Pinto Antonio, Russo Anna, Reginelli Alfonso, Iacobellis Francesca, Di Serafino Marco, Giovine Sabrina, Romano Luigia
Department of Radiology, CTO Hospital, Naples, Italy.
Department of Radiology, SG Moscati Hospital, Aversa, ASL Caserta, Italy.
Semin Ultrasound CT MR. 2019 Feb;40(1):25-35. doi: 10.1053/j.sult.2018.10.018. Epub 2018 Nov 2.
Ballistic traumas are defined by a projectile entering the body. Such projectiles include bullets, birdshot, and metal fragments from the covering or the contents of an explosive device. They frequently cause severe wounds characterized by a range of clinical pictures and a large spectrum of concomitant wounds. The major aims of imaging are to define the path of the projectile or projectiles, to evaluate which tissues have been injured, to estimate the severity of injury, and to determine what additional studies are needed. A routine radiograph is performed in patients with gunshot wounds. The diagnostic approach has been changed by the use of multidetector row computed tomography (MDCT) due to its technical developments particularly faster data acquisition and advanced image reconstructions. In the evaluation of patients with gunshot injuries, MDCT is considered the method of choice to identify hemorrhage, bullet, bone fragments, air, hemothorax, nerve lesions, musculoskeletal lesions, and vessel injuries. Moreover, MDCT technology and multiplanar reformation postprocessing allow meticulous trajectory analysis that potentially benefits the clinical outcomes of patients aiding time-saving triage and correct image-based diagnosis of organ and vessel damage. Familiarity of ballistics and forensic sciences will therefore help the radiologist in assessment and localization of the damage caused by projectiles.
弹道创伤是由射弹进入人体所定义的。此类射弹包括子弹、霰弹以及来自爆炸装置外壳或内部的金属碎片。它们常常造成严重创伤，其特征表现为一系列临床症状以及大量伴随创伤。影像学检查的主要目的是确定射弹的路径、评估哪些组织受到了损伤、估计损伤的严重程度以及确定还需要进行哪些其他检查。对于枪伤患者需进行常规X线摄影。由于多排螺旋计算机断层扫描（MDCT）技术的发展，特别是更快的数据采集和先进的图像重建技术，其诊断方法已经发生了改变。在评估枪伤患者时，MDCT被认为是识别出血、子弹、骨碎片、空气、血胸、神经损伤、肌肉骨骼损伤和血管损伤的首选方法。此外，MDCT技术和多平面重组后处理能够进行细致的弹道分析，这可能有益于患者的临床治疗结果，有助于节省时间的分诊以及基于图像对器官和血管损伤进行正确诊断。因此，熟悉弹道学和法医学知识将有助于放射科医生评估和定位射弹造成的损伤。
