Blunt cerebrovascular injuries can be diagnosed using whole body 16 multi-detector CT (MDCT); theres no need for an additional neck MDCT angiography examination according to a recent study conducted by researchers at the University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center, both in Baltimore, MD. The study showed that whole body MDCT is just as accurate as neck MDCTA.
In the past, blunt trauma patients would undergo whole-body MDCT and if there was evidence of cerebrovascular injuries, the patient would also undergo a neck MDCT angiography exam, said Clint Sliker, MD, lead author of the study.
Blunt cerebrovascular injuries are uncommon but potentially devastating injuries that can lead to stroke and death. These include dissections, pseudoaneurysms, and arteriovenous fistulae.
After whole-body MDCT was adopted as a means to scan many blunt trauma patients at our institution, my co-authors and I noted that we diagnosed many blunt cerebrovascular injuries with whole-body MDCT, said Dr. Sliker. With this study, we hoped to determine what role whole-body MDCT could play in the diagnosis of blunt cerebrovascular injuries compared to neck MDCTA and angiography, which were the two techniques routinely used to diagnose these injuries at our institution at that time, he said.
For the study, the researchers identified 108 blunt trauma patients that were examined with either whole-body MDCT or neck MDCTA followed by angiography over a 23-month period. From this group, 77 whole body MDCT and 48 neck MDCTA examinations were compared with the results that were pulled from the reports of correlative angiography.
According to the study, angiography confirmed blunt cerebrovascular injuries in 83 patients with 25 of those showing injury to more than one of the four major arteries (carotid or vertebral). In the neck, where injuries were most common, each technique showed low sensitivity for blunt carotid (69% for whole-body MDCT and 64% for MDCTA) and blunt vertebral artery injuries (74% for whole-body MDCT and 68% for MDCTA), but specificities were high for both carotid (82% for whole-body MDCT and 94% for MDCTA) and vertebral artery injuries (91% for whole-body MDCT and 100% for MDCTA). The two techniques diagnosed blunt cerebrovascular injuries with statistically comparable accuracy, said Dr. Sliker.
Since the specificity of whole-body MDCT and neck MDCTA are comparably high, management decisions can be reliably based on positive whole-body MDCT results. In addition, routine use of whole-body MDCT would facilitate diagnosis and treatment of asymptomatic blunt cerebrovascular injuries in patients without typical risk factors for injuries, said Dr. Sliker.
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