Acute traumatic thoracic aortic injuries: experience with 64-MDCT

Scott D Steenburg, James G Ravenel
AJR. American Journal of Roentgenology 2008, 191 (5): 1564-9

OBJECTIVE: At some institutions, catheter angiography is used for confirmation of aortic injuries and equivocal MDCT findings. Because of the speed and efficiency of 64-MDCT, we believe that diagnostic catheter angiography may be obsolete. The purpose of this study was to review our experience with 64-MDCT in the evaluation of acute traumatic aortic injury (ATAI).

MATERIALS AND METHODS: The trauma registry at a level 1 trauma center was reviewed to find cases of ATAI occurring between March 1, 2005, and July 31, 2007. MDCT images were correlated with transcatheter angiograms when obtained. Surgical and clinical reports were reviewed to confirm abnormal and normal findings and the stability of the conditions of patients undergoing conservative treatment.

RESULTS: After level 1 or level 2 trauma, 1,344 patients underwent contrast-enhanced 64-MDCT. Twenty-four patients (1.79%) were found to have 25 aortic injuries. All patients had direct MDCT signs of ATAI. Ten catheter angiograms were obtained after MDCT. The presence of direct signs was confirmed in three cases. In five cases, indirect signs were found to be normal findings. In two cases, the findings remained equivocal after MDCT and conventional angiography. Fourteen patients underwent surgical repair of the aorta, six underwent conservative management, and four patients died of other injuries. No patient with equivocal or indirect findings needed surgical repair. The sensitivity of 64-MDCT was 96.0%; specificity, 99.8%; positive predictive value, 92.3%; negative predictive value, 99.9%; and accuracy, 99.8%.

CONCLUSION: Direct signs of ATAI on contrast-enhanced 64-MDCT scans do not have to be confirmed with catheter angiography. In our population, diagnostic transcatheter angiography was of limited value for clarifying equivocal or indirect MDCT findings.

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