MDCT in the assessment of laryngeal trauma: value of 2D multiplanar and 3D reconstructions.
OBJECTIVE
The purpose of this study was to analyze fracture patterns and related effects of laryngeal trauma and to assess the value of 2D multiplanar reformation (MPR) and 3D reconstruction.


METHODS
Among 4222 consecutively registered trauma patients who underwent emergency MDCT, 38 patients had presented with laryngeal trauma. Axial, 2D MPR, 3D volume-rendered, and virtual endoscopic images were analyzed retrospectively by two blinded observers according to predefined criteria. Laryngeal fractures, soft-tissue injuries, and airway compromise were evaluated and correlated with clinical, endoscopic, surgical, and follow-up findings.


RESULTS
Fifty-nine fractures (37 thyroid, 13 cricoid, nine arytenoid) were present in 38 patients. They were isolated in 21 (55%) patients. The other 17 (45%) patients had additional injuries to the neck, face, brain, chest, or abdomen. Laryngeal fractures were bilateral in 31 (82%) patients and were associated with hyoid bone fractures in nine (24%) patients. Arytenoid luxation was present in eight cartilages. Axial imaging missed 7 of 59 (12%) laryngeal fractures, six of eight (75%) arytenoid luxations, and four of nine (44%) hyoid bone fractures. Additional 2D MPR imaging missed 5 of 59 (8%) laryngeal fractures, five of eight (62.5%) arytenoid luxations, and two of nine (22%) hyoid bone fractures, whereas 3D volume-rendered images depicted them all. Virtual endoscopy and 3D volume rendering added diagnostic accuracy with respect to the length, width, shape, and spatial orientation of fractures in 22 of 38 (58%) patients; arytenoid luxation in six of eight (75%) luxations; and the evaluation of airway narrowing in 19 of 38 (50%) patients. Three-dimensional volume rendering was not of additional value in evaluation of the cricoid cartilage.


CONCLUSIONS
The use of 2D MPR and 3D volume rendering with or without virtual endoscopy improved assessment of thyroid and hyoid bone fractures, arytenoid luxations, and laryngotracheal narrowing, providing helpful data for optimal management.
1 Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
Minerva
M
Becker
Pier-Olivier
PO
Duboé
Alexandra
A
Platon
Romain
R
Kohler
Jean-Pierre
JP
Tasu
Christoph D
CD
Becker
Pierre-Alexandre
PA
Poletti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data*; D007830:Larynx / Q000000981:diagnostic imaging* / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013557:Switzerland / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*