European Radiology

, Volume 14, Issue 10, pp 1751–1760 | Cite as

Traumatic injuries of the pelvis and thoracic and lumbar spine: does thin-slice multidetector-row CT increase diagnostic accuracy?

  • C. HerzogEmail author
  • H. Ahle
  • M. G. Mack
  • B. Maier
  • W. Schwarz
  • S. Zangos
  • V. Jacobi
  • A. Thalhammer
  • J. Peters
  • H. Ackermann
  • T. J. Vogl
Computer Tomography


The objective is to evaluate different multidetector-row CT (MDCT) strategies for adequate classification of spinal and pelvic injuries. Seventy intubated patients after multiple trauma underwent conventional radiography (CR) and MDCT. Examinations included the pelvis (P), the lumbar spine (LS) and the thoracic spine (TS). Conventional radiographs, 3-mm (CT5) and 5-mm scans (CT3) and 3-mm and 5-mm scans combined with MPR (CT3R/CT5R) were compared to surgery, autopsy and clinical course. MDCT led to significantly better results than CR (P<0.01). Correlation coefficients were r=1.0 (CT3R), r=0.96 [TS] to r=1.0 [P/LS] (CT5R), r=0.8 [P] to r=1.0 [TS] (CT3), r=0.80 [P] to r=0.86 [TS] (CT5) and r=0.3 [TS] to r=0.69 [P] (CR). Fractures were identified by CT3R in 100% of cases, by CT5R in 95%, by CT3 in 90% [P]−100% [TS], by CT5 in 83.3% [LS]−90% [P] and by CR in 57.1% [TS]−87.2% [P]. Unstable fractures were identified in 100% by CT3R, CT5R and CT3, 85.7% [TS]−100% [P/LS] by CT5 and 57.1% [TS]−80% [P] by CR. Only overlapping thin-slice multiplanar reformation allows for an adequate classification of spinal and pelvic injuries and thus is highly emphasized in patients after severe blunt trauma.


