Value of Coronal Reformations in the CT Evaluation of Acute Head Trauma

• Published in: American journal of neuroradiology : AJNR Vol. 31; no. 2; pp. 334 - 339
• Main Authors: Wei, S.C, Ulmer, S, Lev, M.H, Pomerantz, S.R, Gonzalez, R.G, Henson, J.W
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL Am Soc Neuroradiology 01.02.2010; American Society of Neuroradiology
• Series: Fellows' Journal Club
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Brain; Cerebral Hemorrhage, Traumatic - diagnostic imaging; Cerebral Hemorrhage, Traumatic - surgery; Child; Child, Preschool; Craniocerebral Trauma - diagnostic imaging; Craniocerebral Trauma - surgery; Craniotomy; Electrodiagnosis. Electric activity recording; Emergency Medical Services; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Nervous system; Preoperative Care; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Tomography, X-Ray Computed - methods; Young Adult; Evaluation; Nervous system diseases; Computerized axial tomography; Radiodiagnosis; Craniocerebral
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A1824

Routine axial CT images may not be ideally suited for detecting ICH in transversely oriented locations such as the floor of the anterior and middle cranial fossas and vertex. This study was performed to evaluate whether coronal reformations improve detection of ICH in NCCT performed for head trauma. All patients undergoing a first NCCT in the ED for evaluation of head trauma were included prospectively during a 6-month interval. NCCT images were reconstructed into standard 5-mm axial datasets and were also reformatted into coronal datasets of 5-mm sections and 2.5-mm intervals. Thirty-two of 213 (15%) scans were interpreted as showing traumatic ICH. These cases were interspersed with 30 studies without ICH. Cases were reviewed for the presence and location of ICH by 2 staff neuroradiologists. Of 213 patients, 32 NCCTs demonstrated ICH (a total of 104 foci). Fifteen of 104 (14%) ICHs (8 patients) were detected solely on coronal images. Locations included the floor of the anterior and middle cranial fossas, vertex, corpus callosum, falx, tentorium, and occipital convexity. Coronal reformations allowed exclusion of suspicious findings on axial images in 14 instances (7 patients). Coronal images aided interpretation in 29/104 (28%) findings. Coronal reformations improve the detection of ICH over axial images alone, especially for lesions that lie in the axial plane immediately adjacent to bony surfaces. The use of coronal reformations should be considered in the routine interpretation of head CT examinations performed for the evaluation of head trauma.