Computed Tomographic Angiography for the Diagnosis of Blunt Carotid/Vertebral Artery Injury

• DOI: 10.1097/sla.0b013e3181568cab
• Publication Date: 2007-09-19T07:05:30Z
• Authors: Ajai K. Malhotra; Marc Camacho; Rao R. Ivatury; Ivan C. Davis; Daniel J. Komorowski; Daniel A. Leung; John D. Grizzard; Michel B. Aboutanos; Therese M. Duane; Charlotte Cockrell; Luke G. Wolfe; C Todd Borchers; Nancy R. Martin
• Keywords: Digital subtraction angiography; Blunt trauma; Computed Tomography Angiography; Vertebral artery dissection

Computed tomographic angiography (CTA) by 16-channel multidetector scanner is increasingly replacing conventional digital subtraction (DSA) for diagnosing or excluding blunt carotid/vertebral injuries (BCVI). To date there has been only 1 study in which all patients received both examinations. That reported a high accuracy 16-detector CTA. The current prospective parallel comparative aims at validating this and examining the rates of evaluability CTA performed with image reconstruction modern imaging software.Patients risk BCVI (facial/cervical-spinal fractures; unexplained neurologic deficit; anisocoria; lateral neck soft tissue injury; clinical suspicion) underwent (16-channel scanner) DSA. Results 2 studies course were prospectively recorded.During 40-month period ending March 2007, approximately 7000 trauma evaluated these 119 (1.7%) consecutive meeting inclusion criteria screened Ninety-two confirmatory Twenty-three (22%) DSA identified 26 (vertebral, 13; carotid, 13). Among 23 CTAs, 17 19 BCVIs 10; 9) (true positives), 6 failed to identify 7 3; 4) (false negatives). Sixty-nine 92 normal. Of 69 10 falsely suspicious 11 7; 56 normal remaining 3 CTAs nonevaluable (mistimed contrast, 1; streak artifact, 2). Sixteen 89 (18%) evaluable suboptimal 9; artifacts, 4; motion 2; body habitus, 1). Excluding sensitivity, specificity, positive negative predictive values 74%, 86%, 65%, 90% respectively. One patient grade II carotid artery (by DSA) on antiplatelet agent developed stroke related injuries.Current technology cannot reliably diagnose exclude BCVI. Twenty percent are either suboptimal. Until more data available technique standardized, trend towards using screen and/or rare but potentially devastating dangerous.