FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3161661050> ?p ?o ?g. }

• W3161661050 endingPage "E120" @default.
• W3161661050 startingPage "E119" @default.
• W3161661050 abstract "HomeRadioGraphicsVol. 41, No. 4 PreviousNext Emergency RadiologyFree AccessInvited Commentary: Key Concepts of CT for Penetrating Abdominopelvic InjuriesFabio M. Paes, Felipe Munera Fabio M. Paes, Felipe Munera Author AffiliationsFrom the Department of Radiology, University of Miami-Miller School of Medicine, Jackson Memorial Hospital/Ryder Trauma Center, University of Miami Health System (UHealth), 1611 NW 12th Ave, West Wing 279, Miami, FL 33136. Address correspondence to F.M. (e-mail: [email protected]).Fabio M. PaesFelipe Munera Published Online:May 21 2021https://doi.org/10.1148/rg.2021210041MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In See also the article by Naeem et al in this issue. Penetrating injuries are among the most important public health problems worldwide and in the United States, resulting in substantial mortality, morbidity, and disability annually. Even in the middle of a viral pandemic, penetrating trauma remains in the minds of all emergency personnel because of the concomitant epidemic of gun violence. Recent data have shown that large urban cities like New York, Chicago, and Baltimore had a paradoxical increase in gun-related violence during the COVID-19 pandemic in 2020 (1). In the United States, firearm-related deaths have progressively increased in the past decade, claiming the lives of more than 40 000 individuals yearly since 2017 (2). The rate of premature gunshot-related mortality now exceeds that of motor vehicle accidents. Further estimates show that the number of nonfatal firearm injuries treated in emergency departments is almost double the number of firearm-related deaths, bringing the total societal cost of gunshot-related injuries and deaths close to $229 billion in 2015 (2). In most trauma centers, multidetector CT has had an increasing role in diagnostic algorithms for hemodynamically stable patients after penetrating wounds to the torso, helping triage these patients for surgery or expectant nonsurgical treatment. In their article, Naeem et al (3) provide a comprehensive, informative, and practical discussion of the role of multidetector CT in penetrating injury evaluation, reviewing basic information on ballistics and describing important imaging patterns of solid-organ and hollow viscus injuries. Given the subtleties and complexities of the imaging findings after penetrating trauma to the abdominal and pelvic cavity, the information provided is of great importance to all radiologists, especially those in training or routinely involved in emergency and trauma care.Naeem et al (3) begin their article by reviewing ballistics concepts that are crucial for understanding the imaging characteristics associated with the tissue damage that follows a gunshot wound. In short, the type of gun and bullet determine the amount of energy deposition, which, together with injured tissue characteristics, determines how much damage occurs (4). High-density or nonelastic tissues (eg, bone, liver, spleen, and kidney) usually incur more damage in response to penetrating forces than do elastic or low-density tissues such as the lung. The presentation of the kinetic energy equation and the precise drawings of the terminal ballistic injury path help the reader understand and solidify these concepts.The controversial topic of enteric contrast material use in the penetrating trauma CT examination is discussed, with a short review of the pros and cons of its use. Although limited, data exist that show the additive value of triple-contrast CT (ie, intravenous, oral, and rectal) in evaluation of patients with penetrating trauma (5,6). However, its adoption still varies greatly among trauma centers and is very dependent on the trauma team’s experience with the protocol. At our institution, triple-contrast CT is often used in hemodynamically stable patients with penetrating injury with excellent reproducibility and accuracy. The theoretical treatment delay and aspiration concerns have not proved to be a significant deterrent to our trauma surgeons in these patients (6,7).Thorough and cautious evaluation of the entire trajectory of the penetrating trauma mechanism on CT images, from its entrance site to the exit wound, is fundamental for identifying all significant injuries (5,7). Unlike a blunt trauma mechanism where injury pattern recognition is based on an efficient imaging search strategy, most injuries are determined by the penetrating object trajectory in cases of penetrating trauma. The authors strengthen these concepts by reviewing tractography’s value by using multiplanar reformations and discussing the limitations and pitfalls, particularly with attention to ricochets of bullets, patient motion, and multiple gunshot wound scenarios, which make imaging evaluation more difficult (3).Multidetector CT provides a large amount of useful information for treatment planning, decision making, and outcome prediction in patients with penetrating injury. The authors provide a broad discussion of selected abdominal and pelvic traumatic injury imaging findings and the corresponding clinical significance, including the importance of characterizing fluid in the peritoneal cavity, depicting the sentinel clot sign, and understanding the limitations of pneumoperitoneum in the detection of intraperitoneal organ injuries. The detection and correct classification of bowel, anorectal, bladder, and mesenteric injuries can be challenging and require a high degree of suspicion and familiarity by radiologists. The presentation of direct and indirect signs of injury and trajectography