Impact of MDCT Angiography on the Use of Catheter Angiography
Impact of MDCT Angiography on the Use of Catheter Angiography
Objective: The objective of our study was to assess the impact of the increasing use of MDCT angiography in the setting of blunt and penetrating neck trauma on the use of digital subtraction angiography (DSA) at our institution, a level 1 trauma center.
Materials and Methods: From January 2001 to December 2003, 57 patients were referred for CT angiography or DSA of the neck after blunt or penetrating neck trauma. All CT angiograms were acquired with a 4-MDCT scanner. The patients were divided into three groups on the basis of consecutive 12-month periods (2001, 2002, and 2003), and the initial imaging technique was recorded. The Results of CT and digital subtraction angiograms were compared with operative findings and with clinical course, when available.
Results: In 2001, 12 patients were referred for imaging: nine patients were evaluated initially with DSA and three patients were evaluated with CT angiography and subsequently with DSA. In 2002 and 2003, 11 and 34 patients, respectively, underwent CT angiography as the initial imaging examination. During these 2 years, no patient underwent DSA as the initial diagnostic test, but five patients underwent DSA after CT angiography for the following indications: evaluation of nondiagnostic CT angiograms (n = 1), confirmation of findings when requested by the clinical service (n = 2), and catheter-guided therapy (n = 2).
Conclusion: CT angiography has essentially replaced DSA as the study of choice for the initial evaluation of the neck vessels in the setting of blunt or penetrating trauma at our institution. CT angiography is adequate for the initial evaluation, allows appropriate triage of patients to conventional angiography or surgery for appropriate treatment, and can guide conservative management when appropriate.
Penetrating and blunt trauma of the neck can result in significant vascular injury. In the past decade, radiologists have played an increasingly important role in detecting such injuries. Although digital subtraction angiography (DSA) is still accepted as the gold standard for imaging the major vessels of the neck, the reported high number of patients with negative Results and the risk associated with performing such procedures have prompted a search for other less invasive imaging techniques. Noninvasive techniques that have been explored as a potential replacement for catheter angiography in this patient population include MR angiography, duplex sonography, and CT angiography.
CT is now the main technique used for the evaluation of the trauma patient with multiple injuries. In this setting, CT has been shown to be effective in the detection and characterization of solid abdominal organ injuries, bowel and mesenteric injuries, spine and pelvic fractures, and thoracic aortic injuries. In recent years, CT angiography has also been reported to be useful in the detection of injuries to the major arteries. Prior studies using single-detector helical CT have shown high sensitivity and specificity for detecting injuries to major vessels of the neckthe common and internal carotid arteries, proximal branches of the external carotid arteries, vertebral arteries, and proximal extremity arteriesin the setting of both blunt and penetrating trauma.
At our institution, a level 1 trauma center, we introduced neck CT angiography as an alternative to DSA for evaluating blunt and penetrating trauma patients after acquisition of MDCT technology. In this study, we evaluated the impact of the increasing use of MDCT angiography in the setting of suspected traumatic cervical arterial injury from blunt or penetrating trauma on our use of DSA.
Objective: The objective of our study was to assess the impact of the increasing use of MDCT angiography in the setting of blunt and penetrating neck trauma on the use of digital subtraction angiography (DSA) at our institution, a level 1 trauma center.
Materials and Methods: From January 2001 to December 2003, 57 patients were referred for CT angiography or DSA of the neck after blunt or penetrating neck trauma. All CT angiograms were acquired with a 4-MDCT scanner. The patients were divided into three groups on the basis of consecutive 12-month periods (2001, 2002, and 2003), and the initial imaging technique was recorded. The Results of CT and digital subtraction angiograms were compared with operative findings and with clinical course, when available.
Results: In 2001, 12 patients were referred for imaging: nine patients were evaluated initially with DSA and three patients were evaluated with CT angiography and subsequently with DSA. In 2002 and 2003, 11 and 34 patients, respectively, underwent CT angiography as the initial imaging examination. During these 2 years, no patient underwent DSA as the initial diagnostic test, but five patients underwent DSA after CT angiography for the following indications: evaluation of nondiagnostic CT angiograms (n = 1), confirmation of findings when requested by the clinical service (n = 2), and catheter-guided therapy (n = 2).
Conclusion: CT angiography has essentially replaced DSA as the study of choice for the initial evaluation of the neck vessels in the setting of blunt or penetrating trauma at our institution. CT angiography is adequate for the initial evaluation, allows appropriate triage of patients to conventional angiography or surgery for appropriate treatment, and can guide conservative management when appropriate.
Penetrating and blunt trauma of the neck can result in significant vascular injury. In the past decade, radiologists have played an increasingly important role in detecting such injuries. Although digital subtraction angiography (DSA) is still accepted as the gold standard for imaging the major vessels of the neck, the reported high number of patients with negative Results and the risk associated with performing such procedures have prompted a search for other less invasive imaging techniques. Noninvasive techniques that have been explored as a potential replacement for catheter angiography in this patient population include MR angiography, duplex sonography, and CT angiography.
CT is now the main technique used for the evaluation of the trauma patient with multiple injuries. In this setting, CT has been shown to be effective in the detection and characterization of solid abdominal organ injuries, bowel and mesenteric injuries, spine and pelvic fractures, and thoracic aortic injuries. In recent years, CT angiography has also been reported to be useful in the detection of injuries to the major arteries. Prior studies using single-detector helical CT have shown high sensitivity and specificity for detecting injuries to major vessels of the neckthe common and internal carotid arteries, proximal branches of the external carotid arteries, vertebral arteries, and proximal extremity arteriesin the setting of both blunt and penetrating trauma.
At our institution, a level 1 trauma center, we introduced neck CT angiography as an alternative to DSA for evaluating blunt and penetrating trauma patients after acquisition of MDCT technology. In this study, we evaluated the impact of the increasing use of MDCT angiography in the setting of suspected traumatic cervical arterial injury from blunt or penetrating trauma on our use of DSA.
Source...