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MR imaging evaluation of hemidiaphragms in acute blunt trauma: experience with 16 patients
K Shanmuganathan1, S E Mirvis, C S White
1Department of Diagnostic Radiology, University of Maryland Medical Center, University of Maryland Medical System, Baltimore 21201, USA.
Objective:
The aim of this retrospective study was to evaluate the usefulness of MR imaging in excluding or confirming the diagnosis of diaphragmatic injury after blunt trauma.
Materials And Methods:
MR imaging studies were performed in 16 patients with blunt trauma and with indeterminate radiographs of the chest suspicious for but not diagnostic of diaphragmatic injury. T1-weighted images were obtained in all patients, and fast gradient-echo pulse sequence images were obtained in 11 patients. The results of all imaging studies performed before the MR imaging studies and those performed during out-patient follow-up, including chest radiography and thoracoabdominal CT scanning, were reviewed for evidence of diaphragmatic injury. Medical records were reviewed to ascertain the indications for the MR imaging studies as well as the surgical findings and the duration of outpatient follow-up.
Results:
MR imaging studies confirmed diaphragmatic injury in seven patients (44%) and revealed an intact diaphragm in nine (66%). In seven patients MR imaging studies were able to correctly reveal the site of the diaphragmatic tear and the abdominal viscera that herniated into the thoracic cavity. None of the nine patients with intact diaphragms on MR imaging studies had delayed presentation of a diaphragmatic rupture on outpatient follow-up.
Conclusions:
MR imaging studies can be reliably used to diagnose or exclude injury in blunt trauma patients.
Insights
Magnetic Resonance (MR) imaging reliably diagnoses diaphragmatic injuries in blunt trauma patients. This study found MR imaging accurately confirmed injuries or ruled them out, aiding clinical decisions.
Area of Science:
- Radiology
- Medical Imaging
- Trauma Care
Background:
- Diaphragmatic injuries can be challenging to diagnose after blunt trauma.
- Conventional imaging like chest radiography may be inconclusive.
- Accurate diagnosis is crucial for timely management and preventing complications.
Purpose of the Study:
- To assess the diagnostic utility of MR imaging for diaphragmatic injuries in blunt trauma.
- To determine if MR imaging can exclude or confirm diaphragmatic injury.
- To evaluate MR imaging's role in cases with indeterminate initial radiographs.
Main Methods:
- Retrospective review of 16 blunt trauma patients with suspected diaphragmatic injury.
- MR imaging (T1-weighted and fast gradient-echo sequences) was performed.
- Comparison with prior imaging (radiography, CT) and surgical/follow-up data.
Main Results:
- MR imaging confirmed diaphragmatic injury in 44% (7/16) and showed an intact diaphragm in 66% (9/16).
- MR imaging accurately identified tear sites and herniated viscera in confirmed cases.
- No patients with an intact diaphragm on MR imaging showed delayed rupture.
Conclusions:
- MR imaging is a reliable tool for diagnosing or excluding diaphragmatic injury in blunt trauma.
- It aids in definitive diagnosis when initial imaging is equivocal.
- This can improve patient management and outcomes.