Screening for carotid injury in trauma patients: image quality of 16-detector-row computed tomography angiography.
BACKGROUND
The introduction of multidetector-row computed tomography (MDCT) has revolutionized the initial management of multiply injured patients. This technology has the potential to improve the imaging of traumatic vascular injuries.


OBJECTIVE
To evaluate the quality of multidetector-row computed tomography angiography (MDCTA) of the carotid arteries in the setting of a routine whole-body trauma scan.


METHODS
87 trauma patients underwent a routine whole-body CT scan in a 16-detector-row scanner including an MDCTA with a reconstructed axial slice thickness of 3 mm. Images were reviewed by three experienced radiologists with emphasis on image quality. Contrast density, severity, and origin of artifacts and the occurrence of vessel lesions were assessed for different vessel segments.


RESULTS
3642 separate vessel segments were evaluated. Contrast density was rated good or sufficient for diagnosis in 99.8%. A total of 67.3% of vessel segments were free of artifacts, while 27.9% of vessel segments showed minor artifacts not impairing diagnostic evaluation. Clinically relevant artifacts obscuring a vessel segment occurred in 4.7% and were mostly caused by dental hardware. Four dissections of the internal carotid artery were diagnosed by all three radiologists.


CONCLUSIONS
As a rapid screening test for blunt carotid artery injury, integration of MDCTA in the routine imaging workup of trauma patients utilizing a whole-body CT trauma scan is possible and practicable. Image quality is mostly sufficient for diagnosis, but impaired in a few cases by artifacts deriving primarily from dental hardware.
Borisch
I
I
Department of Diagnostic Radiology, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93042 Regensburg, Germany. ingitha@web.de
Boehme
T
T
Butz
B
B
Hamer
O W
OW
Feuerbach
S
S
Zorger
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging