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

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.

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —38-year-old man with both blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Axial whole-body MDCT image shows right internal carotid artery injury with intramural hematoma (arrowheads) and marked eccentric luminal narrowing (arrow).

View larger version (78K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —38-year-old man with both blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Angiogram confirms marked eccentric luminal narrowing (arrow).

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —38-year-old man with both blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Axial (C) and sagittal multiplanar reconstruction (D) whole-body MDCT images show right vertebral artery injury with intimal flap (arrows).

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —38-year-old man with both blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Axial (C) and sagittal multiplanar reconstruction (D) whole-body MDCT images show right vertebral artery injury with intimal flap (arrows).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —38-year-old man with both blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Angiogram confirms findings in C and D—that is, right vertebral artery injury with intimal flap (arrow).

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —21-year-old man with blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Sagittal maximum-intensity-projection (MIP) reconstruction from neck MDCT angiography (MDCTA) (A) and angiography images (B) show right internal carotid artery injury with eccentric luminal narrowing (arrows) as result of dissection. Right vertebral artery (curved arrows, A and C) is normal on both sagittal MIP (A) and axial (C) neck MDCTA images, although angiogram (D) shows pseudoaneurysm (curved arrow, D) at corresponding level.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —21-year-old man with blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Sagittal maximum-intensity-projection (MIP) reconstruction from neck MDCT angiography (MDCTA) (A) and angiography images (B) show right internal carotid artery injury with eccentric luminal narrowing (arrows) as result of dissection.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —21-year-old man with blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Right vertebral artery (curved arrows, A and C) is normal on both sagittal MIP (A) and axial (C) neck MDCTA images, although angiogram (D) shows pseudoaneurysm (curved arrow, D) at corresponding level.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —21-year-old man with blunt carotid artery and blunt vertebral artery injuries resulting from motor vehicle collision. Right vertebral artery (curved arrows, A and C) is normal on both sagittal MIP (A) and axial (C) neck MDCTA images, although angiogram (D) shows pseudoaneurysm (curved arrow, D) at corresponding level.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —49-year-old woman with bilateral vertebral artery injuries and right internal carotid artery injury resulting from motor vehicle collision. Axial images from whole-body MDCT (A) and neck MDCT angiography (MDCTA) (B) with correlative angiogram (C) show right vertebral artery injury with dissection causing eccentric luminal narrowing (arrows). Note beam hardening (arrowheads, A) from abducted arms on whole-body MDCT image (A).

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —49-year-old woman with bilateral vertebral artery injuries and right internal carotid artery injury resulting from motor vehicle collision. Axial images from whole-body MDCT (A) and neck MDCT angiography (MDCTA) (B) with correlative angiogram (C) show right vertebral artery injury with dissection causing eccentric luminal narrowing (arrows). Note beam hardening (arrowheads, A) from abducted arms on whole-body MDCT image (A).

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —49-year-old woman with bilateral vertebral artery injuries and right internal carotid artery injury resulting from motor vehicle collision. Axial images from whole-body MDCT (A) and neck MDCT angiography (MDCTA) (B) with correlative angiogram (C) show right vertebral artery injury with dissection causing eccentric luminal narrowing (arrows). Note beam hardening (arrowheads, A) from abducted arms on whole-body MDCT image (A).

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —49-year-old woman with bilateral vertebral artery injuries and right internal carotid artery injury resulting from motor vehicle collision. Axial images from whole-body MDCT (D) and neck MDCTA (E) with correlative angiogram (F) show left vertebral artery injury with dissection causing eccentric luminal narrowing (arrows). Right internal carotid artery injury (not shown) was not detected on whole-body MDCT or neck MDCTA.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —49-year-old woman with bilateral vertebral artery injuries and right internal carotid artery injury resulting from motor vehicle collision. Axial images from whole-body MDCT (D) and neck MDCTA (E) with correlative angiogram (F) show left vertebral artery injury with dissection causing eccentric luminal narrowing (arrows). Right internal carotid artery injury (not shown) was not detected on whole-body MDCT or neck MDCTA.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3F —49-year-old woman with bilateral vertebral artery injuries and right internal carotid artery injury resulting from motor vehicle collision. Axial images from whole-body MDCT (D) and neck MDCTA (E) with correlative angiogram (F) show left vertebral artery injury with dissection causing eccentric luminal narrowing (arrows). Right internal carotid artery injury (not shown) was not detected on whole-body MDCT or neck MDCTA.

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