Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Multidetector CT Findings of Solid Organ Injury Based on 2018 Updated American Association for the Surgery of Trauma Organ Injury Scaling System

2018 개정 미국외상수술협회 복부고형장기 손상척도에 따른 다중검출 CT 소견

  • Hyo Hyeon Yu (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Yoo Dong Won (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Su Lim Lee (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Young Mi Ku (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sun Wha Song (Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 유효현 (가톨릭대학교 의정부성모병원 영상의학과) ;
  • 원유동 (가톨릭대학교 의정부성모병원 영상의학과) ;
  • 이수림 (가톨릭대학교 의정부성모병원 영상의학과) ;
  • 구영미 (가톨릭대학교 의정부성모병원 영상의학과) ;
  • 송선화 (가톨릭대학교 의정부성모병원 영상의학과)
  • Received : 2020.03.02
  • Accepted : 2020.03.31
  • Published : 2020.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

The newly revised 2018 Organ Injury Scale (OIS) has a similar format to the previous American Association for Surgery and Trauma (AAST) Emergency General Surgery Grading System, dividing the criteria for grading solid organ damage into three groups; imaging, operation, and pathology. The most significant alteration in the OIS system 2018 revision is the incorporation of multidetector CT (MDCT) findings of vascular injury including pseudoaneurysm and arteriovenous fistula. Similar to the previous OIS, the highest of the three criteria is assigned the final grade. In addition, if multiple grade I or II injuries are present, one grade is advanced for multiple injuries up to grade III. This pictorial essay demonstrates the MDCT findings of solid organ injury grades based on the 2018 OIS system.

2018년에 새롭게 개정된 장기 손상척도는 이전 미국외상수술협회의 응급수술분류체계와 유사한 형식을 가지며, 고형장기 손상의 등급을 지정하는 기준을 영상(imaging), 수술(operative), 병리(pathologic) 세 가지 세트로 나누어 분류하였다. 2018년 개정에서 가장 중요한 변화는 거짓동맥류와 동정맥 누공을 포함한 혈관 손상의 다중검출CT (multidetector CT; 이하 MDCT) 소견을 정의하여 장기 손상척도에 통합한 것이다. 이전 장기 손상척도와 동일하게 세 가지 기준 중에 가장 높은 등급이 최종 등급이 된다. 또한 한 장기 내에 여러 개의 1등급 또는 2등급 소견이 있으면, 다발성 손상에 대해 3등급의 부여가 가능하다. 본 임상화보에서는 2018년 개정된 미국외상수술협회 장기 손상척도의 MDCT 소견을 소개하고자 한다.

