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DOI:10.2214/AJR.07.2378
AJR 2008; 190:790-799
© American Roentgen Ray Society

Original Research

Diagnosis of Blunt Cerebrovascular Injuries with 16-MDCT: Accuracy of Whole-Body MDCT Compared with Neck MDCT Angiography

Clint W. Sliker1, Kathirkamanathan Shanmuganathan and Stuart E. Mirvis

1 All authors: Department of Diagnostic Imaging, University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center, 22 S Greene St., Baltimore, MD 21201.

OBJECTIVE. The objective of our study was to determine whether whole-body 16-MDCT and neck MDCT angiography (MDCTA) can be used to diagnose blunt cerebrovascular injuries with comparable accuracy using angiography as the reference standard.

MATERIALS AND METHODS. Retrospective review of radiology reports and prospective clinical observation identified 108 blunt trauma patients examined with either whole-body MDCT or neck MDCTA followed by angiography over a 23-month period. From this group, results from the retrospective interpretations of 77 whole-body MDCT and 48 neck MDCTA examinations were compared with the results extracted from angiography reports to estimate the accuracy of each protocol for detecting blunt cerebrovascular injuries. Fisher's exact test was used to determine any significant difference in the results of those patients scanned with both protocols.

RESULTS. Angiography confirmed blunt cerebrovascular injury in 83 patients, with 25 (30%) showing multiple sites of injury. Most injuries were detected in cervical arterial segments. The respective sensitivities of whole-body MDCT and neck MDCTA were 69% (36/52) and 64% (16/25) for cervical internal carotid artery injuries, and specificities were 82% (58/71) and 94% (49/52). Respective sensitivities for cervical vertebral artery injuries were 74% (17/23) and 68% (13/19), and specificities were 91% (60/66) and 100% (40/40). In 17 patients scanned with both protocols, the results were not significantly different (carotid arteries, p = 1.00; vertebral arteries, p = 0.68).

CONCLUSION. Whole-body 16-MDCT and neck MDCTA can be used to diagnose blunt cerebrovascular injuries with comparable accuracy. Both show high specificities for cervical arterial injury. The sensitivity of whole-body 16-MDCT is sufficiently high to serve as an initial screening examination for blunt cerebrovascular injuries.

Keywords: blunt trauma • cerebrovascular injury • MDCT • MDCT angiography • whole-body MDCT


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