Spine fractures Computed tomography Multiplanar reformations Trauma 


  1. 1.
    Flohr T, Stierstorfer K, Bruder H, Simon J, Polacin A, Schaller S (2003) Image reconstruction and image quality evaluation for a 16-slice CT scanner. Med Phys 30:832–845CrossRefPubMedGoogle Scholar
  2. 2.
    Linsenmaier U, Krotz M, Hauser H, Rock C, Rieger J, Bohndorf K et al (2002) Whole-body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740CrossRefPubMedGoogle Scholar
  3. 3.
    Wintermark M, Mouhsine E, Theumann N, Mordasini P, van Melle G, Leyvraz P et al (2003) Thoracolumbar spine fractures in patients who have sustained severe trauma: depiction with multi-detector row CT. Radiology 227:681–689PubMedGoogle Scholar
  4. 4.
    Wintermark M, Poletti P, Becker C, Schnyder P (2002) Traumatic injuries: organization and ergonomics of imaging in the emergency environment. Eur Radiol 12:959–968CrossRefPubMedGoogle Scholar
  5. 5.
    Magerl F, Aebi M, Gertzbein S, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201PubMedGoogle Scholar
  6. 6.
    Tile M (1984) Fractures of the pelvis and acetabulum. Wiliams & Wilkins, BaltimoreGoogle Scholar
  7. 7.
    Theumann N, Verdon J, Mouhsine E, Denys A, Schnyder P, Portier F (2002) Traumatic injuries: imaging of pelvic fractures. Eur Radiol 12:1312–1330CrossRefPubMedGoogle Scholar
  8. 8.
    Rommens P, Vanderschot P, Broos P (1992) Conventional radiography and CT examination of pelvic ring fractures. A comparative study of 90 patients. Unfallchirurg 95:387–392PubMedGoogle Scholar
  9. 9.
    Daffner R (2001) Helical CT of the cervical spine for trauma patients: a time study. Am J Roentgenol 177:677–679Google Scholar
  10. 10.
    Low R, Duber C, Schweden F, Lehmann L, Blum J, Thelen M (1997) Whole body spiral CT in primary diagnosis of patients with multiple trauma in emergency situations. Fortschr Rontgenstr 166:382–388Google Scholar
  11. 11.
    Weishaupt D, Grozaj A, Willmann J, Roos J, Hilfiker P, Marincek B (2002) Traumatic injuries: imaging of abdominal and pelvic injuries. Eur Radiol 12:1295–1311CrossRefPubMedGoogle Scholar
  12. 12.
    Schroder R, Albus M, Kandziora F, Herzog H, Rottgen R, Maurer J et al (2003) Diagnostic value of three-dimensional reconstruction in CT of traumatic spinal fractures. Fortschr Rontgenstr 175:1500–1507CrossRefGoogle Scholar
  13. 13.
    Bensch F, Kiuru M, Koivikko M, Koskinen S (2004) Spine fractures in falling accidents: analysis of multidetector CT findings. Eur Radiol 14:618–624CrossRefPubMedGoogle Scholar
  14. 14.
    Kalender W (2003) Computed Tomography. MCD, MunichGoogle Scholar
  15. 15.
    Kosling S, Dietrich K, Steinecke R, Kloppel R, Schulz H (1997) Diagnostic value of 3D CT surface reconstruction in spinal fractures. Eur Radiol 7:61–64CrossRefPubMedGoogle Scholar
  16. 16.
    Lehner K, von GS, Maurer J, Daschner H, Gerhardt P (1993) A comparison of plain film, axial CT, 2D and 3D reconstructions in unstable spinal injuries following surgery. Fortschr Rontgenstr 158:577–582Google Scholar
  17. 17.
    Wedegartner U, Lorenzen M, Lorenzen J, Nolte-Ernsting C, Weber C, Dieckmann C et al (2004) Multislice CT of the pelvis: dose reduction with regard to image quality. Fortschr Rontgenstr 176:106–112CrossRefGoogle Scholar
  18. 18.
    Robertson D, Sutherland C, Chan B, Hodge J, Scott W, Fishman E (1995) Depiction of pelvic fractures using 3D volumetric holography: comparison of plain X-ray and CT. J Comput Assist Tomogr 19:967–974PubMedGoogle Scholar
  19. 19.
    Resnik C, Stackhouse D, Shanmuganathan K, Young J (1992) Diagnosis of pelvic fractures in patients with acute pelvic trauma: efficacy of plain radiographs. Am J Roentgenol 158:109–112Google Scholar
  20. 20.
    Guillamondegui O, Pryor J, Gracias V, Gupta R, Reilly P, Schwab C (2002) Pelvic radiography in blunt trauma resuscitation: a diminishing role. J Trauma 53:1043–1047PubMedGoogle Scholar
  21. 21.
    Rhee P, Bridgeman A, Acosta J, Kennedy S, Wang D, Sarveswaran J et al (2002) Lumbar fractures in adult blunt trauma: axial and single-slice helical abdominal and pelvic computed tomographic scans versus portable plain films. J Trauma 53:663–667PubMedGoogle Scholar
  22. 22.
    Hauser C, Visvikis G, Hinrichs C, Eber C, Cho K, Lavery R et al (2003) Prospective validation of computed tomographic screening of the thoracolumbar spine in trauma. J Trauma 55:228–234PubMedGoogle Scholar
  23. 23.
    Ptak T, Rhea J, Novelline R (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 229:902–905PubMedGoogle Scholar
  24. 24.
    Kalender W (2003) The use of flat-panel detectors for CT imaging. Radiologe 43:379–387CrossRefPubMedGoogle Scholar
  25. 25.
    Pathria M, Petersilge C (1991) Spinal trauma. Radiol Clin North Am 29:847–865PubMedGoogle Scholar
  26. 26.
    Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831PubMedGoogle Scholar
  27. 27.
    Mirvis S (2003) Imaging in trauma and critical care. Elsevier, AmsterdamGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • C. Herzog
    • 1
    Email author
  • H. Ahle
    • 1
  • M. G. Mack
    • 1
  • B. Maier
    • 2
  • W. Schwarz
    • 1
  • S. Zangos
    • 1
  • V. Jacobi
    • 1
  • A. Thalhammer
    • 1
  • J. Peters
    • 1
  • H. Ackermann
    • 3
  • T. J. Vogl
    • 1
  1. 1.Institute for Diagnostic and Interventional RadiologyJ. W. Goethe-UniversityFrankfurtGermany
  2. 2.Department of TraumatologyJ. W. Goethe-UniversityFrankfurtGermany
  3. 3.Department of Epidemiology and Medical StatisticsJ. W. Goethe-UniversityFrankfurtGermany

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