Supplementary value and diagnostic performance of computed tomography scout view in the detection of thoracolumbar spine injuries

Milavec, Helena; Gasser, Vera T.; Ruder, Thomas D.; Deml, Moritz C.; Hautz, Wolf; Exadaktylos, Aristomenis; Benneker, Lorin M.; Albers, Christoph E. (2024). Supplementary value and diagnostic performance of computed tomography scout view in the detection of thoracolumbar spine injuries. Emergency radiology, 31(1), pp. 63-71. Springer 10.1007/s10140-023-02196-9

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Purpose
Assessing the diagnostic performance and supplementary value of whole-body computed tomography scout view (SV) images in the detection of thoracolumbar spine injuries in early resuscitation phase and identifying frequent image quality confounders.

Methods
In this retrospective database analysis at a tertiary emergency center, three blinded senior experts independently assessed SV to detect thoracolumbar spine injuries. The findings were categorized according to the AO Spine classification system. Confounders impacting SV image quality were identified. The suspected injury level and severity, along with the confidence level, were indicated. Diagnostic performance was estimated using the caret package in R programming language.

Results
We assessed images of 199 patients, encompassing 1592 vertebrae (T10–L5), and identified 56 spinal injuries (3.5%). Among the 199 cases, 39 (19.6%) exhibited at least one injury in the thoracolumbar spine, with 12 (6.0%) of them displaying multiple spinal injuries. The pooled sensitivity, specificity, and accuracy were 47%, 99%, and 97%, respectively. All experts correctly identified the most severe injury of AO type C. The most common image confounders were medical equipment (44.6%), hand position (37.6%), and bowel gas (37.5%).

Conclusion
SV examination holds potential as a valuable supplementary tool for thoracolumbar spinal injury detection when CT reconstructions are not yet available. Our data show high specificity and accuracy but moderate sensitivity. While not sufficient for standalone screening, reviewing SV images expedites spinal screening in mass casualty incidents. Addressing modifiable factors like medical equipment or hand positioning can enhance SV image quality and assessment.

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