Case Study

Evaluation of a Polytrauma Patient

with the SOMATOM Emotion 6 Multislice CT
 Evaluation of a Polytrauma Patient
with the SOMATOM Emotion 6 Multislice CT

History

A 29-year-old man was admitted to the
hospital after a motor bike accident. He had
been hit by a truck. An initial CT scan
revealed multiple lesions: a bilateral fracture
of the occipital condyles at the skull base,
an unstable fracture of the cervical spine
at level C4, a double left-sided upper arm
fracture, bilateral contusions in the lower
lung lobes, a left-sided fracture in the sacral
bone, a fracture/dislocation of the right
hip and a right-sided tibial fracture.
He underwent neurosurgery for fixation
of the unstable C4-fracture and orthopedic
surgery stabilized his upper arm and tibial
fractures and reduced the hip dislocation.
He was put in traction for the occipital
condylar fractures and the hip fracture-
dislocation.
One week later, the intensive care
specialist ordered a new CT scan because
of respiratory distress, fever of unknown
origin and to reevaluate the status of the
brain, the occipital skull base fracture, the
postoperative cervical spine, the condition
of the lungs, the abdomen in search of an
infectious focus, and a pelvis examination
for the position of the sacral fracture and
the right hip.

2 Case Study
Technical Data

A multi-region whole body CT examination After IV iodine contrast administration

was performed with the following scan the following scan parameters were
parameters (polytrauma-protocol): used with CARE* Dose:

Skull: Base-Fossa Posterior Thorax

kV 130 kV kV 130 kV
Eff. mAs 160 mAs Eff. mAs 51 mAs
Rotation 1s Rotation 0.6 s
Slice collimation 6 x 1 mm Slice collimation 6 x 2 mm
Table feed/rotation 4 mm Table feed/rotation 16 mm
Reconstruction 3/3 mm medium smooth Reconstruction 8/8 mm medium filter
filter (H30s-fossa/base (B40s-mediastinum
window) and 2/1 mm window), 2/1 mm
sharp filter (H70s-bone sharp filter (B70s-bone
window) window) and 8/8 mm
Skull: Brain moderate sharp filter
kV 130 kV (B50s-lung window)
Eff. mAs 160 mAs
Rotation 1s Abdomen-Pelvis
Slice collimation 6 x 2 mm kV 130 kV
Table feed/rotation 8 mm Eff. mAs 95 mAs
Reconstruction 8/8 mm medium smooth Rotation 1s
filter (H30s-brain window) Slice collimation 6 x 2 mm
and 2/2 mm sharp filter Table feed/rotation 9 mm
(H70s-bone window) Reconstruction 5/5 mm medium
smooth filter (B40s-
Cervical Spine abdomen window) and
kV 130 kV 2/1 mm sharp filter
Eff. mAs 70 mAs (B70s-bone window)
Rotation 1.5 s
Slice collimation 6 x 1 mm
Table feed/rotation 7.5 mm
Reconstruction 1.25/0.6 mm medium
sharp filter (H60s-bone
window) for MPR * Combined Applications to Reduce Exposure

3
A B
[1] (A): Axial image
of bilateral condylar
fractures
(B): Coronal MPR
image of bilateral
condylar fractures

Results

The CT of the head showed the bilateral
occipital condylar fractures, type III [1], non-
displaced on the right side and slightly
inferomedially displaced on the left side [1].
There was no change in comparison with
the first CT scan performed upon admission
of the patient. There were no intracranial
lesions.
The cervical spine CT showed a correct
neurosurgical stabilization and reduction
of the complex C4 fracture by intersomatic
arthrodesis and anterior plate osteo-
synthesis [2]. At the thoriac level there was
a bilaterial pleural effusion, atelactasis of
the lower lobes and an image suggestive
of the onset of ARDS in the upper lobes [3].
Especially of interest is the ”Extended Field-
of-View” reconstruction option, whereby
anatomy contained within the entire 70 cm
gantry opening can be displayed. This
feature allows imaging of the thorax and
abdomen with the patient’s arms resting at
the side of the body without a significant
loss in image quality [4].

