Use of 64-Row Multidetector CT Angiography in Blunt and Penetrating Trauma of the Upper and Lower Extremities

Abstract

Computed tomographic (CT) angiography is rapidly becoming the preferred imaging test for the initial evaluation of patients suspected to have arterial injuries after blunt and penetrating trauma to the extremities. The increasingly widespread use of 64-row multidetector CT technology offers considerable benefits in extremity CT angiography in the trauma setting. These include the ability to generate isotropic data sets of long vascular territories, with the acquisition performed in a short time (10 seconds or less). Isotropic voxels make CT a fully multiplanar modality, a capability that is particularly useful for evaluating tortuous vessels. Sixty-four-row multidetector CT angiography of the extremities has the ability to demonstrate a variety of vascular injuries such as occlusion, pseudoaneurysm, active extravasation, and intimal dissection. Radiologists should be aware of the various potential pitfalls and limitations of extremity CT angiography in evaluation of trauma patients suspected to have extremity vascular injuries, including inadequate arterial enhancement, motion artifact, inadequate positioning, and streak artifact. By demonstrating the extent, location, and type of injury, CT angiography aids in the decision-making process to determine the appropriate management for each injury in each patient.

Application of 64-slice spiral computed tomography angiography in extremity vascular injuries

“…Also, 64-slice spiral CTA can elucidate the relationship between vascular injury and adjacent structures through VR, MPR, and CPR images (Karcaaltincaba et al, 2004;Willmann and Wildermuth, 2005;Bunger et al, 2006;Gakhal and Sartip, 2009;Ichinose et al, 2009;Pieroni et al, 2009;Shah et al, 2009;Smith et al, 2010;Uyeda et al, 2010;Foster et al, 2011;Halvorson et al, 2011;Sarac et al, 2011). The following are examples of the types of limb trauma with vascular injury included in the analysis: 1) arterial rupture, 2) arterial spasm or occlusion, 3) vascular compression shift, 4) pseudoaneurysm, 5) arteriovenous fistula, and 6) popliteal vein embolism.…”

Imaging of Vascular Injuries of the Extremities

“…23 The presence of these indirect signs should raise the suspicion for an occult vascular injury. 24 The incidence of vascular injuries in patients with soft signs of vascular injury ranges from 3% to 25% depending on which soft sign or combination of soft signs are present. 25,26 The presence of peripheral pulses equal to those in the contralateral uninjured extremity may represent absence of arterial injury, or a nonflow-limiting arterial injury such as intimal injury, compression by surrounding tissues or hematoma, or vasospasm.…”

Imaging for the Evaluation and Treatment of Vascular Trauma

“…However, the availability and diagnostic accuracy of CTA has made it the imaging modality of choice in most centers. 23 Adding extremity CTA to an already-planned scan of the chest, abdomen, and pelvis adds little time or contrast but does provide detailed information that may be particularly useful in the polytrauma patient ( Fig. 6-8).…”