A retrospective study of computed tomography angiography versus digital subtraction angiography in penetrating neck trauma at Groote Schuur Hospital, South Africa

Abstract

Background: Penetrating neck trauma is commonly encountered in South African trauma units, and is associated with high mortality and morbidity rates. The imaging protocol for stable patients with penetrating neck trauma remains controversial. There is only sparse data validating the use of computed tomography angiography (CTA) in the evaluation of penetrating neck trauma in South Africa.Objectives: To assess the sensitivity and specificity of CTA versus digital subtraction angiography (DSA) in detecting arterial injury and secondarily evaluate the ability of CT to assess non-arterial injury.Method: Using hospital and radiology databases, 23 patients were identified who had undergone both CTA and DSA for penetrating neck trauma. The data was retrospectively anonymised and randomised. A radiologist experienced in the interpretation of both trauma CTA and DSA re-reported all the imaging and the findings were compared and analysed.Results: Twenty-four arterial injuries were detected. The sensitivity of CTA for detecting arterial injury was 78% and the specificity 83%. The ability of CTA to delineate wound track and detect non-arterial visceral injury was also confirmed.Conclusion: CTA is an attractive initial diagnostic investigation that, along with clinical evaluation, effectively guides further investigation and intervention. It is important for the radiologist to understand the limitations of CTA and have a low threshold for DSA in equivocal cases.

Computed tomography angiography for aerodigestive injuries in penetrating neck trauma: A systematic review

“…The majority of the full‐text reviewed articles were rejected for only reporting vascular injuries (LeBlang et al, 12 Munera et al, 13 Ofer et al, 14 Munera et al, 15 Stuhlfaut et al, 16 Hogan et al, 17 Kazi et al 18 ). Methodological concerns related to sampling bias were responsible for removing the articles by Scholtz et al, 19 Schroll et al, 20 Woo et al, 21 Osborn et al, 22 Siau et al, 23 and Bell et al 24 Missing data preventing the generation of 2×2 tables forced the removal of Maritz et al 25 and Ibraheem et al 26 Finally, the article by LeBlang et al 27 was removed for lack of CTA testing and the article by Morales‐Uribe et al 3 was a review article, leaving seven articles for our final review.…”

Diagnostic Approaches to Vascular Injury in Polytrauma—A Literature Review

“…It requires mobilisation of theatre personnel, and it is performed in specialised centres. Although this imaging has been regarded as the gold-standard imaging modality for vascular trauma, in the modern practice, its role has been restricted to equivocal cases after CTA [ 33 ]. DSA has a high sensitivity and is preferred for diagnosis of penetrating cerebrovascular injuries (PCVI) since it has been demonstrated that CTA has lower sensitivity, specificity and positive and negative predictive values for the diagnosis of PCVI cerebrovascular injuries [ 34 ] (see Figure 2 ).…”