Journal Conference 20030621

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Journal Conference2003-06-21

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LIMITATIONS OF ROUTINE SPIRAL COMPUTERIZED
TOMOGRAPHY IN THE EVALUATION OF BLADDER TRAUMA

• Clinical Urology Original ArticlesVolume
  162(1) July 1999 
• HAAS, CHRISTOPHER A. BROWN, SCOTT L. SPIRNAK,
  J. PATRICK

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Purpose

• Evaluate the accuracy of spiral CT in diagnosing
  traumatic bladder rupture

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Materials and Methods

• Retrospective review of 24 patient with traumatic
  bladder rupture
• 15 patients underwent spiral CT and retrograde
  cystography
• The result of both protocol were compared

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Results

• Retrograde cystography successfully diagnosed all
  cases of bladder rupture and correctly classified
  injuries confirmed surgically.
• Spiral CT successfully diagnosed 9 of 15 bladder
  ruptures (60), and correctly classified 4 of 5
  intraperitoneal (80) and 6 of 11 extraperitoneal
  (55) ruptures.

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Conclusions

• Spiral CT is less accurate than retrograde
  cystography in diagnosing traumatic bladder
  rupture

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COMPUTERIZED TOMOGRAPHY CYSTOGRAPHY FOR THE
DIAGNOSIS OF TRAUMATIC BLADDER RUPTURE

• Clinical Urology Original Articles
• Volume 164(1) July 2000
• DECK, ANDREW J. SHAVES, SARAH TALNER, LEE
  PORTER, JAMES R.

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Purpose

• Compare the results of CT cystography with those
  of surgical exploration for bladder rupture in
  patients with blunt abdominal and pelvic trauma

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Materials and methods

• Retropectively review 316 patients who underwent
  CT cystography as part of the hospital admission
  blunt trauma evaluation
• CT cystography was performed as part of the
  initial blunt trauma evaluation
• The usual indications for plain film and CT
  cystography were gross hematuria or combined
  pelvic fracture and microscopic hematuria

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Materials and methods

• CT cystography protocol involved 3 sets of
  images.
• Initial fill images were obtained after infusion
  of 100 ml. of retrograde contrast material
• Complete fill images were then obtained after
  bladder distention to 40 cm. water pressure and a
  volume of 350 ml. in intubated cases and to
  tolerance in responsive patients. Images were
  then obtained after drainage.
• Helical CT studies were done at a pitch of 1.5
  with 7 mm. collimation reconstructed at 7 mm.
  intervals.
• All CT cystography was initially interpreted and
  reported by an attending radiologist and then
  reevaluated the aurthors

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Results

• Of the 44 patients with the ultimate diagnosis of
  bladder rupture CT cystography revealed bladder
  rupture in 42
• 23 of the 28 (82) who underwent formal bladder
  exploration had operative findings that exactly
  matched the CT cystography interpretation in
  terms of the presence and type of rupture
• In the 316 patients CT cystography detected
  bladder rupture with an overall sensitivity and
  specificity of 95 and 100, respectively. For
  intraperitoneal rupture sensitivity was 78 and
  specificity was 99