Value of coronal reformations in the CT evaluation of acute head trauma.
OBJECTIVE
Routine axial CT images may not be ideally suited for detecting ICH in transversely oriented locations such as the floor of the anterior and middle cranial fossas and vertex. This study was performed to evaluate whether coronal reformations improve detection of ICH in NCCT performed for head trauma.


METHODS
All patients undergoing a first NCCT in the ED for evaluation of head trauma were included prospectively during a 6-month interval. NCCT images were reconstructed into standard 5-mm axial datasets and were also reformatted into coronal datasets of 5-mm sections and 2.5-mm intervals. Thirty-two of 213 (15%) scans were interpreted as showing traumatic ICH. These cases were interspersed with 30 studies without ICH. Cases were reviewed for the presence and location of ICH by 2 staff neuroradiologists.


RESULTS
Of 213 patients, 32 NCCTs demonstrated ICH (a total of 104 foci). Fifteen of 104 (14%) ICHs (8 patients) were detected solely on coronal images. Locations included the floor of the anterior and middle cranial fossas, vertex, corpus callosum, falx, tentorium, and occipital convexity. Coronal reformations allowed exclusion of suspicious findings on axial images in 14 instances (7 patients). Coronal images aided interpretation in 29/104 (28%) findings.


CONCLUSIONS
Coronal reformations improve the detection of ICH over axial images alone, especially for lesions that lie in the axial plane immediately adjacent to bony surfaces. The use of coronal reformations should be considered in the routine interpretation of head CT examinations performed for the evaluation of head trauma.
Wei
S C
SC
Division of Neuroradiology, Massachusetts General Hospital, Boston, MA 02114, USA.
Ulmer
S
S
Lev
M H
MH
Pomerantz
S R
SR
González
R G
RG
Henson
J W
JW
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020202:Cerebral Hemorrhage, Traumatic / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000601:surgery; D003399:Craniotomy; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult