RPS 517 - New approaches in trauma imaging in peace and war times

Author Block: U. Pidvalna, D. Beshley; Lviv/UA
Purpose: 1. Understand the role of radiological modalities (X-ray, ultrasound, CT) in triage and evacuation of casualties.
2. Identify imaging findings of combat-related injuries across the head, chest, abdomen, pelvis, and extremities.
3. Recognize key challenges in applying diagnostic imaging in mobile military hospitals.
Methods or Background: Military trauma has evolved with the advancement of modern warfare, creating new challenges in managing battlefield injuries. Timely diagnosis and decision-making are crucial in the resource-limited environment of a mobile military hospital. Radiological tools, including X-ray, ultrasound, and CT, are indispensable for frontline medical teams, enhancing decision-making during patient evacuation and trauma care.
Results or Findings: Imaging in mobile military hospitals reveals a broad spectrum of traumatic injuries, particularly in the head, chest, abdomen, pelvis, and extremities.
Key findings include:
Head injuries: Brain trauma and fractures.
Chest injuries: Pneumothorax, hemothorax, heart and vessel injuries.
Abdominal injuries: Hemoperitoneum, solid organ trauma.
Pelvic and extremity injuries: Amputations and fractures.

X-ray and ultrasound provide rapid initial assessments, while CT is employed for complex injuries. This integration enables faster diagnosis and informed decision-making, ultimately improving patient outcomes.
Conclusion: Radiology significantly enhances trauma care in mobile military hospitals, enabling swift diagnosis and triage. While logistical challenges remain, including limited resources, diagnostic imaging has proven vital in improving survival rates and optimizing patient care on the battlefield. The integration of imaging technologies in mobile settings continues to play a key role in modern military medicine.
Limitations: Single center, potential biases in imaging interpretation due to varying expertise levels, constraints in radiological equipment, and resources in a combat setting.
Funding for this study: No
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. Khurtsylava; Kyiv/UA
Purpose: To present practical considerations and a step-by-step workflow for MRI safety in patients with unknown metallic fragments, a patient group that has become increasingly common due to war-related injuries.
Methods or Background: Patients with shrapnel wounds or metallic foreign bodies of undocumented origin are frequently referred for MRI. The exact composition of fragments is often unknown, while clinical questions usually concern anatomical regions distant from the fragments (e.g. brain MRI in a patient with fragments in the leg). Literature review and analysis of local clinical experience were used to design a pragmatic workflow for risk assessment and decision-making.
Results or Findings: Metallic fragments may include steel, copper/bronze, lead, aluminium, or tungsten. Risks range from ferromagnetic displacement (steel), RF-induced heating, to severe image artefacts.
Proposed workflow:
1. Focused history and inspection for scars.
2. X-ray/CT for localisation and density assessment.
3. Identification of critical sites (orbit, spinal canal, vessels, heart).
4. Risk–benefit evaluation: MRI performed only if clinical necessity outweighs potential risks.
5. Technical precautions: low-SAR protocols, local transmit/receive coils, patient monitoring, clear documentation.
When fragments are remote from the scanned region, mechanical risks are low but heating remains possible; each case requires individual assessment.
Conclusion: Patients with unknown metallic fragments represent a growing challenge in MRI practice. A structured workflow helps improve safety and avoid unnecessary refusals of clinically important examinations.
Limitations: This workflow is based on literature and local practice. Prospective multicentre validation is required.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: M. Palermo, R. A. Trapani, M. Pane, F. Tiralongo, S. Palmucci, P. V. Foti, C. Pomara, A. Basile; Catania/IT
Purpose: To compare CT findings in polytrauma patients due to traffict accident undergoing emergency CT scan with those observed in deceased patients examined with post-mortem CT (PMCT), focusing on the most frequent fatal injuries reported in the literature and our experience.
Methods or Background: We performed a retrospective evaluation of findings in patients who underwent emergency whole-body CT (WBCT) in our emergency department due to traffic accidents and of findings on PMCT of trauma victims performed in our Institution.
We also performed a literature review on main findings in this setting of patients and on more common fatal injuries detectable with PMCT.
