Use of Computed Tomography Findings and Contrast Extravasation in Predicting the Need for Embolization with Pelvic Fractures

Transarterial embolization (AE) can be a lifesaving procedure for severe hemorrhage associated with pelvic fractures. The purpose of this study was to identify demographic and radiographic findings that predict the need for embolization. We performed a retrospective review of all patients with at least one pelvic fracture and admission to the intensive care unit over a 35-month period. Computed tomography (CT) and pelvic radiographs were reviewed. Patient demographics, outcomes, time to angiography, and whether or not embolization was performed were determined. Statistical analysis was used to determine factors associated with the need for AE. Of the 327 total patients with pelvic fractures, 317 underwent CT scanning. Forty-four patients (13.5%) underwent angiography and 25 (7.6%) required therapeutic embolization. There were 39 total deaths (11.6%) with five deaths related to pelvic hemorrhage (1.5%). Multivariate analysis revealed that age older than 55 years (odds ratio [OR], 1.06; P < 0.001), systolic blood pressure less than 90 mmHg in the emergency department (OR, 11.64; P = 0.0008), and CT extravasation (OR, 147.152; P < 0.0001) were significantly associated with the need for embolization. Contrast extravasation was not present in 25 per cent of patients requiring therapeutic AE. The presence of contrast extravasation is highly associated with the need for pelvic embolization in patients with pelvic fractures, but its absence does not exclude the need for pelvic angiography.

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Accuracy of Contrast Extravasation on Computed Tomography for Diagnosing Severe Pelvic Hemorrhage in Pelvic Trauma Patients: A Meta-Analysis

Medicina ◽

10.3390/medicina57010063 ◽

2021 ◽

Vol 57 (1) ◽

pp. 63

Author(s):

Sung Nam Moon ◽

Jung-Soo Pyo ◽

Wu Seong Kang

Keyword(s):

Computed Tomography ◽

Meta Analysis ◽

Characteristic Curve ◽

Pelvic Trauma ◽

Test Accuracy ◽

Trauma Patients ◽

Positive Finding ◽

Summary Receiver Operating Characteristic ◽

Contrast Extravasation ◽

Pelvic Hemorrhage

Background and objective: The early detection of underlying hemorrhage of pelvic trauma has been a critical issue. The aim of this study was to systematically determine the diagnostic accuracy of computed tomography (CT) for detecting severe pelvic hemorrhage. Materials and Methods: Relevant articles were obtained by searching PubMed, EMBASE, and Cochrane databases through 28 November 2020. Diagnostic test accuracy results were reviewed to obtain the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of CT for the diagnosis in pelvic trauma patients. The positive finding on CT was defined as the contrast extravasation. As the reference standard, severe pelvic hemorrhage was defined as an identification of bleeding at angiography or by direct inspection using laparotomy that required hemostasis by angioembolization or surgery. A subgroup analysis was performed according to the CT modality that is divided by the number of detector rows. Result: Thirteen eligible studies (29 subsets) were included in the present meta-analysis. Pooled sensitivity of CT was 0.786 [95% confidence interval (CI), 0.574–0.909], and pooled specificity was 0.944 (95% CI, 0.900–0.970). Pooled sensitivity of the 1–4 detector row group and 16–64 detector row group was 0.487 (95% CI, 0.215–0.767) and 0.915 (95% CI, 0.848–0.953), respectively. Pooled specificity of the 1–4 and 16–64 detector row groups was 0.956 (95% CI, 0.876–0.985) and 0.906 (95% CI, 0.828–0.951), respectively. Conclusion: Multi-detector CT with 16 or more detector rows has acceptable high sensitivity and specificity. Extravasation on CT indicates severe hemorrhage in patients with pelvic trauma.

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The Diagnostic Accuracy of 64-Slice Computed Tomography in Detecting Clinically Significant Arterial Bleeding after Pelvic Fractures

The American Surgeon ◽

10.1177/000313481107700930 ◽

2011 ◽

Vol 77 (9) ◽

pp. 1176-1182 ◽

Cited By ~ 13

Author(s):

Shahin Mohseni ◽

Peep Talving ◽

Leslie Kobayashi ◽

Lydia Lam ◽

Kenji Inaba ◽

...

Keyword(s):

Computed Tomography ◽

Diagnostic Accuracy ◽

Pelvic Fracture ◽

Predictive Value ◽

Clinical Signs ◽

Pelvic Fractures ◽

Contrast Extravasation ◽

Arterial Bleeding ◽

Transfusion Requirements ◽

Clinically Significant

The purpose of this study was to determine the diagnostic accuracy of the 64-slice multidetector computed tomography (MDCT) in detecting active pelvic arterial bleeding associated with blunt pelvic fractures. We hypothesized that this modality yields high accuracy. We conducted a retrospective review of all MDCT detected pelvic fractures over an 18-month period admitted to LAC+ USC Medical Center, a Level 1 trauma center. The main outcome was the presence of contrast extravasation (CE) on admission MDCT, consistent with clinically significant arterial bleeding requiring a subsequent embolization or intraoperative ligation of pelvic arteries. Overall, 127 patients met study criteria and 12 per cent (n = 15) had CE on admission MDCT of which four were managed conservatively. Eighty-two per cent (n = 9) of the remaining 11 patients who went on to have invasive procedure had active arterial bleeding that required embolization or surgical ligation. Two of the 112 (1.8%) patients without CE on their admission MDCT were subjected to embolization after further investigation with angiography as a result of the severity of their pelvic fracture and continuous transfusion requirements. The calculated sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the 64-slice MDCT to identify clinically relevant arterial bleeding were 82, 95, 60, 98, and 94 per cent, respectively. The modern 64-slice MDCT provides relatively high diagnostic accuracy in detecting a clinically relevant arterial hemorrhage after blunt pelvic fracture. Nevertheless, in patients with clinical signs of ongoing hemorrhage, timely angiography or operative intervention is warranted, even in the absence of MDCT contrast extravasation.

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Prognostic Accuracy of Computed Tomography Findings for Patients With Laryngeal Cancer Undergoing Laryngectomy

Journal of Clinical Oncology ◽

10.1200/jco.2009.24.7544 ◽

2010 ◽

Vol 28 (14) ◽

pp. 2318-2322 ◽

Cited By ~ 70

Author(s):

Jonathan J. Beitler ◽

Susan Muller ◽

William J. Grist ◽

Amanda Corey ◽

Adam M. Klein ◽

...

Keyword(s):

Computed Tomography ◽

Laryngeal Cancer ◽

Thyroid Cartilage ◽

Ct Scanning ◽

Ct Imaging ◽

Predictive Values ◽

Radiographic Findings ◽

Prognostic Accuracy ◽

Cartilage Invasion ◽

Preoperative Ct

Purpose The indications for upfront laryngectomy in the management of laryngeal cancer are a functionless larynx and extralaryngeal extension. Practically, clinicians rely on imaging to predict which patients will have T4 disease. Our goal was to review the accuracy of preoperative computed tomography (CT) scanning in determining the necessity for initial laryngectomy for advanced laryngeal cancer. Patients and Methods In total, 107 consecutive untreated laryngectomy specimens with high-quality, preoperative CT imaging interpreted by our neuroradiologists were reviewed. Radiographic findings, including sclerosis, invasion, penetration, extralaryngeal spread, and subglottic extension were correlated with pathologic findings. CT images were not reinterpreted, since our purpose was to assess the original interpretations. Results CT imaging reported 23 cases of thyroid cartilage penetration and 27 cases of extralaryngeal spread. Pathology reported 12 cases of thyroid cartilage invasion, 29 cases of penetration, and 45 cases of extralaryngeal disease. CT imaging identified 17 (59%) of 29 cases of pathologically documented thyroid cartilage penetration and 22 (49%) of 45 cases of pathologically documented extralaryngeal spread. Pathologically proven extralaryngeal spread without thyroid cartilage penetration occurred in 18 (40%) of 45 cases. The positive predictive values for thyroid cartilage penetration and extralaryngeal spread were 74% and 81%. Sclerosis was of limited value in predicting thyroid cartilage invasion or penetration. Cricoid or arytenoid destruction predicted for thyroid cartilage penetration at rates of 57% and 63%. Conclusion CT imaging has clear limitations when deciding whether there is thyroid cartilage penetration or extralaryngeal spread of advanced laryngeal cancer. Extralaryngeal spread without thyroid cartilage penetration was more common than expected. Alternate methods of pretreatment assessment are needed.

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Delayed Mesenteric Hematoma of the Sigmoid Colon Following Blunt Abdominal Trauma

Medical & Clinical Research ◽

10.33140/mcr.02.01.09 ◽

2017 ◽

Vol 2 (1) ◽

Keyword(s):

Motor Vehicle ◽

Pelvic Fractures ◽

Motor Vehicle Crash ◽

Organ Injury ◽

Contrast Extravasation ◽

Body Fracture ◽

Mesenteric Hematoma ◽

Level I ◽

Hispanic Male ◽

Trauma Bay

A 25-year-old Hispanic male was transferred to our level I trauma center after being ejected 40 feet from a motor vehicle crash. Once stabilized in the trauma bay, a computed tomography (CT) scan of the abdomen/pelvis with IV contrast revealed two AAST Organ Injury Scale grade III liver lacerations without contrast extravasation, bilateral pulmonary contusions, right posterior non-displaced fourth rib fracture, non-displaced right scapular body fracture, and bilateral anterior and posterior pelvic fractures [Figures 1–2]. A non-operative approach to the hepatic lacerations was chosen and the patient underwent closed reduction and percutaneous pinning of his posterior pelvic fractures as well as anterior external fixation of his bilateral pubic rami fractures.

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Morphology and Affinities of Ampelocissites Seeds (Vitaceae: Ampelopsis clade) from the Paleogene of Texas, USA

Systematic Botany ◽

10.1600/036364420x15935294613400 ◽

2020 ◽

Vol 45 (3) ◽

pp. 478-482

Author(s):

Steven R. Manchester

Keyword(s):

Computed Tomography ◽

Cross Sections ◽

Seed Coat ◽

Ct Scanning ◽

Seed Morphology ◽

Early Eocene ◽

Micro Computed Tomography ◽

X Ray ◽

Fossil Seeds ◽

Fossil Genus

Abstract—The type material on which the fossil genus name Ampelocissites was established in 1929 has been reexamined with the aid of X-ray micro-computed tomography (μ-CT) scanning and compared with seeds of extant taxa to assess the relationships of these fossils within the grape family, Vitaceae. The specimens were collected from a sandstone of late Paleocene or early Eocene age. Although originally inferred by Berry to be intermediate in morphology between Ampelocissus and Vitis, the newly revealed details of seed morphology indicate that these seeds represent instead the Ampelopsis clade. Digital cross sections show that the seed coat maintains its thickness over the external surfaces, but diminishes quickly in the ventral infolds. This feature, along with the elliptical chalaza and lack of an apical groove, indicate that Ampelocissites lytlensis Berry probably represents Ampelopsis or Nekemias (rather than Ampelocissus or Vitis) and that the generic name Ampelocissites may be useful for fossil seeds with morphology consistent with the Ampelopsis clade that lack sufficient characters to specify placement within one of these extant genera.

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A deep-learning method using computed tomography scout images for estimating patient body weight

Scientific Reports ◽

10.1038/s41598-021-95170-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shota Ichikawa ◽

Misaki Hamada ◽

Hiroyuki Sugimori

Keyword(s):

