. Jedoch wurde in vielen vergleichenden Studien nachgewiesen, dass die Detektionsrate von Verletzungen bei beiden Modalitäten deutlich geringer ist als durch die Computertomographie (CT).

Durch die Einführung der Multidetektor-CT (MDCT) und der damit verbundenen dramatisch verkürzten Untersuchungszeiten und der höheren diagnostischen Sicherheit ist die CT bei vielen traumatologischen Fragestellungen zum Goldstandard in der Akutdiagnostik geworden. Da die MDCT eine nicht unerhebliche Strahlenbelastung bei der überwiegend jungen Patientenpopulation mit sich bringt, ist eine strenge Indikationsstellung zu beachten. Hinzu kommt die Notwendigkeit zur Optimierung der Untersuchungsprotokolle im Hinblick auf die erwarteten Verletzungsmuster und bzgl. einer individuell anzupassenden Dosiseinsparung bei gleich bleibender Bildqualität.

Durch die enorm angestiegene Bilderzahl einer Mehrzeilen-CT ist es zudem erforderlich, die relevanten Bilder auf ein vernünftiges Maß zu begrenzen. Dieser Artikel gibt Empfehlungen zur Protokolloptimierung hinsichtlich der Untersuchungsparameter und auch zur Bildrekonstruktion und -archivierung.

Abstract

Diagnosis of trauma-related injuries is a key task in modern radiology. Early, thorough and accurate detection of potentially life-threatening injuries is crucial for fast and targeted initiation of treatment.

Conventional radiography (CR) and ultrasound (US) are well-established and still represent the basic diagnostic tools for trauma imaging. However, a number of studies have shown a lower detection rate of injuries for radiography and ultrasound compared with computed tomography (CT).

Multi-detector CT (MDCT) with its shorter scan time and increased accuracy has become the gold standard for many indications in trauma imaging. As MDCT has a higher radiation dose, its use should be restricted and carefully indicated especially when dealing with a younger patient population. Careful optimization of imaging parameters has to be performed to minimize exposure and maximize diagnostic safety.

Modern MDCT examinations produce a large number of images, which have to be limited to a reasonable number for interpretation. This review article focuses on optimization of examination protocols and on how to handle the flood of images for viewing and archiving.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Allen TL, Mueller MT, Bonk RT et al (2004) Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma. J Trauma 56:314–322

    Article  PubMed  Google Scholar 

  2. American College of Radiology (2007) ACR appropriateness criteria: cervical spine. http://www.acr.org/ac

  3. Bagley LJ (2006) Imaging of spinal trauma. Radiol Clin North Am 44:1–12 vii

    Article  PubMed  Google Scholar 

  4. Baumert B, Blautzik J, Körner M et al (2008) Aktuelle bildgebende Diagnostik der Wirbelsäulenerkrankungen. Chirurg 79:906–917

    Article  PubMed  CAS  Google Scholar 

  5. Begemann PG, Kemper J, Gatzka C et al (2004) Value of multiplanar reformations (MPR) in multidetector CT (MDCT) of acute vertebral fractures: do we still have to read the transverse images? J Comput Assist Tomogr 28:572–580

    Article  PubMed  Google Scholar 

  6. Berne JD, Reuland KS, Villarreal DH et al (2006) Sixteen-slice multi-detector computed tomographic angiography improves the accuracy of screening for blunt cerebrovascular injury. J Trauma 60:1204–1209; discussion 1209–1210

    Article  PubMed  Google Scholar 

  7. Fanucci E, Fiaschetti V, Rotili A et al (2007) Whole body 16-row multislice CT in emergency room: effects of different protocols on scanning time, image quality and radiation exposure. Emerg Radiol 13:251–257

    Article  PubMed  Google Scholar 

  8. Haapamaki VV, Kiuru MJ, Mustonen AO et al (2005) Multidetector computed tomography in acute joint fractures. Acta Radiol 46:587–598

    Article  PubMed  CAS  Google Scholar 

  9. Holmes JF, Akkinepalli R (2005) Computed tomography versus plain radiography to screen for cervical spine injury: a meta-analysis. J Trauma 58:902–905

    Article  PubMed  Google Scholar 

  10. Holmes JF, Offerman SR, Chang CH et al (2004) Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries. Ann Emerg Med 43:120–128

