In the 352 Patients included in the study CE-MDCT identified 74 Patients with abdominal positive findings (20%),
with a total of 83 traumatic lesions due to the presence of two lesions in 9 patients (liver= n 30,
spleen= n 35,
Kidney= n 18),
with a diameter range of 1 to 10 cm.
On the basis of CE-MDCT findings,
considered as the reference standard,
we analyze the capacity of US and CEUS to identify the number of traumatic lesions.
US depicted 45/83 traumatic intraparenchymal lesions (liver= 19/30,
spleen= 16/35,
Kidney= 10/18),
with a sensibility of 54%.
83/83 lesions were identified at CEUS examination (liver= n 30,
spleen= n 35,
Kidney= n 18) with a sensibility of 100% (Table 2).
CE-MDCT has successfully staged all the 83 traumatic injuries using the AAST criteria [5-6].
Liver lesions (n=30) were classified as: grade I (n=5),
grade II (n=7),
grade III (n=13) and grade IV (n=5); splenic lesions (n=35) were classified as: grade I (n=6),
grade II (n=10),
grade III (n=13),
grade IV (n=6).
Kidney lesions (n=18) were so distributed: grade I (n=3),
grade II (n=6),
grade III (n=8),
grade IV (n=1).
On the basis of these values CEUS had successfully staged 74/83 traumatic lesions: 28/30 liver lesions (Fig. 4),
31/35 splenic lesions and 15/18 Kidney lesions with a sensibility of 89% (Table 3).
Nine lesions were understaged at CEUS examination: in 5 cases CEUS understaged minor traumatic injuries that needed a conservative,
nonsurgical management; in 3 cases CEUS did not recognize the presence of active bleeding (in 1/2 liver lacerations and in 2/4 splenic injuries) with a sensibility of 50%; finally,
in 1 case,
CEUS did not demonstrate a lesion of the urinary tract,
undestaging a IV grade kidney lesion on CE-MDCT (Fig. 5).
Therefore,
our main CEUS limitations are the poor visualization of active bleeding and the inability to demonstrate unirary tract lesions,
findings that are instead clearly depicted on CE-MDCT.
Only 3 patients with CEUS negative findings at the arrival in our Hospital and recalled on a phone-call one week later,
referred clinical symptoms and were subjected to a new CEUS examination which showed negative results.