title: Dual-source CT in blunt trauma patients: elimination of diaphragmatic motion using high-pitch spiral technique.
abstract: The purpose of this study was to compare diaphragmatic motion on dual-source high-pitch (DS-HP) and conventional single-source (SS) CT scans in trauma patients. Seventy-five consecutive trauma patients who presented to a level one trauma center over a 6-month period were scanned with a standardized whole body trauma CT protocol including both DS-HP chest (pitch = 2.1-2.5) and SS abdominal CT scans. Subjective analysis of diaphragmatic motion was performed by two readers using a four-point motion scale in seven regions of the diaphragm on coronal and axial slices. An overall confidence score to exclude a diaphragmatic tear was determined (1 to 10, 10: completely confident and 1: impossible to exclude). Wilcoxon rank sum tests were used for statistical analysis, and p < 0.05 was considered significant. Mean confidence score of 9.85 for DS-HP was significantly better than the mean score of 7.66 for SS images (p < 0.0001). Diaphragmatic motion scores and subjective diaphragmatic motion artifact on coronal and axial images were significantly better for DS-HP images in all areas when compared individually (p < 0.0001) and overall (p < 0.0001). Regions of DS-HP (99.2 %) were diagnostic, whereas only 87.0 % % regions on SS were. Complete agreement of motion scores was present in 92 % of cases, with moderate overall agreement for confidence to exclude a diaphragmatic tear (κ = 0.45). Dual-source high-pitch CT scanning is advantageous as it allows for significantly better evaluation of diaphragmatic structures by minimizing motion artifacts on images of freely breathing trauma patients.
authors.affiliation: Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. teresaliang86@gmail.com.
authors.forename: Teresa
authors.initials: T
authors.lastname: Liang
authors.affiliation: Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: McLaughlin
authors.affiliation: Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Chesnal D
authors.initials: CD
authors.lastname: Arepalli
authors.affiliation: Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Luck J
authors.initials: LJ
authors.lastname: Louis
authors.affiliation: Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Bilawich
authors.affiliation: Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Mayo
authors.affiliation: Department of Radiology, Vancouver General Hospital, 3350-950 W 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
authors.forename: Savvas
authors.initials: S
authors.lastname: Nicolaou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D003964:Diaphragm / Q000293:injuries / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D012119:Respiration; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Computed tomography (CT); Diaphragmatic injury; Motion artifact; Respiratory motion; Trauma