and cystography techniques with corresponding well-selected case examples provides the necessary tools to improve radiologic evaluation and accuracy. Regarding the solid organs, the authors emphasize the need for correct and detailed characterization of the injuries with adequate utilization of the American Association for the Surgery of Trauma (AAST) grading system at CT reporting to help triage patients for nonsurgical treatment. The supplementary figures corresponding to the 2018 updated AAST grading system are a bonus feature for the reader. Also, vascular injuries are discussed with attention to the direct and indirect signs (including the uncommon bullet embolism) and classification system, with greater detail about key treatment strategies, including the use of the resuscitative endovascular balloon occlusion of the aorta (REBOA) technique, with which nontrauma radiologists may not be familiar. Unfortunately, discussion of the diaphragm, which is injured in 10%–15% of stab or gunshot wounds to the torso, is missing from the article, likely because of article length constraints. Unlike the large defects or rupture from blunt trauma to the diaphragm, diaphragmatic injuries from penetrating trauma are often small and difficult to depict at early posttraumatic imaging (8). They are also difficult to detect intraoperatively at exploratory laparotomy unless directed by a high degree of clinical suspicion or preoperative imaging findings. The trajectory and evidence of injury above and below the diaphragm are the most important signs to suggest an imaging diagnosis. A delay in diagnosis and management can lead to complications from incarceration and strangulation of herniated contents, with associated high morbidity and mortality (8).In summary, Naeem et al provide us with an excellent review of key concepts of traditional CT in penetrating trauma to the abdomen and pelvis. Newer technologies such as dual-energy CT and automated quantitative analysis by using deep learning algorithms are currently under development and investigation (9,10). These techniques may provide missing quantitative information to increase our diagnostic accuracy and ability to render personalized and objective treatment recommendations in patients with penetrating trauma.The authors have disclosed no relevant relationships.References1. Sutherland M, McKenney M, Elkbuli A. Gun violence during COVID-19 pandemic: paradoxical trends in New York City, Chicago, Los Angeles and Baltimore. Am J Emerg Med 2021;39(225):226. Google Scholar2. McLean RM, Harris P, Cullen J, et al. Firearm-related injury and death in the United States: a call to action from the nation’s leading physician and public health professional organizations. Ann Intern Med 2019;171(8):573–577. Crossref, Medline, Google Scholar3. Naeem M, Hoegger M, Petraglia F, et al. CT of penetrating abdominopelvic trauma. RadioGraphics 2021;41(4):1064–1081. Link, Google Scholar4. Sodagari F, Katz DS, Menias CO, et al. Imaging evaluation of abdominopelvic gunshot trauma. RadioGraphics 2020;40(6):1766–1788. Link, Google Scholar5. Dreizin D, Munera F. Multidetector CT for penetrating torso trauma: state of the art. Radiology 2015;277(2):338–355. Link, Google Scholar6. Lozano JD, Munera F, Anderson SW, Soto JA, Menias CO, Caban KM. Penetrating wounds to the torso: evaluation with triple-contrast multidetector CT. RadioGraphics 2013;33(2):341–359. Link, Google Scholar7. Durso AM, Paes FM, Caban K, et al. Evaluation of penetrating abdominal and pelvic trauma. Eur J Radiol 2020;130109187. Crossref, Medline, Google Scholar8. Paes FM, Durso AM, Danton G, Castellon I, Munera F. Imaging evaluation of diaphragmatic injuries: improving interpretation accuracy. Eur J Radiol 2020;130109134. Crossref, Medline, Google Scholar9. Wortman JR, Uyeda JW, Fulwadhva UP, Sodickson AD. Dual-Energy CT for Abdominal and Pelvic Trauma. RadioGraphics 2018;38(2):586–602. Link, Google Scholar10. Dreizin D, Chen T, Liang Y, et al. Added value of deep learning-based liver parenchymal CT volumetry for predicting major arterial injury after blunt hepatic trauma: a decision tree analysis. Abdom Radiol (NY) 2021. https://doi.org/10.1007/s00261-020-02892-x. Published online January 19, 2021. Google ScholarArticle HistoryReceived: Feb 21 2021Accepted: Feb 24 2021Published online: May 21 2021Published in print: July 2021 FiguresReferencesRelatedDetailsAccompanying This ArticleCT of Penetrating Abdominopelvic TraumaMay 21 2021RadioGraphicsRecommended Articles Imaging Evaluation of Abdominopelvic Gunshot TraumaRadioGraphics2020Volume: 40Issue: 6pp. 1766-1788CT of Penetrating Abdominopelvic TraumaRadioGraphics2021Volume: 41Issue: 4pp. 1064-1081Multidetector CT Findings in the Abdomen and Pelvis after Damage Control Surgery for Acute Traumatic InjuriesRadioGraphics2019Volume: 39Issue: 4pp. 1183-1202Penetrating Colorectal Injuries: Diagnostic Performance of Multidetector CT with TrajectographyRadiology2016Volume: 281Issue: 3pp. 749-762Diagnostic Yield and Clinical Utility of Abdominopelvic CT Following Emergent Laparotomy for TraumaRadiology2016Volume: 280Issue: 3pp. 735-742See More RSNA Education Exhibits Imaging Evaluation of Abdominopelvic Gunshot Trauma: What the Radiologist Needs to KnowDigital Posters2019Bowel And Mesenteric Injuries In Trauma - Correlation With Intraoperative Findings/ Follow-up Imaging: Where An Early Diagnosis Can Save Lives.Digital Posters2021“Point of Care” in Abdominal Trauma: What Not to MissDigital Posters2019 RSNA Case Collection Left Hemidiaphragmatic Rupture RSNA Case Collection2021Traumatic Pseudoaneurysm RSNA Case Collection2021Post-operative intra-abdominal abscess RSNA Case Collection2020 Vol. 41, No. 4 Metrics Altmetric Score PDF download" @default.
