Purpose or Case Report: Trauma is a leading cause of death and disability in children ages 1-18, with blunt trauma causing the majority of abdominal injuries. For radiologists, cases of trauma elicit the necessity of timely reads to determine if a patient requires immediate surgical intervention, or is a candidate for conservative, non-operative management. Spectral Dual-Energy Computed Tomography (DECT) obtains raw data at two energy spectra which by virtue of material decomposition can identify, isolate and or quantify iodine, pure calcium, and uric acid. Multiple image sets can be generated from a single scan allowing both standard anatomic and material-specific analysis. This allows accurate demonstration and grading of solid organ injury, differentiation between acute hematoma from ongoing vascular extravasation, detection of subtle injuries and visualization of compromised vascular structures all of which are imperative in determining the proper course of treatment in the acute trauma setting.
Methods & Materials: At our institution, all emergent patients are scanned using Spectral DECT (Philips Iqon, Philips Healthcare) which allows us to highlight the utilization of virtual non-contrast images (VNC), virtual mono-energetic images (Mono E), iodine density (ID) and iodine fusion images in the evaluation of pediatric blunt abdominal trauma. For this project, we performed a retrospective review of Spectral DECT image findings of pediatric abdominal trauma and compared them to the conventional diagnostic images set taken simultaneously.
Results: We found numerous cases in which DECT aided in the diagnosis and characterization of solid organ injury in children. Specifically, using Spectral DECT enabled confident discrimination of acute hemorrhage from active vascular extravasation with VNC and ID, improved demarcation of solid organ lacerations and detection of perfusion abnormalities (ID and Mono-E), and optimization of vascular visualization with use of low mono-energetic images.
Conclusions: The use of spectral DECT at our institution has improved our ability to confidently diagnose various solid organ injury, discrimination of hematoma from active bleeding, detection of altered perfusion related to blunt trauma, and characterization of incidental lesions when encountered. As we gain more experience in our use of DECT in the pediatric trauma population, we will be able to better define its role in those who can be treated non-operatively, and those who may need additional operative or interventional procedures.