A A
[3] (A): Axial [4] (A): Axial image
image of thorax of abdomen
mediastinal
(B): Coronal MPR
window
image of thorax and
(B): Axial image upper abdomen
of thorax/lung (artifacts due to
window (artifacts external fixation
due to external osteosynthesis of
B fixation osteo- the left humerus)
synthesis of the
left humerus) B

4 Case Study
A B C
[2] (A): Sagittal
MPR image of
postoperative
cervical spine
(B): Sagittal
VRT image of
postoperative
cervical spine
(C): Axial image
of postoperative
cervical spine

Our patient was scanned with the left arm
resting at the side of his body. The scan
showed a double fracture of the humeral
diaphysis with displacement. Artifacts are
due to external fixation osteosynthesis [5].
The pelvis examination showed a posterior
acetabulum fracture and a reduction of
the previous left hip dislocation [6] and
confirmed a non-displaced left-sided
sacrum fracture, extending in the sacral
neuroforamina S1 and S2 [6].
The total scan time for this whole body
CT-examination was 90 seconds (skull base:
21 s; cerebrum: 15 s; cervical spine: 21 s;
thorax and upper abdomen: 17 s; pelvis:
16 s), which is satisfactory in comparison
with the first CT scan of this patient
which was performed on our SOMATOM
Sensation 16 scanner (total scan time:
67 s). Furthermore, in the follow-up study,
a 16-second dedicated pelvis examination
was performed, which was not done in the
first examination.

A B A B
[5] A: SSD image
of left humerus
fracture
(B): VRT image
of left humerus
fracture

C
[6] (A): Axial image
of posterior acetabular
fracture
(B): Axial image of left
sacrum fracture
(C): Coronal MPR image
D of left sacrum fracture
(D): VRT image of pelvis:
posterior view on
acetabular fracture and
sacral fracture

5
 Comments

In the evaluation of the life-threatening For polytrauma patients who undergo CT

situation of a polytrauma patient, there is of the cervical spine, there is no need for
a strong need for fast and accurate medical plain-film examinations on a routine basis.
imaging, minimizing the time between The C-spine X-rays do not lead to additional
the traumatic event and the definitive information or do not increase the
treatment. CT and especially Multislice Spiral diagnostic confidence of the radiologist [7].
CT (MSCT) is hereby the method of choice.
Use of ultrasound examination as a
Recent studies show a marked tendency to screening tool for abdominal injury in
use whole body Multislice CT as a primary the hemodynamically stable trauma
diagnostic tool in the management of patient results in underdiagnosis of intra-
polytraumatized patients. Compared to the abdominal injury, especially in the absence
“gold standard” (a combination of standard of hemoperitoneum and in retroperitoneal
X-rays – thorax AP, cervical spine-lateral injuries. Those patients should undergo CT
view and pelvis AP – and ultrasonography scanning [8][9].
of the abdomen and thorax in the
Pelvis X-ray has limited sensitivity for
emergency room), MSCT has a better
detecting pelvic fractures compared with
diagnostic accuracy and is faster [2][3].
CT scanning [10][11]. Hemodynamically stable
The early use of MSCT shortens the time
patients who undergo CT scanning during
for diagnostic work-up substantially
their immediate resuscitation do not need
(approximately 50%) [3].
a routine pelvis X-ray [10].
CT remains the primary imaging modality
Thorax CT is highly sensitive in detecting
for initial evaluation of patients who have
thoracic injuries after blunt chest trauma
head trauma, while magnetic resonance
and is superior to routine X-ray in visualizing
imaging, despite its partly superior
lung contusions and pneumo- and
diagnostic information, remains reserved
hemothorax [12][13]. However, the chest
to particular diagnostic problems [4][5].
X-ray should stay as a “front-line” screening
In the cervical spine, it is generally
method because of its superbly quick
known that many fractures are missed
feasibility and availability.
or incompletely shown with radiography
(ranging from 10% to 36%), mainly because
of the suboptimal conditions common with
uncooperative trauma victims [6].