    Article  PubMed  Google Scholar 

  11. Huber-Wagner SM, Lefering R, Qvick LM et al (2009) Whole body computed tomography during trauma resuscitation – effect on outcome. Lancet (in press)

  12. Kaewlai R, Avery LL, Asrani AV et al (2008) Multidetector CT of blunt thoracic trauma. Radiographics 28:1555–1570

    Article  PubMed  Google Scholar 

  13. Kanz K-G, Körner M, Linsenmaier U et al (2004) Prioritätenorientiertes Schockraummanagement unter Integration des Mehrschicht-Spiral-Computertomographen. Unfallchirurg 107:937–944

    Article  PubMed  Google Scholar 

  14. Körner M, Krötz M, Degenhart C et al (2008) Current role of emergency ultrasound in patients with major trauma. Radiographics (in press)

  15. Körner M, Krötz M, Kanz KG et al (2006) Development of an accelerated MSCT protocol (triage MSCT) for mass casualty incidents: comparison to MSCT for single-trauma patients. Emerg Radiol 12:203–209

    Article  PubMed  Google Scholar 

  16. Linsenmaier U, Krötz M, Häuser H et al (2002) Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740

    Article  PubMed  Google Scholar 

  17. Mann FA, Cohen WA, Linnau KF et al (2003) Evidence-based approach to using CT in spinal trauma. Eur J Radiol 48:39–48

    Article  PubMed  CAS  Google Scholar 

  18. Marmery H, Shanmuganathan K, Alexander MT et al (2007) Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 189:1421–1427

    Article  PubMed  Google Scholar 

  19. Mirvis SE, Shanmuganagthan K (2007) Imaging hemidiaphragmatic injury. Eur Radiol 17:1411–1421

    Article  PubMed  Google Scholar 

  20. Mirvis SE, Shanmuganathan K (2007) Diagnosis of blunt traumatic aortic injury: still a nemesis. Eur J Radiol 64:27–40

    Article  PubMed  Google Scholar 

  21. Mutschler W, Kanz K-G (2002) Interdisziplinäre Schockraumversorgung: Die Aufgaben der Radiologie aus unfallchirurgischer Sicht. Radiologe 42:506–514

    Article  PubMed  CAS  Google Scholar 

  22. Narayan RK, Maas AI, Servadei F et al (2008) Progression of traumatic intracerebral hemorrhage: a prospective observational study. J Neurotrauma 25:629–639

    Article  PubMed  Google Scholar 

  23. Phal PM, Riccelli LP, Wang P et al (2008) Fracture detection in the cervical spine with multidetector CT: 1-mm versus 3-mm axial images. AJNR Am J Neuroradiol 29:1446–1449

    Article  PubMed  CAS  Google Scholar 

  24. Philipp MO, Funovics MA, Mann FA et al (2003) Four-channel multidetector CT in facial fractures: do we need 2×0.5 mm collimation? AJR Am J Roentgenol 180:1707–1713

    PubMed  Google Scholar 

  25. Platzer P, Jaindl M, Thalhammer G et al (2006) Clearing the cervical spine in critically injured patients: a comprehensive C-spine protocol to avoid unnecessary delays in diagnosis. Eur Spine J 15:1801–1810

    Article  PubMed  Google Scholar 

  26. Poletti PA, Mirvis SE, Shanmuganathan K et al (2004) Blunt abdominal trauma patients: can organ injury be excluded without performing computed tomography? J Trauma 57:1072–1081

    Article  PubMed  Google Scholar 

  27. Provenzale J (2007) CT and MR imaging of acute cranial trauma. Emerg Radiol 14:1–12

    Article  PubMed  Google Scholar 

  28. Ptak T, Rhea JT, Novelline RA (2003) Radiation dose is reduced with a single-pass whole-body multi-detector row CT trauma protocol compared with a conventional segmented method: initial experience. Radiology 229:902–905

    Article  PubMed  Google Scholar 

  29. Rieger M, Mallouhi A, El-Attal R et al (2006) Akutdiagnostik des Wirbelsäulentraumas. Radiologe 46:527–541; quiz 542–523

