title: Penetrating Colorectal Injuries: Diagnostic Performance of Multidetector CT with Trajectography.
abstract: Purpose To determine the diagnostic performance of multidetector computed tomography (CT) with trajectography for penetrating colorectal injuries. Materials and Methods This institutional review board-approved and HIPAA-compliant study was a 6-year blinded retrospective review by two independent readers of 182 consecutive patients who preoperatively underwent 40- or 64-row multidetector CT for penetrating torso trauma below the diaphragm and had surgically confirmed findings. Colorectal perforation was present in 42 patients. Trajectory analysis with postprocessing software was used for all studies. Additional signs evaluated were rectal contrast agent leak, collections of extruded fecal material, mural defect, wall thickening, abnormal enhancement, free fluid or stranding, and free air. The quality of the colorectal contrast agent administration was recorded. Sensitivity, specificity, predictive values, areas under the receiver operating characteristic curves (AUCs), and Cohen κ were determined. Results In patients with rectal contrast agent administration (n = 151), AUCs were 0.90-0.91, which indicated excellent accuracy. Trajectory was sensitive (88%-91%). For single wounds (n = 104), sensitivity of trajectory was 96% for both readers, but was only 80% for multiple wounds (n = 47). Contrast agent leak was highly specific (96%-98%), but insensitive (42%-46%). Improved diagnostic performance was observed in patients with poor colonic distension or opacification. Accuracy remained high (AUC, 0.86-0.99) in the group without rectal contrast agent administration (n = 31). Conclusion Trajectory had excellent sensitivity, while rectal contrast agent leak was specific but insensitive. Sensitivity of trajectory was lower for multiple wounds. Accuracy remained high in patients without rectal contrast agent administration.©RSNA, 2016.
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: David
authors.initials: D
authors.lastname: Dreizin
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Boscak
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Anstadt
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: Nikki
authors.initials: N
authors.lastname: Tirada
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: William C
authors.initials: WC
authors.lastname: Chiu
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: Felipe
authors.initials: F
authors.lastname: Munera
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Bodanapally
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: Michael
authors.initials: M
authors.lastname: Hornick
authors.affiliation: From the Department of Diagnostic Radiology and Nuclear Medicine (D.D., A.R.B., U.K.B., M.H.) and Department of Surgery (M.J.A., W.C.C., D.M.S.), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201; Department of Radiology, Brigham and Women's Hospital, Brookline, Mass (N.T.); and Department of Diagnostic Radiology, University of Miami Leonard Miller School of Medicine, Jackson Memorial Hospital & Ryder Trauma Center, Miami, Fla (F.M.).
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000328:Adult; D003106:Colon / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011446:Prospective Studies; D012007:Rectum / Q000000981:diagnostic imaging / Q000293:injuries*; D012189:Retrospective Studies; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*; D055815:Young Adult