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European Radiology

, Volume 24, Issue 10, pp 2640–2648 | Cite as

Effectiveness of contrast-enhanced ultrasound in the classification and emergency management of abdominal trauma

  • Faqin Lv
  • Yanting Ning
  • Xuan Zhou
  • Yukun Luo
  • Tong Liang
  • Yongkang Nie
  • Tanshi Li
  • Jie Tang
Emergency Radiology

Abstract

Objective

To analyse the correlation between contrast-enhanced ultrasound (CEUS)-based classification of the severity of abdominal parenchymal organ trauma and clinical outcomes, and to explore CEUS in classifying patients with such trauma, expecting that the use of CEUS will potentially enhance the quality and speed of the emergency management of abdominal trauma.

Methods

Three hundred six consecutive patients with blunt abdominal parenchymal organ trauma who received CEUS examination were retrospectively analysed. Two CEUS radiologists (identified as Reader A and Reader B in this study) who were not involved in the CEUS examinations of the patients were then asked to classify the patients independently according to their CEUS results. The classification results were later compared with patients’ clinical outcomes using Spearman’s rank correlation.

Results

The final clinical outcomes showed that 25.5 % (78/306) of patients received conservative treatment, 52.0 % (159/306) received minimally invasive treatment, and 22.5 % (69/306) received surgery. Spearman's rank correlation coefficients between the CEUS-based classification and clinical outcome were 0.952 from Reader A and 0.960 from Reader B.

Conclusions

CEUS can play an important role in the emergency management of abdominal trauma through the classification of patients for different treatment methods.

Key points

The severity of abdominal trauma was classified by contrast-enhanced ultrasound (CEUS)

There was a high correlation between CEUS-based classification and clinical outcomes

CEUS-based classification is helpful for surgeons in the emergency management of abdominal trauma

Keywords

Abdominal parenchymal organ Trauma Contrast-enhanced ultrasound Classification Emergency 

Notes

Acknowledgements

We gratefully acknowledge The National Natural Science Foundation of China (No. 81371561, No. 81327003) and The Welfare Industry Research Program of Ministry of Health (No. 201002014) for their financial support. The scientific guarantor of this publication is Jie Tang. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Professor Xiutang Cao (Department of Statistics, Chinese People’s Liberation Army General Hospital) kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained, and written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, cross sectional study, multicentre study.

