Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis.
OBJECTIVE
To present our experience with helical computed tomographic (CT) arteriography as the initial diagnostic examination in patients suspected to have focal arterial injuries of the proximal extremities.


METHODS
During 19 months, 142 arterial segments in the proximal portions of the extremities of 139 patients with trauma were evaluated with helical CT arteriography. CT arteriograms were interpreted on site by the radiologist in charge of emergency procedures and retrospectively with consensus interpretation between two radiologists. CT study quality and the presence of arterial injuries were noted. CT arteriographic findings were compared with those of surgery, conventional arteriography, and/or clinical follow-up.


RESULTS
Five (3.6%) patients had nondiagnostic studies and underwent conventional arteriography. In the remaining 137 arterial segments in 134 patients, helical CT arteriography demonstrated arterial injuries in 61 segments and normal arteries in 76 segments. These segments were treated initially with surgery (55 segments) or endovascular intervention (four segments) or were observed (78 segments); 77 of the 78 observed segments remained stable at 3-18 months (mean follow-up, 5.2 months). There were no differences between the on-site and consensus interpretations (kappa = 1.0). The sensitivity of CT arteriography was 95.1%, and the specificity was 98.7%.


CONCLUSIONS
Helical CT arteriography can be performed as the initial diagnostic method in most patients suspected to have focal arterial injuries of the proximal portions of the extremities.
Soto
J A
JA
Department of Radiology, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl, Calle 64 x Carrera 51D, Medellín, Colombia. jorgeasoto@aol.com
Múnera
F
F
Morales
C
C
Lopera
J E
JE
Holguín
D
D
Guarín
O
O
Castrillón
G
G
Sanabria
A
A
García
G
G
D000293:Adolescent; D000328:Adult; D000792:Angiography / Q000379:methods; D001132:Arm / Q000098:blood supply*; D001134:Arm Injuries / Q000000981:diagnostic imaging*; D001158:Arteries / Q000293:injuries*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D007869:Leg Injuries / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods