Role of Multidetector CT in evaluation of Traumatic Retroperitoneal Injuries

Abstract

Assessment of the retroperitoneum is critical in the radiologic evaluation of patients who have sustained abdominal trauma. Multidetector CT can allow accurate post-traumatic assessment of patients, including the detection of retroperitoneal injuries, which can be subtle) Fang et al., 2011). Recognition of abnormal blood, fluid, or air within the retroperitoneal spaces is the key to correctly identifying duodenal, pancreatic, vascular, renal, adrenal, and paraspinal injuries (Killeen et al., 2012). Equivocal findings at initial abdominal CT should prompt close clinical follow-up with possible imaging follow-up, particularly for suspected occult duodenal and pancreatic injuries(Huerta et al., 2014). Multidetector CT technology offers unprecedented imaging capabilities that can be readily applied for optimal evaluation of the polytrauma patient. With the decline in the use of diagnostic peritoneal lavage and the current preference for conservative nonsurgical therapy for all but the most severe injuries affecting the retroperitoneal organs, diagnosis is heavily reliant on the findings of CT studies that are acquired in a timely fashion and adequately performed and the results of which are accurately interpreted. However, to maximize the diagnostic potential of the examination and, at the same time, minimize risks, CT protocols need to be tailored to match the need of each individual patient. The interpreting radiologist should emphasize findings that directly affect patient care, such as presence of active extravasation and injuries to the kidneys, pancreas, adrenal glands, and vessels. Essentials 1. • Because conservative nonsurgical therapy is preferred for all but the most severe injuries affecting the solid viscera, accurate diagnosis is heavily reliant on the findings of CT examinations performed adequately and in a timely fashion and accurately interpreted CT images. 2. • A typical blunt abdominal CT protocol includes portal venous phase images and selective acquisition of delayed and/or arterial phase images (CT angiograms). 3. • When acquired, radiation dose settings for arterial and delayed phase images should be adjusted to yield a decrease in tube current and correspondingly higher image noise. 4. • Orthogonal plane reformations should be used routinely to improve the accuracy for diagnosing certain injuries, such as those affecting the diaphragm and spine. 5. • In patients with hemoperitoneum, the presence of active extravasation and the rate of bleeding have a more direct effect on patient care decisions than does the volume of free blood in the abdomen.