Sixteen-Slice Multi-Detector Computed Tomographic Angiography Improves the Accuracy of Screening for Blunt Cerebrovascular Injury

Berne, John D.; Reuland, Kurt S; McGovern, Thomas M.; Rowe, Stephen A.; Norwood, Scott H.

doi:10.1097/01.ta.0000220435.55791.ce

Cited by 131 publications

(79 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Third, the BCVI cohort consists of only 6 patients, which is a small number, but then the entity under investigation is uncommon; this limitation is also shared by other studies. 17,19,33 In comparison with the clinical risk factors, which were used by other authors 9,10,14,15 to identify patients who should undergo screening examinations, sensitivity and specificity for CTA were 100% with a PPV of 1 and a NPV of 0. Because the incidence of BCVI and of patients with multiple injured vessels is in the range reported by other authors, we believe that our data may reflect the true accuracy of 16-row MSCT angiography in screening a general blunt trauma population for BCVI.…”

Section: Discussionmentioning

confidence: 99%

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Langner¹,

Fleck²,

Kirsch³

et al. 2008

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

show abstract

“…Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 .…”

mentioning

confidence: 99%

“…In recent years, many centres have adopted multi-detector computed tomographic angiography (CTA) to diagnose BCVI non-invasively in the setting of trauma. Studies have shown that CTA of the neck can serve as a reliable screening modality for BCVI in patients at risk for vascular injuries 1,3,5,19 .…”

mentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Wei

Montanera

Selchen

et al. 2010

Can. j. neurol. sci.

View full text Add to dashboard Cite

574In recent years, blunt cerebrovascular injury (BCVI) is gaining attention as an important sequela of nonpenetrating trauma to the neck and skull base. Blunt cerebrovascular injury affects approximately 1% of all blunt trauma admissions, and the reported incidence is as high as 2.7% in centres with aggressive screening protocols [1][2][3][4][5][6][7][8] . The pattern of BCVI consists of vascular transection, dissection, thrombosis, and formation of pseudoaneurysm or arteriovenous fistula (AVF) 9,10 . The majority of these injuries occur during motor vehicle accidents, with variable rates of carotid and vertebral artery involvement reported in the literature [11][12][13] . If untreated, BCVI can be fatal and result in devastating neurological sequelae, with mortality and morbidity rates reported up to 38% and 67% respectively 14 .One of the difficulties in initiating treatment for BCVI is related to the variable symptomatology. While approximately ABSTRACT: Background: Blunt cerebrovascular injury (BCVI) to the carotid and vertebral arteries is a potentially devastating injury in trauma patients. The optimal management for BCVI has not been standardized. At our institution, 64-slice multi-detector computed tomographic angiography (CTA) has been used as the initial screening exam for BCVI in patients who met predefined screening criteria. The purpose of this study is to review the incidence of CTA-diagnosed BCVI in at-risk patients and to evaluate the treatment and clinical outcome of patients with BCVI. Methods: This study included trauma patients with a positive diagnosis of BCVI on CTA during a 41-month study period. The medical records and relevant radiographic findings were retrospectively reviewed. Results: Twenty seven of 222 blunt trauma patients evaluated with CTA had a positive diagnosis of BCVI, with an occurrence rate of 12.2%. Traumatic brain injury (72.2%) and basal skull fractures (55.6%) were the most frequent associated injuries with carotid trauma while 100% of blunt vertebral injuries occurred in the setting of cervical fractures. Fourteen (51.8%) patients received medical therapy; Eleven (40.7%) patients received conservative treatment. Endovascular treatment was attempted in a single case of vertebral arteriovenous fistula. BCVI-related stroke was found in four patients (14.8%), one of whom developed an infarct while on medical treatment. Conclusions: BCVI is found in a significant portion of blunt trauma patients with identifiable risk factors, and screening CTA has high diagnostic yield in detecting these lesions. Medical therapy is the mainstay of treatment at our institution; however, BCVI-related stroke may occur despite treatment. RÉSUMÉ: Diagnostic et résultats du traitement des traumatismes cérébrovasclaires contondants. Contexte :Le traumatisme cérébrovasculaire contondant (TCVC) à la carotide et aux artères vertébrales est une lésion qui peut être dévastatrice chez les patients qui ont subi un traumatisme. Le traitement optimal du TCVC n'a pas été standardisé. Dans notre institutio...

show abstract

“…Early studies (in the absence of screening) showed an incidence as low as 0.08%, 1 but with the increased screening and use of CT angiography as the diagnostic test, the incidence is now estimated to be between 1.2% and 2.99% of trauma admissions. [2][3][4] These injuries can have high morbidity and mortality. Many patients with BCVI ultimately die from other injuries; nonetheless, earlier studies (in which BCVI diagnosis was based on symptoms and not on screening) showed that isolated BCVI-related death could be as high as 38%, 5,6 with permanent neurologic deficits in most patients.…”

mentioning

confidence: 99%

Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

Nagpal

Policeni

Bathla³

et al. 2017

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

SUMMARY:Blunt cerebrovascular injury is a relatively uncommon but sometimes life-threatening injury, particularly in patients presenting with ischemic symptoms in that vascular territory. The decision to pursue vascular imaging (generally CT angiography) is based on clinical and imaging findings. Several grading scales or screening criteria have been developed to guide the decision to pursue vascular imaging, as well as to recommend different treatment options for various injuries. The data supporting many of these guidelines and options are limited however. The purpose of this article is to review and compare these scales and criteria and the data supporting clinical efficacy and to make recommendations for future research in this area. ABBREVIATIONS:ATT ϭ antithrombotic therapy; BCVI ϭ blunt cerebrovascular injury; EAST ϭ Eastern Association for the Surgery of Trauma

show abstract

Sixteen-Slice Multi-Detector Computed Tomographic Angiography Improves the Accuracy of Screening for Blunt Cerebrovascular Injury

Cited by 131 publications

References 17 publications

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Whole-Body CT Trauma Imaging with Adapted and Optimized CT Angiography of the Craniocervical Vessels: Do We Need an Extra Screening Examination?

Blunt Cerebrovascular Injuries: Diagnosis and Management Outcomes

Blunt Cerebrovascular Injuries: Advances in Screening, Imaging, and Management Trends

Contact Info

Product

Resources

About