References

  1. 1.
    Mooney DP (2002) Multiple traumas: liver and spleen injury. Curr Opin Pediatr 14:482–485PubMedCrossRefGoogle Scholar
  2. 2.
    Novelline RA, Rhea JT, Rao PM, Stuk JL (1999) Helical CT in emergency radiology. Radiology 213:321–339PubMedCrossRefGoogle Scholar
  3. 3.
    Poletti PA, Wintermark M, Schnyder P, Becker CD (2002) Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol 12:969–978PubMedCrossRefGoogle Scholar
  4. 4.
    Linsenmaier U, Krötz M, Hauser H et al (2002) Whole body computed tomography in polytrauma: techniques and management. Eur Radiol 12:1728–1740PubMedCrossRefGoogle Scholar
  5. 5.
    Fang JF, Chen RJ, Wong YC et al (2000) Classification and treatment of pooling of contrast material on computed tomographic scan of blunt hepatic trauma. J Trauma 49:1083–1088PubMedCrossRefGoogle Scholar
  6. 6.
    Clemente N, Di Saverio S, Giorgini E et al (2011) Management and outcome of 308 cases of liver trauma in Bologna trauma center in 10 years. Ann Ital Chir 82:351–359PubMedGoogle Scholar
  7. 7.
    Ohtsuka Y, Iwasaki K, Okazumi S et al (2003) Management of blunt hepatic injury in children: usefulness of emergency transcatheter arterial embolization. Pediatr Surg Int 19:29–34PubMedGoogle Scholar
  8. 8.
    Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ (2002) Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma 52:420–425PubMedCrossRefGoogle Scholar
  9. 9.
    Advanced Trauma Life Support for Doctors - Student Course Manual (2008) Committee on trauma. American College of Surgeons, ChicagoGoogle Scholar
  10. 10.
    Körner M, Krötz MM, Degenhart C, Pfeifer KJ, Reiser MF, Linsenmaier U (2008) Current role of emergency US in patients with major trauma. Radiographics 28:225–242PubMedCrossRefGoogle Scholar
  11. 11.
    Poletti PA, Kinkel K, Vermeulen B, Irmay F, Unger PF, Terrier F (2003) Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology 227:95–103PubMedCrossRefGoogle Scholar
  12. 12.
    Valentino M, Serra C, Zironi G, De Luca C, Pavlica P, Barozzi L (2006) Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. Am J Roentgenol 186:1361–1367CrossRefGoogle Scholar
  13. 13.
    Valentino M, Serra C, Pavlica P, Barozzi L (2007) Contrast-enhanced ultrasound for blunt abdominal trauma. Semin Ultrasound CT MR 28:130–140PubMedCrossRefGoogle Scholar
  14. 14.
    Valentino M, Ansaloni L, Catena F, Pavlica P, Pinna AD, Barozzi L (2009) Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med 114:1080–1093PubMedCrossRefGoogle Scholar
  15. 15.
    Catalano O, Lobianco R, Raso MM, Siani A (2005) Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application. J Ultrasound Med 24:299–310PubMedGoogle Scholar
  16. 16.
    Catalano O, Cusati B, Nunziata A, Siani A (2006) Active abdominal bleeding: contrast-enhanced sonography. Abdom Imaging 31:9–16PubMedCrossRefGoogle Scholar
  17. 17.
    Tang J, Wang YX, Mei XG, An L, Li J, Lin Q (2007) The Value of contrast-Enhanced gray-scale ultrasound in the diagnosis of hepatic trauma: an animal experiment. J Trauma 62:1468–1472PubMedCrossRefGoogle Scholar
  18. 18.
    Tang J, Zhang H, Lv F, Li W, Luo Y, Wang Y, Li J (2008) Percutaneous injection treatment for blunt splenic trauma guided by contrast-enhanced ultrasound. J Ultrasound Med 27:925–933PubMedGoogle Scholar
  19. 19.
    Morel DR, Schwieger I, Hohn L et al (2000) Human pharmacokinetics and safety evaluation of SonoVue_, a new contrast agent for ultrasound imaging. Invest Radiol 35:80–85PubMedCrossRefGoogle Scholar
  20. 20.
    Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR (1995) Organ injury scaling: spleen and liver (1994 revision). J Trauma 38:323–324PubMedCrossRefGoogle Scholar
  21. 21.
    Bouillon B, Kanz KG, Lackner CK, Mutschler W, Sturm J (2004) The importance of Advanced Trauma Life Support (ATLS) in the emergency room. Unfallchirurg. 107(10):844–850Google Scholar
  22. 22.
    Lv FQ, Tang J, Luo YK, Nie YK, Jiao ZY, Li TS, Zhou X (2012) Percutaneous treatment of blunt hepatic and splenic trauma under contrast-enhanced ultrasound guidance. Clin Imaging 36:191–198PubMedCrossRefGoogle Scholar
  23. 23.
    Zago TM, Tavares Pereira BM, Araujo Calderan TR, Godinho M, Nascimento B, Fraga GP (2012) Nonoperative management for patients with grade IV blunt hepatic trauma. World J Emerg Surg 7:S8.1–S8.6Google Scholar
  24. 24.
    Stein DM, Scalea TM (2006) Nonoperative management of spleen and liver injuries. J Intensive Care Med 21:296–304PubMedCrossRefGoogle Scholar
  25. 25.
    Galvan DA, Peitzman AB (2006) Failure of nonoperative management of abdominal solid organ injuries. Curr Opin Crit Care 12:590–594PubMedCrossRefGoogle Scholar
  26. 26.
    Stassen NA, Bhullar I, Cheng JD et al (2012) Eastern Association for the Surgery of Trauma. Selective nonoperative management of blunt splenic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 73:S294–S300PubMedCrossRefGoogle Scholar
  27. 27.
    Raza M, Abbas Y, Devi V, Prasad KV, Rizk KN, Nair PP (2013) Non operative management of abdominal trauma – a 10 years review. World J Emerg Surg 8:14.1–6CrossRefGoogle Scholar
  28. 28.
    Lv F, Tang J, Luo Y, Li Z, Meng X, Zhu Z, Li T (2011) Contrast-enhanced ultrasound imaging of active bleeding associated with hepatic and splenic trauma. Radiol Med 116:1076–1082PubMedCrossRefGoogle Scholar
  29. 29.
    Mihalik JE, Smith RS, Toevs CC, Putnam AT, Foster JE (2012) The use of contrast-enhanced ultrasound for the evaluation of solid abdominal organ injury in patients with blunt abdominal trauma. J Trauma Acute Care Surg 73:1100–1105PubMedCrossRefGoogle Scholar
  30. 30.
    Dormagen J, Meyerdierks O, Gaarder C, Naess P, Sandvik L, Klow NE (2011) Contrast-enhanced ultrasound of the injured spleen after embolization—comparison with computed tomography. Ultraschall Med 32:485–491PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2014

Authors and Affiliations

  1. 1.Department of UltrasoundChinese People’s Liberation Army General HospitalBeijingChina
  2. 2.Department of EmergencyChinese People’s Liberation Army General HospitalBeijingChina
  3. 3.Department of Ultrasound, Foshan Hospital of Traditional Chinese MedicineGuangzhou University of Chinese MedicineGuangzhouChina
  4. 4.Department of RadiologyChinese People’s Liberation Army General HospitalBeijingChina

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