Emergency Radiology

, Volume 17, Issue 2, pp 97–102 | Cite as

Subtle pathology detection with multidetector row coronal and sagittal CT reformations in acute head trauma

  • T. Thomas ZachariaEmail author
  • Dan T. D. Nguyen
Original Article


We sought to analyze retrospectively the advantages of coronal and sagittal reformations obtained with multidetector row computed tomography (CT) in patients with acute head trauma. Multidetector 16-section CT was performed in 200 patients (110 male and 90 female; age range, 3–87 years; mean age, 45 years) with acute head trauma. Scans were performed sequentially, and axial 5-mm-thick slices were obtained from base of skull to vertex. The source data set was reformatted in coronal and sagittal planes, with 2-mm-thick sections at 2-mm intervals. Images were analyzed retrospectively by two independent, blinded readers. The final diagnosis was determined by clinical follow-up. CT imaging abnormalities were detected in 55 out of 200 patients who were scanned for head trauma. Acute traumatic intracranial abnormality was detected on axial scans in 45 patients. Subtle findings were confirmed on coronal and sagittal CT reformations in ten cases, and these were undetected initially on axial CT. Coronal and sagittal reformations confirmed subtle findings in 18.2% (10/55) of the cases (P = 0.001). Indeterminate neuroimaging findings confirmed by coronal and sagittal CT head reformations include tentorial and interhemispheric fissure subdural hemorrhage, subarachnoid hemorrhage, and inferior frontal and temporal lobe contusions. Coronal and sagittal CT head reformations improve the sensitivity and diagnostic confidence in the clinical setting of acute trauma. Overall, coronal and sagittal reformations improved diagnostic confidence and interobserver agreement over axial images alone for visualization of normal structures and in the diagnosis of acute abnormality.


Head trauma Multidetector CT Coronal reformations Sagittal reformations 


  1. 1.
    Murray JG, Gean AD, Evans SJ (1996) Imaging of acute head injury. Semin Ultrasound CT MR 17(3):185–205CrossRefPubMedGoogle Scholar
  2. 2.
    Levy RA, Rosenbaum AE, Kellman RM et al (1991) Assessing whether the plane of section on CT affects accuracy in demonstrating facial fractures in 3-D reconstruction when using a dried skull. AJNR Am J Neuroradiol 12(5):861–866PubMedGoogle Scholar
  3. 3.
    Luka B, Brechtelsbauer D, Gellrich NC et al (1995) 2D and 3D CT reconstructions of the facial skeleton: an unnecessary option or a diagnostic pearl? Int J Oral Maxillofac Surg 24:76–83CrossRefPubMedGoogle Scholar
  4. 4.
    Lee HJ, Jilani M, Frohman L et al (2004) CT of orbital trauma. Emerg Radiol 10(4):168–172CrossRefPubMedGoogle Scholar
  5. 5.
    Rake PA, Rake SA, Swift JQ et al (2004) A single reformatted oblique sagittal view as an adjunct to coronal computed tomography for the evaluation of orbital floor fractures. J Oral Maxillofac Surg 62(4):456–459CrossRefPubMedGoogle Scholar
  6. 6.
    Kreipke DL, Moss JJ, Franco JM et al (1984) Computed tomography and thin-section tomography in facial trauma. AJR Am J Roentgenol 142(5):1041–1045PubMedGoogle Scholar
  7. 7.
    Ball JB Jr (1987) Direct oblique sagittal CT of orbital wall fractures. AJR Am J Roentgenol 148(3):601–608PubMedGoogle Scholar
  8. 8.
    Altman DG (1994) Practical statistics for medical research. Chapman and Hall, London, pp 403–409Google Scholar
  9. 9.
    Kuhls DA, Malone DL, McCarter RJ et al (2002) Predictors of mortality in adult trauma patients: the physiologic trauma score is equivalent to the trauma and injury severity score. J Am Coll Surg 194:695–704CrossRefPubMedGoogle Scholar
  10. 10.
    Gupta AK, Nelson RC, Johnson GA et al (2003) Optimization of eight-element multi-detector row helical CT technology for evaluation of the abdomen. Radiology 227:739–745CrossRefPubMedGoogle Scholar
  11. 11.
    Marin D, Catalano C, De Filippis G et al (2009) Detection of hepatocellular carcinoma in patients with cirrhosis: added value of coronal reformations from isotropic voxels with 64-MDCT. AJR Am J Roentgenol 192(1):180–187CrossRefPubMedGoogle Scholar
  12. 12.
    Fayad M, Johnson P, Fishman EK et al (2005) Multidetector CT of musculoskeletal disease in the pediatric patient: principles, techniques, and clinical applications. Radio Graphics 25(3):603–618Google Scholar
  13. 13.
    Jaffe A, Nelson RC, Johnson GA et al (2006) Optimization of multiplanar reformations from isotropic data sets acquired with 16-detector row helical CT scanner. Radiology 238(1):292–299CrossRefPubMedGoogle Scholar
  14. 14.
    Poon WS, Rehman SU, Poon CY et al (1992) Traumatic extradural hematoma of delayed onset is not a rarity. Neurosurgery 30(5):681–686CrossRefPubMedGoogle Scholar
  15. 15.
    Hamilton M, Wallace C (1992) Nonoperative management of acute epidural hematoma diagnosed by CT: the neuroradiologist's role. AJNR Am J Neuroradiol 13(3):853–859PubMedGoogle Scholar
  16. 16.
    Wilberger JE Jr, Harris M, Diamond DL (1991) Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg 74(2):212–218CrossRefPubMedGoogle Scholar
  17. 17.
    Numerow LM, Fong TC, Wallace CJ (1994) Pseudo-delta sign on computed tomography: an indication of bilateral interhemispheric hemorrhage. J Can Assoc Radiol 45:23–27Google Scholar
  18. 18.
    Brocker B, Rabin M, Levin A (1991) Clinical and surgical management of head injury. Neuroimaging Clin N Amer 1:387–396Google Scholar
  19. 19.
    Guzzo JL, Bochicchio GV, Napolitano LM et al (2005) Prediction of outcomes in trauma: anatomic or physiologic parameters? J Am Coll Surg 201(6):891–897CrossRefPubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2009

Authors and Affiliations

  1. 1.Department of Radiology, Division of NeuroradiologyPennsylvania State UniversityHersheyUSA

Personalised recommendations