Sixteen-slice computed tomographic angiography is a reliable noninvasive screening test for clinically significant blunt cerebrovascular injuries

Walter L Biffl, Thomas Egglin, Bernard Benedetto, Frantz Gibbs, William G Cioffi
Journal of Trauma 2006, 60 (4): 745-51; discussion 751-2

BACKGROUND: In light of their potential for devastating consequences, a liberalized screening approach for blunt cerebrovascular injuries (BCVI) is becoming increasingly accepted. The gold standard for diagnosis of BCVI is arteriography (ART), but noninvasive diagnostic alternatives offer clear advantages. Prospective comparative studies found that computed tomographic angiography (CTA) was unreliable in detecting BCVI. However, with advanced CTA technology, it has become more difficult to justify ART in asymptomatic patients. We implemented a liberal screening protocol for BCVI, employing 16-slice CTA. We hypothesized that CTA would detect all clinically significant BCVI.

METHODS: Patients undergoing computed tomography scanning for cranial or cervical trauma, as well as those with high-risk injury mechanisms or patterns, had craniocervical CTA performed. Abnormal CTA studies were confirmed with ART. Patients were followed for signs or symptoms of ischemic neurologic events.

RESULTS: Over an 11-month period, 331 patients underwent CTA. Eighteen (5.4%) patients had a total of 20 BCVI. There were 11 carotid and 9 vertebral artery injuries. Seven of nine (78%) vertebral injuries were associated with cervical spine fractures. Two patients who did not meet screening criteria had signs or symptoms of BCVI before CTA. No patient with normal CTA developed evidence of BCVI.

CONCLUSIONS: CTA detected all clinically significant injuries during this study period. Liberal screening with 16-slice CTA is appropriate and is likely to miss very few significant injuries. A multicenter trial will help to clarify risk factors and the accuracy of noninvasive diagnostic modalities.

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