Keywords

References

  1. Moore EE, Shackford SR, Pachter HL, McAninch JW, Browner BD, Champion HR, et al. Organ injury scaling: spleen, liver, and kidney. J Trauma 1989;29:1664-1666 https://doi.org/10.1097/00005373-198912000-00013
  2. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma 1995;38:323-324 https://doi.org/10.1097/00005373-199503000-00001
  3. Shafi S, Aboutanos M, Brown CV, Ciesla D, Cohen MJ, Crandall ML, et al. Measuring anatomic severity of disease in emergency general surgery. J Trauma Acute Care Surg 2014;76:884-887 https://doi.org/10.1097/TA.0b013e3182aafdba
  4. Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg 2018;85:1119-1122 https://doi.org/10.1097/TA.0000000000002058
  5. Boscak AR, Shanmuganathan K, Mirvis SE, Fleiter TR, Miller LA, Sliker CW, et al. Optimizing trauma multidetector CT protocol for blunt splenic injury: need for arterial and portal venous phase scans. Radiology 2013;268:79-88 https://doi.org/10.1148/radiol.13121370
  6. Gavant ML, Schurr M, Flick PA, Croce MA, Fabian TC, Gold RE. Predicting clinical outcome of nonsurgical management of blunt splenic injury: using CT to reveal abnormalities of splenic vasculature. AJR Am J Roentgenol 1997;168:207-212 https://doi.org/10.2214/ajr.168.1.8976947
  7. Saksobhavivat N, Shanmuganathan K, Chen HH, DuBose JJ, Richard H, Khan MA, et al. Blunt splenic injury: use of a multidetector CT-based splenic injury grading system and clinical parameters for triage of patients at admission. Radiology 2015;274:702-711 https://doi.org/10.1148/radiol.14141060
  8. Shanmuganathan K, Mirvis SE, Boyd-Kranis R, Takada T, Scalea TM. Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology 2000;217:75-82 https://doi.org/10.1148/radiology.217.1.r00oc0875
  9. Charbit J, Manzanera J, Millet I, Roustan JP, Chardon P, Taourel P, et al. What are the specific computed tomography scan criteria that can predict or exclude the need for renal angioembolization after high-grade renal trauma in a conservative management strategy? J Trauma 2011;70:1219-1227; discussion 1227-1228 https://doi.org/10.1097/TA.0b013e31821180b1
  10. Chiron P, Hornez E, Boddaert G, Dusaud M, Bayoud Y, Molimard B, et al. Grade IV renal trauma management. A revision of the AAST renal injury grading scale is mandatory. Eur J Trauma Emerg Surg 2016;42:237-241 https://doi.org/10.1007/s00068-015-0537-5
  11. Dugi DD 3rd, Morey AF, Gupta A, Nuss GR, Sheu GL, Pruitt JH. American Association for the Surgery of Trauma grade 4 renal injury substratification into grades 4a (low risk) and 4b (high risk). J Urol 2010;183:592-597 https://doi.org/10.1016/j.juro.2009.10.015
  12. Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg 2016;80:529-537 https://doi.org/10.1097/TA.0000000000000942
  13. Keihani S, Xu Y, Presson AP, Hotaling JM, Nirula R, Piotrowski J, et al. Contemporary management of highgrade renal trauma: results from the American Association for the Surgery of Trauma Genitourinary Trauma study. J Trauma Acute Care Surg 2018;84:418-425 https://doi.org/10.1097/TA.0000000000001796
  14. Lee YH, Wu CH, Wang LJ, Wong YC, Chen HW, Wang CJ, et al. Predictive factors for early failure of transarterial embolization in blunt hepatic injury patients. Clin Radiol 2014;69:e505-511 https://doi.org/10.1016/j.crad.2014.08.013
  15. Letoublon C, Morra I, Chen Y, Monnin V, Voirin D, Arvieux C. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications. J Trauma 2011;70:1032-1036; discussion 1036-1037 https://doi.org/10.1097/TA.0b013e31820e7ca1
  16. Marmery H, Shanmuganathan K, Alexander MT, Mirvis SE. Optimization of selection for nonoperative management of blunt splenic injury: comparison of MDCT grading systems. AJR Am J Roentgenol 2007;189:1421-1427 https://doi.org/10.2214/AJR.07.2152
  17. Marmery H, Shanmuganathan K, Mirvis SE, Richard H 3rd, Sliker C, Miller LA, et al. Correlation of multidetector CT findings with splenic arteriography and surgery: prospective study in 392 patients. J Am Coll Surg 2008;206:685-693 https://doi.org/10.1016/j.jamcollsurg.2007.11.024
  18. Melloul E, Denys A, Demartines N. Management of severe blunt hepatic injury in the era of computed tomography and transarterial embolization: a systematic review and critical appraisal of the literature. J Trauma Acute Care Surg 2015;79:468-474 https://doi.org/10.1097/TA.0000000000000724
  19. Misselbeck TS, Teicher EJ, Cipolle MD, Pasquale MD, Shah KT, Dangleben DA, et al. Hepatic angioembolization in trauma patients: indications and complications. J Trauma 2009;67:769-773 https://doi.org/10.1097/TA.0b013e3181b5ce7f
  20. Nuss GR, Morey AF, Jenkins AC, Pruitt JH, Dugi DD 3rd, Morse B, et al. Radiographic predictors of need for angiographic embolization after traumatic renal injury. J Trauma 2009;67:578-582; discussion 582 https://doi.org/10.1097/TA.0b013e3181af6ef4
  21. Shariat SF, Roehrborn CG, Karakiewicz PI, Dhami G, Stage KH. Evidence-based validation of the predictive value of the American Association for the Surgery of Trauma kidney injury scale. J Trauma 2007;62:933-939 https://doi.org/10.1097/TA.0b013e318031ccf9
  22. Zarzaur BL, Dunn JA, Leininger B, Lauerman M, Shanmuganathan K, Kaups K, et al. Natural history of splenic vascular abnormalities after blunt injury: A Western Trauma Association multicenter trial. J Trauma Acute Care Surg 2017;83:999-1005 https://doi.org/10.1097/TA.0000000000001597
  23. Zarzaur BL, Kozar R, Myers JG, Claridge JA, Scalea TM, Neideen TA, et al. The splenic injury outcomes trial: an American Association for the Surgery of Trauma multi-institutional study. J Trauma Acute Care Surg 2015;79:335-342 https://doi.org/10.1097/TA.0000000000000782
  24. Leung V, Sastry A, Woo TD, Jones HR. Implementation of a split-bolus single-pass CT protocol at a UK major trauma centre to reduce excess radiation dose in trauma pan-CT. Clin Radiol 2015;70:1110-1115 https://doi.org/10.1016/j.crad.2015.05.014
  25. Lee J, Ahn JH. Multidetector CT in blunt abdominal trauma: imaging findings and pitfalls. J Korean Soc Radiol 2019;80:445-465 https://doi.org/10.3348/jksr.2019.80.3.445
  26. Orwig D, Federle MP. Localized clotted blood as evidence of visceral trauma on CT: the sentinel clot sign. AJR Am J Roentgenol 1989;153:747-749 https://doi.org/10.2214/ajr.153.4.747
  27. Schweizer W, Bohlen L, Dennison A, Blumgart LH. Prospective study in adults of splenic preservation after traumatic rupture. Br J Surg 1992;79:1330-1333 https://doi.org/10.1002/bjs.1800791229
  28. Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 2017;12:40
  29. Coccolini F, Catena F, Moore EE, Ivatury R, Biffl W, Peitzman A, et al. WSES classification and guidelines for liver trauma. World J Emerg Surg 2016;11:50