Diagnosis of Arterial Injuries Caused by Penetrating Trauma to the Neck: Comparison of Helical CT Angiography and Conventional Angiography

Múnera, Felipe; Soto, Jorge A.; Palacio, Diana; Velez, Sol M.; Medina, Elcy

doi:10.1148/radiology.216.2.r00jl25356

Cited by 231 publications

(162 citation statements)

References 31 publications

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“…The limited sensitivity of CTA in patients with PTBI (72.7%, range 63.6%-77.3%) compared with nontraumatic intracranial aneurysms (pooled sensitivity 98%) 16 and vascular injuries in the neck after penetrating trauma (range 90%-100%) 8,11,12,15 can be explained by several factors. The fact that the vascular injuries after PTBI are usually located along the harboring vessel, rather than at the central branching point as with nontraumatic aneurysms, may have yielded a lower sensitivity due to decreasing resolution as we move farther from the circle of Willis.…”

Section: Discussionmentioning

confidence: 99%

“…13 Computed tomography angiography (CTA) is a noninvasive imaging modality that has been used for the evaluation of nontraumatic intracranial aneurysms 16 and arterial injuries in the neck after penetrating trauma. 11,12 The diagnostic performance of CTA in those groups compared favorably with that of DSA. 11,12,16 The role of CTA in the evaluation of patients with PTBI has not been investigated.…”

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confidence: 98%

“…11,12 The diagnostic performance of CTA in those groups compared favorably with that of DSA. 11,12,16 The role of CTA in the evaluation of patients with PTBI has not been investigated. The purpose of our study was to determine the sensitivities and specificities of helical CTA for detection of all types of intracranial arterial injuries caused by PTBI, with separate analysis of the subpopulation with TICAs, compared with DSA as the standard of reference.…”

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confidence: 98%

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Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Bodanapally¹,

Shanmuganathan²,

Boscak³

et al. 2014

JNS

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Object 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.

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Section: Discussionmentioning

confidence: 99%

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confidence: 98%

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confidence: 98%

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Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Bodanapally¹,

Shanmuganathan²,

Boscak³

et al. 2014

JNS

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“…6) The primary concern in managing such injuries is control of bleeding 1,7,13,14) and airway management. 7,11) Serious injuries resulting from penetrating neck trauma may be clinically asymptomatic 10,13) or masked by coma and other life-threatening injuries. The leading cause of death in penetrating neck trauma is vascular injury.…”

Section: Discussionmentioning

confidence: 99%

“…Comparison of CT angiography and conventional angiography for detecting penetrating trauma to the arteries of the neck has demonstrated that CT angiography has 90% sensitivity, 100% specificity, 100% positive predictive value, and 98% negative predictive value. 3,[8][9][10] The anterior location of the larynx and trachea makes them exposed to injury in blunt and penetrating trauma of the neck. Rapidly expanding subcutaneous emphysema of the neck and voice tone changes are obvious indications.…”

Section: Discussionmentioning

confidence: 99%

Settled Nail Injury in the Corpus of the Seventh Cervical Vertebra -Case Report-

Gülşen

Sonmez

Aydemir

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 26-year-old construction worker presented with a nail settled in the C-7 corpus. He had no neurological or physical abnormalities. Preoperative evaluation of the vascular, neural, and aerodigestive structures with cervical radiography, computed tomography (CT), CT angiography, and contrast esophagography found no damage. The nail was completely exposed surgically and removed. The patient recovered with no deficits. Penetrating neck injury may be associated with significant morbidity and mortality due to vascular, neural, and aerodigestive tract injury. Patients in stable clinical condition should be evaluated by CT angiography, esophagography, and chest and cervical radiography.

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Evaluation and Management of Pediatric Oropharyngeal Trauma

Soose¹,

Simons²,

Mandell³

2006

Arch Otolaryngol Head Neck Surg

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To examine the clinical factors that influence medical decision making in children with oropharyngeal trauma. Design: Retrospective chart review (spanning 6 years). Setting: Tertiary care children's hospital. Patients: One hundred seven consecutive children with traumatic oropharyngeal injuries. Interventions: Computed tomographic angiography (CTA) (n = 52), surgical therapy (n = 16), inpatient admission (n=44), and antibiotic administration (n=77). Main Outcome Measures: The likelihood of a patient undergoing each of the 4 interventions and having positive radiographic findings or clinical complications was assessed with respect to the following clinical factors: (1) age, (2) sex, (3) mechanism of injury, (4) site of injury, (5) wound severity (3-point scale), and (6) otolaryngology consultation. Results: The following factors were significantly associated with an increased likelihood of a patient undergoing CTA to rule out occult internal carotid artery damage: (1) injury to the lateral soft palate, (2) high wound severity score, and (3) otolaryngology consultation. Radiographic abnormalities (including free air, parapharyngeal edema, and hematoma) were present in 16 (31%) of 52 CTAs but were not associated with any specific clinical factors. Patients with more severe wounds were more likely to undergo CTA, go to the operating room, receive antibiotics, and be admitted to the hospital but were not more likely to have positive CTA findings or an adverse clinical outcome. Conclusions: We were unable to identify any clinical factors that would help predict which children with oropharyngeal trauma are at high risk of developing neurologic sequelae. Radiographic screening for vascular injury in children with oropharyngeal trauma remains controversial.

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Diagnosis of Arterial Injuries Caused by Penetrating Trauma to the Neck: Comparison of Helical CT Angiography and Conventional Angiography

Abstract: The sensitivity and specificity of helical CT angiography are high for detection of major carotid and vertebral arterial injuries resulting from penetrating trauma.

Cited by 231 publications

References 31 publications

Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Settled Nail Injury in the Corpus of the Seventh Cervical Vertebra -Case Report-

Evaluation and Management of Pediatric Oropharyngeal Trauma

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