• W3161661050 created "2021-05-24" @default.
• W3161661050 creator A5045571589 @default.
• W3161661050 creator A5077790388 @default.
• W3161661050 date "2021-07-01" @default.
• W3161661050 modified "2023-10-13" @default.
• W3161661050 title "Invited Commentary: Key Concepts of CT for Penetrating Abdominopelvic Injuries" @default.
• W3161661050 cites W2140223894 @default.
• W3161661050 cites W2166940879 @default.
• W3161661050 cites W2792257050 @default.
• W3161661050 cites W2964524253 @default.
• W3161661050 cites W3036939931 @default.
• W3161661050 cites W3043848874 @default.
• W3161661050 cites W3089894006 @default.
• W3161661050 cites W3165419740 @default.
• W3161661050 doi "https://doi.org/10.1148/rg.2021210041" @default.
• W3161661050 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/34019438" @default.
• W3161661050 hasPublicationYear "2021" @default.
• W3161661050 type Work @default.
• W3161661050 sameAs 3161661050 @default.
• W3161661050 citedByCount "0" @default.
• W3161661050 crossrefType "journal-article" @default.
• W3161661050 hasAuthorship W3161661050A5045571589 @default.
• W3161661050 hasAuthorship W3161661050A5077790388 @default.
• W3161661050 hasConcept C126838900 @default.
• W3161661050 hasConcept C141071460 @default.
• W3161661050 hasConcept C19527891 @default.
• W3161661050 hasConcept C26517878 @default.
• W3161661050 hasConcept C2909044596 @default.
• W3161661050 hasConcept C38652104 @default.
• W3161661050 hasConcept C41008148 @default.
• W3161661050 hasConcept C71924100 @default.
• W3161661050 hasConceptScore W3161661050C126838900 @default.
• W3161661050 hasConceptScore W3161661050C141071460 @default.
• W3161661050 hasConceptScore W3161661050C19527891 @default.
• W3161661050 hasConceptScore W3161661050C26517878 @default.
• W3161661050 hasConceptScore W3161661050C2909044596 @default.
• W3161661050 hasConceptScore W3161661050C38652104 @default.
• W3161661050 hasConceptScore W3161661050C41008148 @default.
• W3161661050 hasConceptScore W3161661050C71924100 @default.
• W3161661050 hasIssue "4" @default.
• W3161661050 hasLocation W31616610501 @default.
• W3161661050 hasOpenAccess W3161661050 @default.
• W3161661050 hasPrimaryLocation W31616610501 @default.
• W3161661050 hasRelatedWork W2035439607 @default.
• W3161661050 hasRelatedWork W2049214470 @default.
• W3161661050 hasRelatedWork W2081340600 @default.
• W3161661050 hasRelatedWork W2213156983 @default.
• W3161661050 hasRelatedWork W2462844131 @default.
• W3161661050 hasRelatedWork W2482660221 @default.
• W3161661050 hasRelatedWork W2748952813 @default.
• W3161661050 hasRelatedWork W2899084033 @default.
• W3161661050 hasRelatedWork W2902148150 @default.
• W3161661050 hasRelatedWork W3031052312 @default.
• W3161661050 hasVolume "41" @default.
• W3161661050 isParatext "false" @default.
• W3161661050 isRetracted "false" @default.
• W3161661050 magId "3161661050" @default.
• W3161661050 workType "article" @default.