Results or Findings: In living patients, WBCT typically demonstrated limb fractures, intracranial hemorrhages, thoracic and abdominal bleeding, and solid organ injuries, often supporting timely therapeutic decisions.
In deceased trauma victims, in accordance with Schmitt-Sody et al. , the predominant fatal injuries on PMCT were:
• Severe thoracic injuries (~65%), including massive hemothorax, pulmonary lacerations, and major vascular ruptures, especially aortic rupture.
• Severe cranio-cerebral trauma (~47%), such as extensive intracranial hemorrhage or destruction of brain parenchyma.
• Massive intra-abdominal hemorrhage (e.g., liver or splenic rupture), less frequent but still relevant.
Conclusion: CT in living polytrauma patients reveals a broad spectrum of injuries, many of which are potentially treatable if promptly identified. PMCT, on the other hand, consistently highlights the lesions that are most often fatal—severe thoracic hemorrhage, aortic rupture, extensive cranial trauma, and massive abdominal bleeding. Awareness of these patterns from PMCT can help radiologists maintain a higher index of suspicion during emergency reporting, facilitating early recognition of critical injuries and potentially life-threatening complications, ultimately improving patient management in the acute setting.
Limitations: Retrospective study, small number of cases
Funding for this study: No fundings received.
Has your study been approved by an ethics committee? Not applicable
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Author Block: F. Iacobellis, C. Camillo, M. Di Serafino, L. Barbuto, R. Ronza, D. Grimaldi, C. Rinaldo, F. Verde, S. Giovine; Naples/IT
Purpose: To assess the diagnostic value of diffusion-weighted imaging (DWI) in the early MRI follow-up of abdominal solid organ injuries in polytraumatized patients, comparing its performance with conventional and contrast-enhanced sequences, and to define an optimized protocol tailored to trauma-related findings.
Methods or Background: MRI studies performed between 2018 and 2022 for early follow-up of high-energy abdominal trauma were retrospectively reviewed. Each protocol included T1- and T2-weighted sequences (with and without fat suppression), DWI, and 3D T1-weighted fat-saturated sequences before and after intravenous (IV) gadolinium-based contrast administration. Three radiologists in consensus evaluated the contribution of each sequence to lesion detection, characterization, and follow-up assessment.
Results or Findings: Forty-six MRI examinations were analyzed. Conventional T1W, T2W, and T2W fat-sat sequences provided essential morphological and evolutionary information about parenchymal lesions and hemoperitoneum. DWI sequences improved lesion conspicuity compared to unenhanced sequences in 50% of cases, were equivalent in 18.7%, and inferior in 14.5%. Compared to post-contrast sequences, DWI showed equivalent diagnostic performance in 54.1%, superior in 27.1%, and inferior in 18.7% of cases. Contrast-enhanced sequences remained essential in confirming contained vascular injuries (8.6%) and urinary leakage.
Conclusion: DWI provides substantial diagnostic value in the early follow-up of abdominal parenchymal injuries, frequently matching or exceeding the information obtained from contrast-enhanced imaging. Incorporating DWI as a core component of trauma MRI protocols may reduce dependence on contrast agents, shorten scan times, and improve diagnostic safety in patients with renal impairment or critical conditions.
Limitations: Retrospective design of the study, limited sample size, heterogeneity of trauma severity and timing of follow-up MRI. No quantitative analysis of ADC values was performed.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
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Author Block: H-J. Meyer, S. Ebel, T. Denecke, M. Struck; Leipzig/DE
Purpose: : Contrast extravasation on imaging studies is a clinical surrogate for bleeding severity. However, the prognostic relevance of this imaging sign needs to be evaluated. The aim of this study was to analyze the impact of contrast extravasation defined by computed tomography (CT) and angiography on massive transfusion and 30-day mortality in patients with acute bleeding undergoing transarterial embolization (TAE).
Methods or Background: A mixed cohort of patients with acute bleeding requiring treatment with TAE between 2018 and 2022 was retrospectively evaluated. All patients underwent triphasic CT to localize the source of bleeding and to calculate extravasation volumes in the arterial and portal venous phases. The bleeding rate k was calculated from the CT images.
