| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
1 Department of Radiology, SS Annunziata Hospital, University of G. d'Annunzio,
Via P. Valignani 1, Chieti 66100, Italy.
2 Department of Radiology, Rm. M-391, University of California, 505 Parnassus
Ave., San Francisco, CA 94143-0628.
3 Department of Radiology, Thoracic Imaging Section, Rm. 1X 55A, Box 1325, San
Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110.
4 Centers for Disease Control and Prevention, National Center for Environmental
Health Centers for Disease Control and Prevention, MS E70, 1600 Clifton Rd.,
N.E., Atlanta, GA 30323.
OBJECTIVE. The objectives of our study were to determine the accuracy of single-detector helical CT (including coronal and sagittal reconstructions) for the diagnosis of traumatic diaphragmatic injury, establish measurements for the thickness of the normal diaphragmatic crus, and describe an additional sign of diaphragmatic injury: active arterial extravasation of contrast material at the level of the diaphragm.
MATERIALS AND METHODS. The CT scans of 25 patients with surgically proven diaphragmatic injury and 22 patients with surgically confirmed uninjured diaphragms were blindly reviewed by five thoracic radiologists. Sagittal and coronal reconstructions were performed for 20 of the 25 patients with a proven diaphragmatic injury and for all the patients without a diaphragmatic injury. Scans were evaluated for findings suggestive of diaphragmatic injury and for associated injuries. Reviewers scored the usefulness of the reconstructed images for establishing the final diagnosis. Measurements of the right and left crura were performed to establish a threshold measurement that would enable radiologists to discriminate between a normal diaphragm and an injured diaphragm.
RESULTS. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of helical CT were 84%, 77%, 81%, 81%, and 83%, respectively. Scans showing active arterial extravasation of contrast material enabled reviewers to correctly identify diaphragmatic injury in two patients. Reconstructed images confirmed the correct diagnosis in three patients but supported an incorrect diagnosis in two. The mean thickness of the diaphragmatic crura (right and left) was not significantly greater in patients with an injured diaphragm than in those with an uninjured diaphragm.
CONCLUSION. Helical CT shows good sensitivity, specificity, and accuracy for the diagnosis of diaphragmatic injury. Coronal and sagittal reconstructions are of limited use in establishing or refuting this diagnosis. Active arterial extravasation of contrast material near the diaphragm should raise suspicion for injury. Crus measurements cannot be used to reliably distinguish between injured and uninjured diaphragms.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  B. Hoffmann, H. Nguyen, and H. F. Hill Diaphragmatic Laceration After Penetrating Trauma: Direct Visualization and Indirect Findings on Focused Assessment With Sonography for Trauma in the Emergency Department J. Ultrasound Med., September 1, 2009; 28(9): 1259 - 1263. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Kaewlai, L. L. Avery, A. V. Asrani, and R. A. Novelline Multidetector CT of Blunt Thoracic Trauma1 RadioGraphics, October 1, 2008; 28(6): 1555 - 1570. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Restrepo, A. Eraso, D. Ocazionez, J. Lemos, S. Martinez, and D. F. Lemos The Diaphragmatic Crura and Retrocrural Space: Normal Imaging Appearance, Variants, and Pathologic Conditions1 RadioGraphics, September 1, 2008; 28(5): 1289 - 1305. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. P. Cantwell The Dependent Viscera Sign Radiology, February 1, 2006; 238(2): 752 - 753. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Nchimi, D. Szapiro, B. Ghaye, V. Willems, J. Khamis, L. Haquet, C. Noukoua, and R. F. Dondelinger Helical CT of Blunt Diaphragmatic Rupture Am. J. Roentgenol., January 1, 2005; 184(1): 24 - 30. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nishino, M. Kuroki, P. M. Boiselle, J. F. Copeland, V. Raptopoulos, and H. Hatabu Coronal Reformations of Volumetric Expiratory High-Resolution CT of the Lung Am. J. Roentgenol., April 1, 2004; 182(4): 979 - 982. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
