Blunt cerebrovascular injury screening with 32-channel multidetector computed tomography: more slices still don't cut it.
OBJECTIVE
We sought to determine the diagnostic accuracy of computed tomographic angiography (CTA) using 32-channel multidetector computed tomography for blunt cerebrovascular injuries (BCVIs).


BACKGROUND
Unrecognized BCVI is a cause of stroke in young trauma patients. Digital subtraction angiography (DSA), the reference standard, is invasive, expensive, and time-consuming. Computed tomographic angiography has been rapidly adopted by many institutions because of its availability, less resource intensive, and noninvasive nature. However, conflicting results comparing CTA and DSA have been reported. Studies with 16-channel CTA report a wide range of sensitivities for BCVI diagnosis.


METHODS
From January 2007 through May 2009, patients with risk factors for BCVI underwent both CTA and DSA. All CTAs were performed using a 32-channel multidetector CT scanner. Using DSA as the reference standard, the diagnostic accuracy of CTA for determination of BCVI was calculated.


RESULTS
There were 684 patients who met the inclusion criteria. Ninety patients (13%) had 109 injuries identified; 52 carotid and 57 vertebral injuries were diagnosed. CTA failed to detect 53 confirmed BCVI, yielding a sensitivity of 51%.


CONCLUSIONS
Given the devastation of stroke, and high mortality from missed injuries, this study demonstrates that even with more advanced technology (32 vs 16 channel), CTA is inadequate for BCVI screening. Digital subtraction angiography remains the gold standard for the diagnosis of BCVI.
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Jennifer M
JM
DiCocco
Katrina P
KP
Emmett
Timothy C
TC
Fabian
Ben L
BL
Zarzaur
James S
JS
Williams
Martin A
MA
Croce
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000009:adverse effects / Q000592:standards; D001926:Brain Death; D002533:Cerebral Angiography; D005260:Female; D016489:Head Injuries, Closed / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020198:Intracranial Hemorrhage, Traumatic / Q000000981:diagnostic imaging* / Q000628:therapy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012015:Reference Standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D055815:Young Adult