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

Abstract

BACKGROUND AND PURPOSE: Blunt carotid and vertebral artery injury (BCVI) is rare but potentially devastating. The objective of our study was to prospectively evaluate the usefulness of a dedicated and optimized CT angiography (CTA) protocol of the craniocervical vessels as part of a whole-body CT work-up of patients with multiple trauma in a population of patients with blunt trauma.

Multidetector CT Angiography in the Evaluation of Acute Blunt Head and Neck Trauma: A Proposed Acute Craniocervical Trauma Scoring System

“…However, patients with low-impact MOIs would merit multidetector CT angiographic evaluation only if there is a fracture reaching the expected location of an arterial structure or a high index of clinical suspicion. Among the different unenhanced CT fi ndings, we found the risk of arterial injury to be highest in patients with cervical interfacetal subluxations/ dislocations (44.4%), and fracture lines that reached either the foramen transversarium (22.8%) or the ICA canal (18.5%), which are similar to the results of prior studies ( 7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). However, for cervical spine fractures reaching the foramen transversarium, we found that the risk for vertebral artery injury was signifi cantly higher in the lower cervical spine (36.3%) than in the upper cervical spine (12.3%).…”

“…However, for cervical spine fractures reaching the foramen transversarium, we found that the risk for vertebral artery injury was signifi cantly higher in the lower cervical spine (36.3%) than in the upper cervical spine (12.3%). These fi ndings are similar to some of the prior multidetector CT angiographic studies that have reported specifi c cervical spine fracture levels for patients with vertebral artery injury ( 11,14 ), although Utter et al ( 18 ) and other catheter angiographic studies ( 6,16,17 ) have reported higher yields in patients with fractures of the upper cervical spine. Notably, we found the risk of vertebral artery injury to be particularly high in patients with fractures of the C5 vertebral body reaching the foramen transversarium (38.5%) and the risk of ICA injury to be highest in CT angiographic studies, which have reported yields ranging from 1.2% to 28.4% ( 7,(9)(10)(11)(12)(13)(14)(15)18 ).…”

“…Although a few studies ( 5,6,12 ) have reported a lower accuracy of CT angiography compared with catheter angiography for the detection of arterial injury in patients with blunt head and neck trauma, with the advent of multidetector CT angiography, the majority of studies assessing the accuracy of this modality have shown it to be equivalent to catheter angiography in this patient population (7)(8)(9)(10)(11)(12)14,15,(18)(19)(20). At our institution, multidetector CT angiography has replaced catheter angiography as the initial modality in the evaluation of patients with acute blunt head and neck trauma to assess for arterial injury.…”

“…There was no signifi cant difference between the mean age of patients with arterial injury (47.6 years) and those without (48.4 years; Student t test, P = .8). Table 2 provides a summary of the MOIs and the frequency of associated arterial injury for patients with and 14), respectively ( Fig 2 ). Of note, two (15.4%) of 13 patients with occipital condyle fractures and fi ve (13.5%) of 37 patients with C1 ring fractures reaching the ipsilateral vertebral artery's dural penetration had vascular injury adjacent to the fracture line.…”

Stroke Secondary to Traumatic Carotid Artery Injury – A Case Report

“…The reported incidence of these has increased owing to the extensive application of screening imagistic methods, such as ultrasound, CT angiography and digital subtraction angiography (DSA). (1,2) These types of injuries are associated with morbidity and mortality rates ranging between 23 to 28%, and 48-58% of survivors have significant neurological complications. (3,4) Blunt cerebrovascular injuries differ in many ways from spontaneous carotid, and vertebral artery dissections and frequently are associated with other traumatic lesions.…”