Helical CT with sagittal and coronal reconstructions: Accuracy for detection of diaphragmatic injury

Anna R. Larici, Michael Gotway, Harold I. Litt, Gautham P. Reddy, W. Richard Webb, Carol A. Gotway, Samuel K. Dawn, Shelley R. Marder, Maria Luigia Storto

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)451-457
Number of pages7
JournalAmerican Journal of Roentgenology
Volume179
Issue number2
StatePublished - 2002
Externally publishedYes

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Spiral Computed Tomography
Diaphragm
Wounds and Injuries
Contrast Media
Sensitivity and Specificity
Thorax

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Larici, A. R., Gotway, M., Litt, H. I., Reddy, G. P., Webb, W. R., Gotway, C. A., ... Storto, M. L. (2002). Helical CT with sagittal and coronal reconstructions: Accuracy for detection of diaphragmatic injury. American Journal of Roentgenology, 179(2), 451-457.

Helical CT with sagittal and coronal reconstructions : Accuracy for detection of diaphragmatic injury. / Larici, Anna R.; Gotway, Michael; Litt, Harold I.; Reddy, Gautham P.; Webb, W. Richard; Gotway, Carol A.; Dawn, Samuel K.; Marder, Shelley R.; Storto, Maria Luigia.

In: American Journal of Roentgenology, Vol. 179, No. 2, 2002, p. 451-457.

Research output: Contribution to journalArticle

Larici, AR, Gotway, M, Litt, HI, Reddy, GP, Webb, WR, Gotway, CA, Dawn, SK, Marder, SR & Storto, ML 2002, 'Helical CT with sagittal and coronal reconstructions: Accuracy for detection of diaphragmatic injury', American Journal of Roentgenology, vol. 179, no. 2, pp. 451-457.
Larici, Anna R. ; Gotway, Michael ; Litt, Harold I. ; Reddy, Gautham P. ; Webb, W. Richard ; Gotway, Carol A. ; Dawn, Samuel K. ; Marder, Shelley R. ; Storto, Maria Luigia. / Helical CT with sagittal and coronal reconstructions : Accuracy for detection of diaphragmatic injury. In: American Journal of Roentgenology. 2002 ; Vol. 179, No. 2. pp. 451-457.
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abstract = "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.",
author = "Larici, {Anna R.} and Michael Gotway and Litt, {Harold I.} and Reddy, {Gautham P.} and Webb, {W. Richard} and Gotway, {Carol A.} and Dawn, {Samuel K.} and Marder, {Shelley R.} and Storto, {Maria Luigia}",
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T1 - Helical CT with sagittal and coronal reconstructions

T2 - Accuracy for detection of diaphragmatic injury

AU - Larici, Anna R.

AU - Gotway, Michael

AU - Litt, Harold I.

AU - Reddy, Gautham P.

AU - Webb, W. Richard

AU - Gotway, Carol A.

AU - Dawn, Samuel K.

AU - Marder, Shelley R.

AU - Storto, Maria Luigia

PY - 2002

Y1 - 2002

N2 - 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.

AB - 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.

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