title: Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography.
abstract: OBJECTIVE
  The authors conducted a study to compare the sensitivity and specificity of helical CT angiography (CTA) and digital subtraction angiography (DSA) in detecting intracranial arterial injuries after penetrating traumatic brain injury (PTBI).
  
  
  METHODS
  In a retrospective evaluation of 48 sets of angiograms from 45 consecutive patients with PTBI, 3 readers unaware of the DSA findings reviewed the CTA images to determine the presence or absence of arterial injuries. A fourth reader reviewed all the disagreements and decided among the 3 interpretations. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were calculated on a per-injury basis and in a subpopulation of patients with traumatic intracranial aneurysms (TICAs).
  
  
  RESULTS
  Sensitivity of CTA for detecting arterial injuries was 72.7% (95% CI 49.8%-89.3%); specificity, 93.5% (95% CI 78.6%-99.2%); PPV, 88.9% (95% CI 65.3%-98.6%); and NPV, 82.9% (95% CI 66.4%-93.4%). All 7 TICAs were correctly identified by CTA. Sensitivity, specificity, PPV, and NPV of CTA in detecting TICAs were 100%. To compare agreement with DSA, the standard of reference, confidence scores categorized as low, intermediate, and high probability yielded an overall effectiveness of 77.8% (95% CI 71.8%-82.9%).
  
  
  CONCLUSIONS
  Computed tomography angiography had limited overall sensitivity in detecting arterial injuries in patients with PTBI. However, it was accurate in identifying TICAs, a subgroup of injuries usually managed by either surgical or endovascular approaches, and non-TICA injuries involving the first-order branches of intracranial arteries.
authors.affiliation: Departments of 1 Radiology and.
authors.forename: Uttam K
authors.initials: UK
authors.lastname: Bodanapally
authors.forename: Kathirkamanathan
authors.initials: K
authors.lastname: Shanmuganathan
authors.forename: Alexis R
authors.initials: AR
authors.lastname: Boscak
authors.forename: Paul M
authors.initials: PM
authors.lastname: Jaffray
authors.forename: Giulia
authors.initials: G
authors.lastname: Van der Byl
authors.forename: Ashis K
authors.initials: AK
authors.lastname: Roy
authors.forename: David
authors.initials: D
authors.lastname: Dreizin
authors.forename: Thorsten R
authors.initials: TR
authors.lastname: Fleiter
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Mirvis
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Krejza
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging; D005189:False Positive Reactions; D005260:Female; D020197:Head Injuries, Penetrating / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed; D055815:Young Adult
keywords: AUC = area under the curve; CT angiography; CTA = CT angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; MCA = middle cerebral artery; MIP = maximum intensity projection; MPR = multiplanar reconstructed; NPV = negative predictive value; PPV = positive predictive value; PTBI = penetrating traumatic brain injury; TICA = traumatic intracranial aneurysm; digital subtraction angiography; intracranial arterial injuries; penetrating traumatic brain injury; traumatic intracranial pseudoaneurysms; vascular disorders