Computed Tomography ◽

Body Weight ◽

Deep Learning ◽

Contrast Medium ◽

Model Performance ◽

Ct Scanning ◽

Drug Dosing ◽

Body Weights ◽

Dose Management ◽

Medium Dose

AbstractBody weight is an indispensable parameter for determination of contrast medium dose, appropriate drug dosing, or management of radiation dose. However, we cannot always determine the accurate patient body weight at the time of computed tomography (CT) scanning, especially in emergency care. Time-efficient methods to estimate body weight with high accuracy before diagnostic CT scans currently do not exist. In this study, on the basis of 1831 chest and 519 abdominal CT scout images with the corresponding body weights, we developed and evaluated deep-learning models capable of automatically predicting body weight from CT scout images. In the model performance assessment, there were strong correlations between the actual and predicted body weights in both chest (ρ = 0.947, p < 0.001) and abdominal datasets (ρ = 0.869, p < 0.001). The mean absolute errors were 2.75 kg and 4.77 kg for the chest and abdominal datasets, respectively. Our proposed method with deep learning is useful for estimating body weights from CT scout images with clinically acceptable accuracy and potentially could be useful for determining the contrast medium dose and CT dose management in adult patients with unknown body weight.

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Quantitative dual contrast photon-counting computed tomography for assessment of articular cartilage health

Scientific Reports ◽

10.1038/s41598-021-84800-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Petri Paakkari ◽

Satu I. Inkinen ◽

Miitu K. M. Honkanen ◽

Mithilesh Prakash ◽

Rubina Shaikh ◽

...

Keyword(s):

Computed Tomography ◽

Articular Cartilage ◽

Contrast Agent ◽

Contrast Agents ◽

Photon Counting ◽

Spectral Imaging ◽

Ct Scanning ◽

Photon Counting Detector ◽

Tissue Contrast ◽

Reference Parameters

AbstractPhoton-counting detector computed tomography (PCD-CT) is a modern spectral imaging technique utilizing photon-counting detectors (PCDs). PCDs detect individual photons and classify them into fixed energy bins, thus enabling energy selective imaging, contrary to energy integrating detectors that detects and sums the total energy from all photons during acquisition. The structure and composition of the articular cartilage cannot be detected with native CT imaging but can be assessed using contrast-enhancement. Spectral imaging allows simultaneous decomposition of multiple contrast agents, which can be used to target and highlight discrete cartilage properties. Here we report, for the first time, the use of PCD-CT to quantify a cationic iodinated CA4+ (targeting proteoglycans) and a non-ionic gadolinium-based gadoteridol (reflecting water content) contrast agents inside human osteochondral tissue (n = 53). We performed PCD-CT scanning at diffusion equilibrium and compared the results against reference data of biomechanical and optical density measurements, and Mankin scoring. PCD-CT enables simultaneous quantification of the two contrast agent concentrations inside cartilage and the results correlate with the structural and functional reference parameters. With improved soft tissue contrast and assessment of proteoglycan and water contents, PCD-CT with the dual contrast agent method is of potential use for the detection and monitoring of osteoarthritis.

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Dual-Energy Computed Tomography of the Liver: Uses in Clinical Practices and Applications

Diagnostics ◽

10.3390/diagnostics11020161 ◽

2021 ◽

Vol 11 (2) ◽

pp. 161

Author(s):

Masakatsu Tsurusaki ◽

Keitaro Sofue ◽

Masatoshi Hori ◽

Kosuke Sasaki ◽

Kazunari Ishii ◽

...

Keyword(s):

Computed Tomography ◽

Liver Tumors ◽

Energy Levels ◽

Ct Scanning ◽

Dual Energy ◽

Liver Imaging ◽

X Rays ◽

Clinical Practices ◽

Dual Energy Computed Tomography ◽

Noise Ratio

Dual-energy computed tomography (DECT) is an imaging technique based on data acquisition at two different energy settings. Recent advances in CT have allowed data acquisitions and simultaneous analyses of X-rays at two energy levels, and have resulted in novel developments in the field of abdominal imaging. The use of low and high X-ray tube voltages in DECT provide fused images that improve the detection of liver tumors owing to the higher contrast-to-noise ratio (CNR) of the tumor compared with the liver. The use of contrast agents in CT scanning improves image quality by enhancing the CNR and signal-to-noise ratio while reducing beam-hardening artifacts. DECT can improve detection and characterization of hepatic abnormalities, including mass lesions. The technique can also be used for the diagnosis of steatosis and iron overload. This article reviews and illustrates the different applications of DECT in liver imaging.

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