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Diagnostic Performance of Helical CT Angiography in Trauma to Large Arteries of the Extremities

Soto, Jorge A.; Múnera, Felipe; Cardoso, Neftalí; Guarín, Olga; Medina, Santiago

Journal of Computer Assisted Tomography: March-April 1999 - Volume 23 - Issue 2 - p 188-196
Vascular Imaging

Purpose: The purpose of this work was to assess the performance of helical CT angiography (CTA) in the diagnosis of injuries to large arteries of the extremities.

Method: We performed helical CTA on 45 consecutive patients referred for conventional angiography for evaluation of suspected arterial injuries after sustaining trauma to the extremities (13 upper, 32 lower). Two radiologists interpreted the helical CTA studies independently. Diagnostic performance parameters evaluated included sensitivity, specificity, receiver operating characteristic (ROC) curves, and interobserver agreement (κ statistics). Conventional angiography was used as the standard of reference for determination of final diagnoses.

Results: Forty-three of 45 patients (96%) had diagnostic helical CTA examinations. Final diagnoses in these 43 patients were arterial occlusion (n = 7), partial obstruction (n = 3), pseudoaneurysm (n = 5), arteriovenous fistula (n = 1), pseudoaneurysm and arteriovenous fistula (n = 3), and normal findings (n = 24). Sensitivity and specificity were 90% [95% confidence interval (CI), 80-99] and 100% (95% CI, 99-100), respectively, for Reader 1 and 100% (95% CI, 99-100) and 100% (95% CI, 99-100), respectively, for Reader 2. ROC curve analysis revealed high diagnostic performance, with areas under the curve of >0.9 for both readers. Interobserver agreement was 0.9.

Conclusion: The diagnostic performance of helical CTA for detection of major injuries of large arteries of the extremities is high.

From the Department of Radiology, Universidad de Antioquia, Hospital Universitario San Vicente de Paul, Medellin, Colombia (J. A. Soto, F. Múnera, N. Cardoso, and O. Guarín), and Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH, U.S.A. (S. Medina).

This article was presented at the 98th Annual Meeting of the American Roentgen Ray Society, San Francisco, CA, U.S.A., April 29, 1998.

Address correspondence and reprint requests to Dr. J. A. Soto at Department of Radiology, Universidad de Antioquia, Hospital Universitario San Vicente de Paul, Calle 64 x Kra. 51D, Medellin, Colombia.

© 1999 Lippincott Williams & Wilkins, Inc.