Validity of computerized tomography in blunt renal trauma.
OBJECTIVE
Improved imaging techniques and new therapeutic possibilities require rethinking the indication for laparotomy with regard to blunt renal trauma. Refined classification systems would facilitate the decision relating to therapy but they are based on knowledge of the imaging accuracy of computerized tomography (CT). We evaluated the validity of the CT depiction of renal injuries.


METHODS
A total of 42 porcine kidneys were subjected to traumatization of various degrees. They then underwent CT examination and were subsequently cross-dissected into slices 3 mm thick. The comparative evaluation involved 2,080 CT images and 1,819 macroscopic sectional views, which showed 3,521 and 3,778 individual lesions, respectively.


RESULTS
Using CT the overall extent of injury in renal trauma was only slightly overrated at an average of 15% higher than that seen on macroscopy. Simple linear lesions tended to be over assessed and parenchymal destruction tended to be under assessed. Central lesions were depicted more frequently than peripheral lesions. CT of medullary lesions and parenchymal detachment was not feasible.


CONCLUSIONS
CT of the kidney enables the distinction of different kinds of lesions and their localization well. Pelvic structures or vessels can imitate linear lesions. However, this imaging procedure can be used as a basis for refining categorization systems for blunt renal trauma. It can also be used to obtain a large quantity of lesion data for biomechanical investigations.
Bschleipfer
Thomas
T
Department of Urology, Ulm Military Hospital, Ulm/Donau, Germany.
Kallieris
Dimitrios
D
Hallscheidt
Peter
P
Hauck
Ekkehard W
EW
Weidner
Wolfgang
W
Pust
Reiner A
RA
D000818:Animals; D003287:Contrast Media / Q000008:administration & dosage; D066298:In Vitro Techniques; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D012680:Sensitivity and Specificity; D013552:Swine; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000473:pathology
D003287:Contrast Media