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Computed Tomographic Angiography for the Diagnosis of Blunt Cervical Vascular Injury: Is It Ready for Primetime?

Eastman, Alexander L. MD; Chason, David P. MD; Perez, Carlos L. MD; McAnulty, Amy L. BSN; Minei, Joseph P. MD

Journal of Trauma-Injury Infection & Critical Care: May 2006 - Volume 60 - Issue 5 - pp 925-929
doi: 10.1097/01.ta.0000197479.28714.62
Original Articles

Introduction: Although the reported sensitivity of computed tomographic angiography (CTA) for the diagnosis of blunt cervical vascular injury (BCVI) has been inadequate, we hypothesized that advances in computed tomographic technology have improved the diagnostic sensitivity of CTA at least to that of invasive catheter angiography (CA).

Methods: Data from all patients at risk for BCVI presenting to a Level I trauma center were collected prospectively. Each patient was evaluated with CTA and these findings were confirmed with standard catheter arteriograms (CA).

Results: Over 11 months, 162 patients were at risk for BCVI. In all, 146 patients received both CTA and CA. Forty-six BCVIs were identified among 43 patients. In 45 of 46 cases (98%), the results of CTA and CA were concordant. There was a single false-negative CTA in a patient with a grade I vertebral artery injury (VAI). The remaining 103 patients had normal CTAs confirmed by a normal CA. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTA for the diagnosis of BCVI were 97.7%, 100%, 100%, 99.3%, and 99.3%, respectively.

Conclusions: CTA, using a 16-channel detector, can be used to accurately screen at-risk patients for BCVI.

From the Division of Burns, Trauma and Critical Care, Department of Surgery (A.L.E., J.P.M.), and the Division of Neuroradiology, Department of Radiology (D.P.C., C.L.P., A.L.M.), University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas, Texas.

Submitted for publication September 28, 2005.

Accepted for publication October 31, 2005.

Presented at the 64th Annual Meeting of the American Association for the Surgery of Trauma, September 22–24, 2005, Atlanta, Georgia.

Address for reprints: Alexander Eastman, MD, Department of Surgery, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd MC8890, Dallas, Texas 75390-8890; email: alexander.eastman@utsouthwestern.edu.

© 2006 Lippincott Williams & Wilkins, Inc.