Results or Findings: A total of 128 patients (79 male, 61.7%) with a mean age of 67.4 years (range 21-95 years) and an all-cause 30-day mortality rate of 34.4% were included in the present analysis. A moderate positive correlation was identified between transfused packed red blood cell units and bleeding rate k (r=0.33, p<0.001). In multivariable logistic regression analysis, bleeding rate k was identified as an independent prognostic factor for massive transfusion (OR 25.77, 95% CI 1.35-493.61, p=0.031, area under the receiver operating characteristic curve (AUROC) of the model: 0.847) and 30-day mortality (OR 25.04, 95% CI 2.29-273.42, p=0.008, AUROC of the model: 0.781).
Conclusion: CT-defined bleeding rate k is a prognostic factor for massive transfusion and 30-day mortality in patients with acute bleeding undergoing TAE and may be superior to the volume of contrast extravasation volume alone. Further studies are needed to confirm this finding.
Limitations: The study has to address the limitation of a retrospective single center, and the heterogenous nature of the patient cohort.
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
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Author Block: M. E. Çevik¹, E. ZENGİN², K. B. Memiş³; ¹Kırıkkale/TR, ²Ankara/TR, ³Erzincan/TR
Purpose: Computerized tomography (CT) has been increasingly utilized in the differential diagnosis of acute chest pain. Combining the triple rule out CT angiography (TRO-CT) approach with dual-energy CT (DECT) can enhance the diagnostic capability by identifying myocardial
perfusion deficiencies. This combination can yield a quadruple-rule-out computed tomography angiography (QRO-CT) technique. The aim of this study is to determine the efficacy of the QRO-CT.
Methods or Background: Intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. The myocardial dark spots on the color-coded iodine map were identified as perfusion deficiencies. Pulmonary arteries and aorta were also evaluated.
Results or Findings: The study population consisted of 211 patients. The sensitivity, specificity, and positive and negative predictive values of QRO-CT for pulmonary embolism were 93.5%, 100%, 100%, and 95.3%, respectively. For obstructive coronary artery disease, the values were 96.1%, 93.4%, 89.2%, and 97.7%, respectively. For myocarditis, the values were 69.2%, 100%, 100%, and 93.6%, respectively.
Conclusion: the QRO-CT method may successfully evaluate myocardial perfusion deficits, hence expanding the differential diagnosis capabilities of the standard TRO-CT method for myocarditis. It can provide useful information on myocardial perfusion, which may influence the choice to perform invasive catheterization in cases of coronary artery obstruction.
Limitations: Main limitations are the single-center design, moderate sample size, incomplete troponin data in some patients, and the fact that not all patients had MRI correlation.
Funding for this study: No external funding was received.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Our study was approved by the ethics committee. The ethics committee approval number is as follows: 14.12.2021-EBYU-KAEK-21/12-18.

Author Block: N. Al Balushi, S. RANIGA , A. K. Mittal, N. M. Fazaldad; Muscat/OM
Purpose: Pelvic fractures in polytrauma patients are a critical concern due to their association with vascular injuries, haemorrhage and shock. While CT is the gold standard for evaluation of bony and articular injuries, pelvic radiographs remain the primary screening imaging modality in many trauma protocols. This study aims to assess the diagnostic accuracy of anteroposterior pelvic radiographs for detecting pelvic fractures using CT as reference and to evaluate interobserver agreement among radiologists.
Methods or Background: In this retrospective, cross sectional study approved by the institutional ethics board, adult patients presenting with acute pelvic trauma between 2016-2022 who underwent both pelvic radiography and CT were included. Two staff radiologists independently reviewed the pelvic radiographs, blinded to CT results. Diagnostic accuracy was assessed using CT as the reference standard, calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Interobserver agreement was analysed using Fleiss multirater kappa statistics. Findings were compared with those reported in existing literature.
Results or Findings: Total of 99 patients were included (mean age 33.2±13.1 years, 77.5% male). Acetabular fractures were the most frequently missed, with 53% of cases falsely negative and 1.2% false positives. Sacral fractures had a 50% miss rate on radiographs. The overall interobserver agreement was substantial (kappa= 0.788), with highest agreement seen in iliac, pubic and proximal femur fractures and lowest in acetabular and sacral fractures.
