Jose C. Varghese

Accuracy of MDCT in the diagnosis of choledocholithiasis.

OBJECTIVE Our purpose was to evaluate the diagnostic performance of contrast-enhanced and unenhanced MDCT, performed for various indications, in detecting choledocholithiasis. CONCLUSION Unenhanced and contrast-enhanced MDCT images, interpreted in PACS workstations with axial images, are moderately sensitive and specific for showing choledocholithiasis.

Evaluation of Blunt Abdominal Trauma Using PACS-Based 2D and 3D MDCT Reformations of the Lumbar Spine and Pelvis

OBJECTIVE The purpose of this study was to show the value of 2D and 3D reformations of CT data from abdominal and pelvic CT performed immediately at the workstation using a PACS-based software program to evaluate the lumbar spine and pelvis in patients with blunt abdominal trauma. MATERIALS AND METHODS We reviewed the abdominopelvic CT scans and conventional radiographs of the lumbar spine or pelvis of 156 consecutive patients with blunt abdominal trauma. The CT data were compared with the radiographic findings and also with the findings of dedicated repeat CT of the spine or pelvis, when performed. RESULTS CT depicted 80 fractures of the lumbar spine and 178 pelvic fractures. Radiography showed 40 fractures of the lumbar spine and 138 pelvic fractures. No additional fractures were identified on dedicated repeat CT. CONCLUSION Conventional radiographs to clear the lumbar spine are no longer required when abdominopelvic CT data are available. CT and reformatted CT data show more fractures than radiography and miss no fractures compared with dedicated CT of the lumbar spine or pelvis. Having these images immediately available through the PACS workstation saves time for the trauma team in the management of critically ill patients.

Trauma Imaging: Protocol Considerations Utilizing 64MDCT

The application of 64MDCT technology offers a significant evolution in imaging of patients with multiple trauma. Technological advances have allowed the integration of novel protocols into the initial assessment of the critically injured patient. This article details current trauma protocols using 64MDCT and discusses considerations in applying 64MDCT to trauma imaging, including multiplanar and three-dimensional image analysis, as well as radiation issues.

Spontaneous Hemoperitoneum: Imaging Findings and Etiologies

Spontaneous hemoperitoneum may be extremely difficult to diagnose and may have a catastrophic outcome. It most commonly presents as acute abdominal pain, which may be accompanied by abdominal distention, hypotension, and tachycardia. There are few physical signs that point specifically to hemoperitoneum. Hematologic parameters suggesting the diagnosis include an unexplained drop in hematocrit in a patient presenting with acute abdominal pain; however, in the acute setting, the hematocrit may not drop in tandem with the intraperitoneal hemorrhage. As a result, imaging is the most reliable examination for diagnosing spontaneous hemoperitoneum, and its role is three-fold: (1) to make the diagnosis of hemoperitoneum; (2) to identify ongoing active bleeding; and (3) to identify an underlying cause of the hemorrhage. The possible etiologies of spontaneous hemoperitoneum are varied, with causes including visceral rupture, vascular rupture, coagulopathy, and gynecologic pathology.