Comparison of digital subtraction and cut film arteriography in the evaluation of suspected thoracic aortic injury.
OBJECTIVE
To determine whether intraarterial digital subtraction arteriography (DSA) is as sensitive and specific as cut film arteriography (CFA) in the evaluation of suspected aortic injury resulting from blunt chest trauma.


METHODS
Both CFA and DSA images of the thoracic aorta were obtained in the right posterior oblique (RPO) projection in 100 of 103 consecutive patients undergoing arteriography after blunt chest trauma. Diagnoses based on blinded separate review of both studies (CFA vs DSA) by four independent reviewers were compared. Reviewers graded their confidence in their diagnoses from 1 (certain) to 10 (uncertain).


RESULTS
Eleven of 100 patients had aortic or great vessel injuries confirmed by operation (n = 10) or transesophageal echocardiography (n = 1). Three hundred eighty-eight of 400 diagnoses based on RPO CFA and 390 of 400 diagnoses based on RPO DSA agreed with the correct diagnoses. The sensitivity, specificity, and diagnostic accuracy of CFA versus DSA were not significantly different. The reviewers' confidence in their diagnoses was equivalent between CFA (average confidence score, 1.373) and DSA (average confidence score, 1.375).


CONCLUSIONS
DSA and CFA yield equivalent sensitivity, specificity, and diagnostic accuracy in the evaluation of blunt chest trauma.
Johnson
M S
MS
Indiana University Medical Center, Indianapolis 46202-5253, USA.
Shah
H
H
Harris
V J
VJ
Snidow
J J
JJ
Ambrosius
W T
WT
Trerotola
S O
SO
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*