Purpose: Multi-phase CT scans are commonly used in trauma cases. Early arterial phase is routinely the first phase, followed by the portal/late arterial phase. In pediatric patients, each scan increases the radiation exposure, thus should be carefully utilized. Our purpose was to compare the imaging findings in 2 groups of pediatric patients. Those who had a single phase study and those who had multi-phase study, and analyze the efficacy of the different protocols.
Materials and methods: A retrospective analysis of all pediatric (ages 0-18 years) trauma cases who underwent abdominal CT, in the last 2 years in Shaare Zedek Medical Center. Demographic and clinical information including age, gender, time of examination, mechanism of injury and physical findings were collected. Imaging technique and findings were assessed.
Results: 134 cases were reviewed, 109 males, average age 13.02±4.55 years (range 7 month-18 years). 17 pts. had a single phase scan and 117 multi-phase scan. In the single phase group, average age was younger (10.49± 4.25 year, vs. 13.52±4.82 in the multi-phase group (p=0.01)). Their initial status at admission was less severe, with higher Glasgow Coma Scale and less intubated patients.
In none of the single phase scans, further work up was required.
In the multi-phase group, in 106/117 (90.6%) of the cases, the delayed phase did not add or change the information achieved from the early scan.
In 11 cases, the delayed phase had an additive value. In 8 cases the late arterial phase caused downgrading of the spleen’s injury scale, In 1 case, pseudo-aneurysm was suspected in the early arterial phase but was not seen in the late arterial phase and in 2 cases renal injury was recognized in the delayed (7 min) scan.
The most informative phase in most cases was the late arterial phase.
Conclusions: In our study, in most abdominal trauma cases, a single phase scan provided the required information. From our analysis, the most informative phase was the late arterial phase, which was sufficient both for active bleeding and accurate grading of splenic injury. Delayed phases can be added to specific studies in cases of suspected kidney injury or unclear findings in the first scan. This method requires the presence of the radiologist in the CT suite during the study, but will lead to decrease in radiation exposure to the pediatric patients