6 Case Study
In general, the use of MSCT in the diagnostic
work-up of polytrauma patients will change
our radiological practice. Advantages for
the patient arose from the standardized
examination protocol using Multislice CT.
If integrated in an interdisciplinary
management concept, it is a good
trade-off between examination time,
comprehensive diagnostic imaging,
life-saving therapeutic procedures, and
therapy planning [2][3].
References
[1] Radiological and clinical spectrum of occipital condyle fractures:
retrospective review of 107 consecutive fractures in 95 patients.
Hanson J. A., Deliganis A. V. et al. Am. J. Roentgenol 2002 May;
178 (5): 1261-8
[2] Early clinical management after polytrauma with 1 and 4-slice
spiral CT. Kloppel R., Schreiter D., et al. Radiologe 2002 Jul;
42 (7): 541-6
[3] Modern CT diagnosis for acute thoracic and abdominal trauma.
Rieger M., Sparr H., et al. Anaesthesist 2002 Oct; 51 (10): 835-42
[4] The Brain Trauma Foundation. The American Association of
Neurological Surgeons. The Joint Section on Neurotrauma and
Critical Care. Computed tomography scan features. J. Neurotrauma
2000 Jun-Jul; 17 (6-7): 597-627
[5] Clinical evaluation of patients with head trauma. Ko DY
Neuroimaging Clin. N. Am. 2002 May; 12 (2): 165-74
[6] Cervical spine trauma: how much more do we learn by routinely
using helical CT? Nunez D. B. Jr., Zuluaga A. et al. Radiographics
1996 Vol. 16; 1307-1318
[7] Plain films not needed with CT to evaluate polytrauma spinal
injuries. Rozenberg D. et al. RSNA meeting Chicago, Dec 2002
[8] Not so FAST (Focused Assessment with Sonography for Trauma).
Miller M. T., Pasquale M. D., et al. J. Trauma 2003 Jan;
54 (1): 52-9
[9] Abdominal injuries without hemoperitoneum: a potential limitation
of focused abdominal sonography for trauma. (FAST). Chiu W. C.,
Cushing B. M. et al. J. Trauma 1997 Oct; 42 (4): 623-625
[10] Pelvic radiography in blunt trauma resuscitation: a diminishing
role. Guillamondegui O. D., Pryor J. P., et al. J. Trauma 2002 Dec;
53 (6): 1043-7
[11] Multislice CT (MSCT) in the Detection and Classification of Pelvic
and Acetabular Fractures. Wedegartner U., Gatzka C., et al. Rofo
Fortschr. Geb. Rontgenstr. Neuen Bildgeb. Verfahr. 2003 Jan;
175 (1): 105-11
[12] Imaging diagnosis of nonaortic thoracic injury. Shanmuganathan
K., Mirvis S. E. Radiol. Clin. North Am. 1999 May; 37 (3): 533-551
[13] Significance of findings of chest X-rays and thoracic CT routinely
performed at the emergency unit: 102 patients with multiple
trauma. A prospective study. Grieser T., Buhne K. H., et al. Rofo
Fortschr. Geb. Rontgenstr. Neuen Bildgeb. Verfahr. 2001 Jan;
173 (1): 44-51
7
Authors:

T. Mulkens, P. Bellinck and J.-L. Termote

Department of Radiology
H.-Hart Ziekenhuis, Lier, Belgium

The information in this document contains general

descriptions of the technical options available, which
do not always have to be present in individual cases.
The required features should therefore be specified in
each individual case at the time of closing the contract.

The information presented in this case report is for

illustration only and is not intended to be relied upon
by the reader for instruction as to the practice of
medicine. Any health care practitioner reading this
information is reminded that he/she must use his/her
own learning, training and expertise in dealing with
his/her individual patients. This material does not
substitute for that duty and is not intended by Siemens
Medical Solutions Inc., to be used for any purpose in
that regard.

The drugs and doses mentioned herein were specified

to the best of our knowledge. We assume no
responsibility whatsoever for the correctness of this
information. Variations may prove necessary for
individual patients. The treating physician bears the
sole responsibility for all of the parameters selected.

Original images always lose a certain amount of detail

when reproduced.

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