Abstract
Background: In a previous study, we clarified the accuracy of screening for blunt cerebrovascular injury (BCVI) by 4 multidetector-row CT angiography (MDCTA). The purpose of this study was to evaluate the accuracy of diagnosis of BCVI by 64 MDCTA.
Patients and Methods: The study comprised 163 patients admitted from 2007 through 2010 with blunt cervical/facial/head trauma who met predefined screening criteria for CTA. Patients with negative MDCTA results underwent no further radiologic evaluation. Patients with positive findings and whose diagnosis was not definitive underwent conventional angiography (CA). Positive predictive value (PPV) was determined, and the detection rate of vascular injuries was compared with that in the previous study.
Results: MDCTA results were positive in 22 of 163 (13.5%) patients. Vascular injuries were diagnosed definitively by MDCTA in 11(14 injuries) of the 22 patients. The other 11 patients had positive MDCTA findings but their diagnosis was not definitive. CA was not performed in 2 of these 11 patients because of brain death. Among the 12 injuries in these 9 patients, 9 injuries (PPV: 75%) were confirmed to be BCVI. The detection rate of vascular injuries was increased to 11.0% from 7.7% in the previous study, although the difference was not statistically significant. Four injuries were detected by conventional angiography but not by MDCTA (mild internal carotid injury at skull base: 1; arteriovenous fistula: 3).
Conclusions: Sixty-four MDCTA is an excellent screening tool for BCVI. However, accuracy of diagnosis for injuries adjacent to bone or for arteriovenous fistula requires improvement in the future.
