European Journal of Radiology 59 (2006) 359–366 MDCT in blunt intestinal trauma Stefania Romano a,* , Mariano Scaglione a , Giovanni Tortora a , Antonio Martino b , Francesco Di Pietto a , Luigia Romano a , Roberto Grassi c a Department of Diagnostic Imaging, “A.Cardarelli” Hospital, 80131 Naples, Italy b TraumaCenter, “A.Cardarelli” Hospital, 80131 Naples, Italy c Department “Magrassi-Lanzara”, Section of Radiology, Second University of Naples, 80138 Naples, Italy Received 21 May 2006; accepted 24 May 2006 Abstract Injuries to the small and large intestine from blunt trauma represent a defined clinical entity, often not easy to correctly diagnose in emergency but extremely important for the therapeutic assessment of patients. This article summarizes the MDCT spectrum of findings in intestinal blunt lesions, from functional disorders to hemorrhage and perforation. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Intestine; Trauma; MDCT; Abdomen; CT; Trauma 1. Introduction Intestinal mesenteric injuries are found in approximately 5% of all patients undergoing laparotomy after blunt abdom- inal trauma [1]. About 1.3% of patients with blunt abdominal trauma presents bowel injuries, that are frequently associated with abdominal solid organs lesions [2]. Mainly, there are three types of injuries: crush, shearing forces at fixed sites of attach- ment, burst injuries from increase in endoluminal pressure [2]. These lesions are related to a high morbidity and mortality, representing a diagnostic dilemma either from trauma surgeons and emergency physicians [3]. Actually, a non-operative man- agement is often the treatment of choice for abdominal solid organs lesions from trauma [4], however because missed bowel and mesenteric injuries are possible [4], early diagnosis and treatment are critical to increased the survival rate [5]. Computed tomography (CT) has been initially proposed in the past two decades in the acute clinical setting of patients with abdominal blunt trauma suspected to have bowel and mesenteric lesions, becoming the primary modality for the imaging in these cases [5–9]. * Corresponding author at: Via G.Fava 28 parco la piramide, 80016 Marano di Napoli, Italy. Tel.: +39 0817426089. E-mail address: stefromano@libero.it (S. Romano). 2. MDCT technique In the recent past years, helical CT was considered a sensi- tive tool in the identification of bowel and mesenteric injury after blunt trauma, providing a wide spectrum of findings [10]. Multi- detector row CT (MDCT) examination without oral contrast material seems adequate for depiction of bowel and mesen- teric injuries that require surgical repair [11]. Because of the improved image quality provided by the new generation of scan- ners, results are comparable with previously reported data for single-detector row helical CT with oral contrast material [11]. The acquisition of initial scans without oral contrast material seems to help to meet criteria of safety and efficiency without sacrificing diagnostic accuracy [11]. Pre-contrast abdomino-pelvis scans (5 mm slice thickness) are useful to better characterize the attenuation values of organs and structures in order to detect or rule out hemorrhagic phe- nomena and to evaluate any post-contrast HU abnormal changes. A biphasic study in arterial and venous phase is indicated espe- cially when active bleeding or major vessels trauma are clinically suspected. In suspicion of low-flux vascular extravasation from minor vessels, a delayed phase may be added to the exam- ination protocol. Acquisition parameters using an optimised ratio between slice thickness and reconstruction interval (i.e.: 3/3 mm acq., back recon. 1/1 mm), may allow a targeted multi- planar reconstruction in the post-processing elaboration. 0720-048X/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejrad.2006.05.011