Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography.
OBJECTIVE
To determine the sensitivity and specificity of helical computed tomographic (CT) angiography in the diagnosis of carotid and vertebral arterial injuries caused by penetrating neck trauma.


METHODS
A prospective study was conducted during 24 months in 60 patients with penetrating neck trauma who were referred for conventional angiography owing to clinical suspicion of arterial injury. In the patient population, 146 arteries (77 carotid, 69 vertebral) were studied by means of conventional angiography. In all patients, conventional angiography and helical CT angiography were completed within 6 hours. Two radiologists interpreted helical CT angiographic studies by means of consensus. Conventional angiography was the standard of reference for determining the sensitivity and specificity of helical CT angiography.


RESULTS
Conventional angiograms showed arterial injuries in 10 (17%) of 60 patients. Conventional angiographic findings were arterial occlusion (n = 4), arteriovenous fistula (n = 2), pseudoaneurysm (n = 3), pseudoaneurysm with arteriovenous fistula (n = 1), and normal arteries (n = 136). Nine of 10 arterial injuries and all normal arteries were depicted adequately at helical CT angiography. Sensitivity of helical CT angiography was 90%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 98%.


CONCLUSIONS
The sensitivity and specificity of helical CT angiography are high for detection of major carotid and vertebral arterial injuries resulting from penetrating trauma.
Department of Radiology, Universidad de Antioquia, Hospital Universitario San Vicente de Paul, Calle 64 x Kra. 51D, Medellin, Colombia. fmunera@epm.net.co
F
F
Múnera
J A
JA
Soto
D
D
Palacio
S M
SM
Velez
E
E
Medina
D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging; D000792:Angiography / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D014950:Wounds, Penetrating / Q000150:complications*