    Article  PubMed  CAS  Google Scholar 

  30. Rozycki GS, Knudson MM, Shackford SR et al (2005) Surgeon-performed bedside organ assessment with sonography after trauma (BOAST): a pilot study from the WTA Multicenter Group. J Trauma 59:1356–1364

    Article  PubMed  Google Scholar 

  31. Sammer M, Wang E, Blackmore CC et al (2007) Indeterminate CT angiography in blunt thoracic trauma: is CT angiography enough? AJR Am J Roentgenol 189:603–608

    Article  PubMed  Google Scholar 

  32. Scaglione M, Pinto A, Pedrosa I et al (2008) Multi-detector row computed tomography and blunt chest trauma. Eur J Radiol 65:377–388

    Article  PubMed  Google Scholar 

  33. Shanmuganathan K, Mirvis SE, Chiu WC et al (2004) Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury – a prospective study in 200 patients. Radiology 231:775–784

    Article  PubMed  CAS  Google Scholar 

  34. Sliker CW (2008) Blunt cerebrovascular injuries: imaging with multidetector CT angiography. Radiographics 28:1689–1708; discussion 1709–1610

    Article  PubMed  Google Scholar 

  35. Sliker CW, Shanmuganathan K, Mirvis SE (2008) Diagnosis of blunt cerebrovascular injuries with 16-MDCT: accuracy of whole-body MDCT compared with neck MDCT angiography. AJR Am J Roentgenol 190:790–799

    Article  PubMed  Google Scholar 

  36. Statistisches Bundesamt (2009) Todesursachenstatistik. http://www.destatis.de

  37. Stein SC, Fabbri A, Servadei F et al (2009) A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumatic brain injury in adolescents and adults. Ann Emerg Med 53:180–188

    Article  PubMed  Google Scholar 

  38. Stiell IG, Clement CM, McKnight RD et al (2003) The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 349:2510–2518

    Article  PubMed  CAS  Google Scholar 

  39. Stuhlfaut JW, Anderson SW, Soto JA (2007) Blunt abdominal trauma: current imaging techniques and CT findings in patients with solid organ, bowel and mesenteric injury. Semin Ultrasound CT MR 28:115–129

    Article  PubMed  Google Scholar 

  40. Takakuwa KM, Halpern EJ (2008) Evaluation of a triple rule-out coronary CT angiography protocol: use of 64-section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome. Radiology 248:438–446

    Article  PubMed  Google Scholar 

  41. Traub M, Stevenson M, McEvoy S et al (2007) The use of chest computed tomography versus chest X-ray in patients with major blunt trauma. Injury 38:43–47

    Article  PubMed  Google Scholar 

  42. Traumaregister der Deutschen Gesellschaft für Unfallchirurgie (DGU) (2007) Jahresbericht. http://www.traumaregister.de/downloads/Jahresbericht_2007.pdf

  43. Vogel T, Ockert B, Krotz M et al (2008) Größenprogrediente intrakranielle Blutungen nach Schädel-Hirn-Trauma. Unfallchirurg 111:898–904

    Article  PubMed  CAS  Google Scholar 

  44. Wedegärtner U, Lorenzen M, Nagel HD et al (2004) Diagnostic imaging in polytrauma: comparison of radiation exposure from whole-body MSCT and conventional radiography with organ-specific CT. Rofo 176:1039–1044

    PubMed  Google Scholar 

  45. Willmann JK, Roos JE, Platz A et al (2002) Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma. AJR Am J Roentgenol 179:437–444

    PubMed  Google Scholar 

  46. Zimmer A, Reith W (2008) Bildgebende Diagnostik bei Schädel-Hirn-Trauma. Radiologe 48:503–516; quiz 517–508

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Forschungskooperation des Instituts mit GE Healthcare.

Author information

Authors and Affiliations

  1. Institut für Klinische Radiologie – Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Nußbaumstr. 20, 80336, München, Deutschland

    M. Körner, M. Reiser & U. Linsenmaier

Authors
  1. M. Körner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Linsenmaier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Körner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Körner, M., Reiser, M. & Linsenmaier, U. Multidetektor-CT zur Diagnostik traumatologischer Notfälle. Radiologe 49, 510–515 (2009). https://doi.org/10.1007/s00117-008-1807-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-008-1807-6

Schlüsselwörter

Keywords

Search

Navigation