Penetrating Neck Injuries: Helical CT Angiography for Initial Evaluation

Múnera, Felipe; Soto, Jorge A.; Palacio, Diana; Castañeda, Jorge Ojeda; Morales, Carlos; Sanábria, Álvaro; Gutiérrez, Juan Escribano; García, Giovanni

doi:10.1148/radiol.2242010973

Cited by 180 publications

(107 citation statements)

References 38 publications

Supporting

Mentioning

102

Contrasting

Unclassified

Order By: Relevance

“…This finding reflects the fact that traumatic lesions tend to occur in zone II of the neck (zone II lies between the cricoid and the angle of the mandible), in concordance with results reported in a study with similar demographic characteristics compared with our patient population. 13 Clinical symptoms produced by arteriovenous vertebral fistulas are related to the flow velocity in the shunt, venous drainage pattern, and lesion chronicity. These factors can affect neighboring structures by means of steal phenomenon or venous hypertension.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

Herrera¹,

Vargas²,

Dublin³

2008

AJNR Am J Neuroradiol

100

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

Herrera¹,

Vargas²,

Dublin³

2008

AJNR Am J Neuroradiol

100

View full text Add to dashboard Cite

show abstract

“…Computed tomography angiography has been shown to have a high sensitivity for detecting CADs, especially soon after the ictus. 31,42,49,51 However, there has been only limited experience with this technique.…”

Section: Diagnosis Of Cadmentioning

confidence: 99%

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

Chamoun

Mawad

Whitehead

et al. 2008

PED

View full text Add to dashboard Cite

Object Currently, no diagnostic or treatment standards exist for extracranial carotid artery dissection (CAD) in children after trauma. The purpose of this study was to review and describe the characteristics, diagnosis, and treatment of this rather uncommon sequelae of pediatric trauma. Methods A systematic review of the literature was performed to examine the pertinent studies of traumatic extracranial carotid artery (CA) injuries in children. Results No randomized trials were identified; however, 19 case reports or small case series consisting of 34 pediatric patients were found in the literature. The diagnosis of CAD was made in 33 of 34 patients only after the onset of ischemic symptomatology. Twenty-four of 34 patients underwent cerebral angiography to confirm diagnosis; MR angiography affirmed the diagnosis in 6 of 34 patients. There was little published experience with CA ultrasonography or CT angiography for diagnosis. Thirty of 34 patients were treated with medical therapy or observation; 2 of 4 patients treated with observation alone died. There was little experience with open surgical treatment of CAD in the pediatric population, and there were no studies on the endovascular treatment of traumatic CAD in children. The literature does not support anticoagulation therapy over antiplatelet therapy. Conclusions As a result of this review of the literature, the authors propose the algorithms for the evaluation and treatment of traumatic extracranial CADs in children. These recommendations include utilizing MR angiography as a screening tool in cases in which the clinical suspicion of CAD is high, using conventional cerebral angiography to confirm the diagnosis, implementing antiplatelet therapy as initial medical management, and reserving endovascular stenting in cases of failed medical treatment.

show abstract

“…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.…”

mentioning

confidence: 99%

“…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.…”

mentioning

confidence: 99%

See 1 more Smart Citation

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

Bodanapally¹,

Shanmuganathan²,

Boscak³

et al. 2014

JNS

View full text Add to dashboard Cite

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.

show abstract

Penetrating Neck Injuries: Helical CT Angiography for Initial Evaluation

Abstract: Results indicate that helical CT angiography can be used as the initial method for evaluation in patients with possible arterial injuries of the neck.

Cited by 180 publications

References 38 publications

Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

Endovascular Treatment of Traumatic Injuries of the Vertebral Artery

Extracranial traumatic carotid artery dissections in children: a review of current diagnosis and treatment options

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

Contact Info

Product

Resources

About