Conclusion: Anteroposterior pelvic radiographs have limited sensitivity for detecting acetabular and posterior ring fractures. In our cohort, all unstable fractures were detected on radiographs, supporting their continued use as effective initial screening tools in polytrauma.
Limitations: The study is constrained by limited sample size and evolving image quality. Radiographic interpretation may have been impacted by patient positioning and obscuring bowel gases, particularly in subtle fractures.
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Approved

Author Block: M. Mitrašinović, D-S. Petkovic, A. Popovic, S. Milosevic, D. Vasin; Belgrade/RS
Purpose: Morel-Lavallée lesions (MLLs) are rare soft tissue injuries occurring in trauma setting, characterized by degloving of subcutaneous tissue from muscular fascia, creating a potential space filled with blood and lymph. They are often overlooked leading to inadequate treatment, complications and recurrence. This study aimed to evaluate the diagnostic role of CT in detecting MLLs and to increase awareness of their recognition on CT, which is usually the first-line imaging tool in polytrauma patients.
Methods or Background: We conducted a retrospective review of trauma patients between 2022 and 2025 based on two criteria: emergency admission for polytrauma and description of a subcutaneous hematoma on CT involving the upper limb, gluteal region, knee, elbow, scapular region, or abdominal wall. These CT scans were then reassessed for misdiagnosed lesions.

Diagnostic CT criteria included: (1) acute, hyperdense collections between subcutaneous fat and fascia; and (2) chronic-appearing, encapsulated collections with fluid–fluid or gas levels, fat lobules, or septations. Patient clinical records were analyzed for confirmation.
Results or Findings: Of 110 trauma patients, 35 (31.8%) showed CT imaging features consistent with MLLs. Clinical confirmation was obtained in 14 patients (12.7% of the cohort; 40% of CT-suspected lesions). The CT-suspected group comprised 22 men (62.9%) and 13 women (37.1%). Most lesions occurred in the gluteal/femoral region (71.4%), followed by scapular (14.3%), knee (8.6%), and elbow (5.7%). CT demonstrated a positive predictive value (PPV) of 40.0% (95% CI: 24.6–57.7%), with a 60% false-positive rate.
Conclusion: CT can raise suspicion for MLLs but does not provide sufficient specificity for definitive diagnosis. While CT is valuable in the acute setting, further evaluation with MRI and clinical examination is essential. Improved awareness of CT features among radiologists may enhance recognition, ensure timely follow-up, and guide management.
Limitations: No
Funding for this study: No
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: Y-C. Wong; New Taipei City/TW
Purpose: Whole-body CT for trauma is a rapid and safe imaging modality. But with hundreds of images per trauma patient, the workload has burned out radiologists and the pressure on timeliness of reporting is increasing. Experimental studies have demonstrated that structured reporting systems can reduce report turn-around time by approximately 25% to 50% (the denominator is about 25 minutes). The purpose of this study is to assess whether brief structural reporting system can reduce the report turn-around time.
Methods or Background: From January 2024 to June 2025, we retrospectively reviewed whole-body CT of trauma patients. We assessed whether brief structured reporting system that includes five key questions can further reduce report turn-around time. The five questions included (1) intracranial midline shift, (2) tension pneumothorax, (3) cardiac tamponade or aortic injury, (4) abdominal contrast medium extravasation and (5) unstable spine or pelvic fracture.
Results or Findings: Among 62 whole-body CT reports, there were 35 males and 27 females, mean age was 46.1 ± 19.1 years, ISS was 25.7 ± 12.6, (min 4 - max 50), report turn-around time was 3.97 ± 1.85 minutes, (min 1 - max 7 minutes). There were 12 intracranial midline shifts, 7 tension pneumothorax, 2 cardiac tamponade or aortic injury, 9 abdominal contrast medium extravasation and 13 unstable spine or pelvic fracture.
Conclusion: The brief structural reporting system could report the whole-body CT, and it took a mean of 3.97 minutes to accomplish.
Limitations: We do not disclose the reliability among different readers. We also do not disclose the impact of the reports on the therapeutic planning of trauma surgeons. Lastly, this initial study is carried out in a single center and the inclusion number is small.
Funding for this study: Chang Gung Medical Foundation Research
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Chang Gung Medical Foundation Ethics Committee