Comparative effectiveness of FAST combined with MRI and CT in wound evaluation of blunt abdominal trauma

TL;DR

This study compares the effectiveness of combining FAST with MRI versus CT in diagnosing abdominal injuries, finding that FAST plus MRI performs better in stable patients.

Contribution

The study introduces a novel comparison of FAST combined with MRI against CT for diagnosing blunt abdominal trauma in hemodynamically stable patients.

Findings

FAST combined with MRI identified more true-positive cases of abdominal injuries than CT.

FAST plus MRI showed significantly higher diagnostic accuracy and localization capability compared to CT.

The combination of FAST and MRI was more effective in diagnosing intra-abdominal cavity injuries than CT.

Abstract

Blunt abdominal trauma, often resulting from motor vehicle collisions (MVCs), assaults, recreational accidents, or falls, is commonly assessed in emergency departments using the focused assessment with sonography for trauma (FAST). FAST offers advantages such as ease of use and rapid identification for intra-abdominal free fluid, an indirect marker of visceral injury. However, its diagnostic performance is highly dependent on operator expertise, limiting its ability to accurately characterize the type and severity of injuries.

This study aimed to assess the diagnostic performance of FAST combined with magnetic resonance imaging (MRI) compared to computed tomography (CT) in the evaluation of hemodynamically stable patients with blunt abdominal trauma.

A retrospective, single-center study was conducted involving 87 patients admitted between February 2018 and September 2023 with suspected blunt abdominal trauma. Only hemodynamically stable patients were included in this study. All patients were underwent FAST, MRI, and CT imaging, with surgical or pathological findings serving as the gold standard. The diagnostic accuracy, localization capability, and time to diagnosis were between the FAST + MRI and CT.

Among the 87 patients, 36 were confirmed to have abdominal organ injuries. The FAST + MRI approach identified 34 true-positive cases, whereas CT identified 30. FAST + MRI showed significantly higher diagnostic accuracy and localization capability compared to CT (p < 0.05). Additionally, for intra-abdominal cavity injuries, 18 cases were accurately diagnosed using FAST + MRI, compared to 12 with CT.

Our findings indicate that in hemodynamically stable patients, the combination of FAST and MRI provides superior diagnostic accuracy and localization for blunt abdominal trauma compared to CT, with timely diagnostic efficiency. These findings suggest that FAST + MRI may serve as a useful complementary imaging strategy in hemodynamically stable patients; however, further prospective studies comparing this approach to contrast-enhanced CT and incorporating patient outcome measures are warranted.

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