Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography

More slices finally cut it

Elena M. Paulus, Timothy Fabian, Stephanie A. Savage, Ben L. Zarzaur, Vandana Botta, Wesley Dutton, Martin Croce

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

BACKGROUND: Aggressive screening to diagnose blunt cerebrovascular injury (BCVI) results in early treatment, leading to improved outcomes and reduced stroke rates. While computed tomographic angiography (CTA) has been widely adopted for BCVI screening, evidence of its diagnostic sensitivity is marginal. Previous work from our institution using 32-channel multidetector CTA in 684 patients demonstrated an inadequate sensitivity of 51% (Ann Surg. 2011,253: 444-450). Digital subtraction angiography (DSA) continues to be the reference standard of diagnosis but has significant drawbacks of invasiveness and resource demands. There have been continued advances in CT technology, and this is the first report of an extensive experience with 64-channel multidetector CTA. METHODS: Patients screened for BCVI using CTA and DSA (reference) at a Level 1 trauma center during the 12-month period ending in May 2012 were identified. Results of CTA and DSA, complications, and strokes were retrospectively reviewed and compared. RESULTS: A total of 594 patients met criteria for BCVI screening and underwent both CTA and DSA. One hundred twenty-eight patients (22% of those screened) had 163 injured vessels: 99 (61%) carotid artery injuries and 64 (39%) vertebral artery injuries. Sixty-four-channel CTA demonstrated an overall sensitivity per vessel of 68% and specificity of 92%. The 52 false-negative findings on CTA were composed of 34 carotid artery injuries and 18 vertebral artery injuries; 32 (62%) were Grade I injuries. Overall, positive predictive value was 36.2%, and negative predictive value was 97.5%. Six procedure-related complications (1%) occurred with DSA, including two iatrogenic dissections and one stroke. CONCLUSION: Sixty-four-channel CTA demonstrated a significantly improved sensitivity of 68% versus the 51% previously reported for the 32-channel CTA (p = 0.0075). Sixty-two percent of the false-negative findings occurred with low-grade injuries. Considering complications, cost, and resource demand associated with DSA, this study suggests that 64-channel CTA may replace DSA as the primary screening tool for BCVI. LEVEL OF EVIDENCE: Diagnostic study, level III.

Original languageEnglish (US)
Pages (from-to)279-285
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number2
DOIs
StatePublished - Feb 1 2014

Fingerprint

Nonpenetrating Wounds
Multidetector Computed Tomography
Angiography
Digital Subtraction Angiography
Carotid Artery Injuries
Vertebral Artery
Stroke
Wounds and Injuries
Trauma Centers
Dissection

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography : More slices finally cut it. / Paulus, Elena M.; Fabian, Timothy; Savage, Stephanie A.; Zarzaur, Ben L.; Botta, Vandana; Dutton, Wesley; Croce, Martin.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 2, 01.02.2014, p. 279-285.

Research output: Contribution to journalArticle

Paulus, Elena M. ; Fabian, Timothy ; Savage, Stephanie A. ; Zarzaur, Ben L. ; Botta, Vandana ; Dutton, Wesley ; Croce, Martin. / Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography : More slices finally cut it. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 2. pp. 279-285.
@article{e4af435a0938439e9dc33b87d1baf9d4,
title = "Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography: More slices finally cut it",
abstract = "BACKGROUND: Aggressive screening to diagnose blunt cerebrovascular injury (BCVI) results in early treatment, leading to improved outcomes and reduced stroke rates. While computed tomographic angiography (CTA) has been widely adopted for BCVI screening, evidence of its diagnostic sensitivity is marginal. Previous work from our institution using 32-channel multidetector CTA in 684 patients demonstrated an inadequate sensitivity of 51{\%} (Ann Surg. 2011,253: 444-450). Digital subtraction angiography (DSA) continues to be the reference standard of diagnosis but has significant drawbacks of invasiveness and resource demands. There have been continued advances in CT technology, and this is the first report of an extensive experience with 64-channel multidetector CTA. METHODS: Patients screened for BCVI using CTA and DSA (reference) at a Level 1 trauma center during the 12-month period ending in May 2012 were identified. Results of CTA and DSA, complications, and strokes were retrospectively reviewed and compared. RESULTS: A total of 594 patients met criteria for BCVI screening and underwent both CTA and DSA. One hundred twenty-eight patients (22{\%} of those screened) had 163 injured vessels: 99 (61{\%}) carotid artery injuries and 64 (39{\%}) vertebral artery injuries. Sixty-four-channel CTA demonstrated an overall sensitivity per vessel of 68{\%} and specificity of 92{\%}. The 52 false-negative findings on CTA were composed of 34 carotid artery injuries and 18 vertebral artery injuries; 32 (62{\%}) were Grade I injuries. Overall, positive predictive value was 36.2{\%}, and negative predictive value was 97.5{\%}. Six procedure-related complications (1{\%}) occurred with DSA, including two iatrogenic dissections and one stroke. CONCLUSION: Sixty-four-channel CTA demonstrated a significantly improved sensitivity of 68{\%} versus the 51{\%} previously reported for the 32-channel CTA (p = 0.0075). Sixty-two percent of the false-negative findings occurred with low-grade injuries. Considering complications, cost, and resource demand associated with DSA, this study suggests that 64-channel CTA may replace DSA as the primary screening tool for BCVI. LEVEL OF EVIDENCE: Diagnostic study, level III.",
author = "Paulus, {Elena M.} and Timothy Fabian and Savage, {Stephanie A.} and Zarzaur, {Ben L.} and Vandana Botta and Wesley Dutton and Martin Croce",
year = "2014",
month = "2",
day = "1",
doi = "10.1097/TA.0000000000000101",
language = "English (US)",
volume = "76",
pages = "279--285",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Blunt cerebrovascular injury screening with 64-channel multidetector computed tomography

T2 - More slices finally cut it

AU - Paulus, Elena M.

AU - Fabian, Timothy

AU - Savage, Stephanie A.

AU - Zarzaur, Ben L.

AU - Botta, Vandana

AU - Dutton, Wesley

AU - Croce, Martin

PY - 2014/2/1

Y1 - 2014/2/1

N2 - BACKGROUND: Aggressive screening to diagnose blunt cerebrovascular injury (BCVI) results in early treatment, leading to improved outcomes and reduced stroke rates. While computed tomographic angiography (CTA) has been widely adopted for BCVI screening, evidence of its diagnostic sensitivity is marginal. Previous work from our institution using 32-channel multidetector CTA in 684 patients demonstrated an inadequate sensitivity of 51% (Ann Surg. 2011,253: 444-450). Digital subtraction angiography (DSA) continues to be the reference standard of diagnosis but has significant drawbacks of invasiveness and resource demands. There have been continued advances in CT technology, and this is the first report of an extensive experience with 64-channel multidetector CTA. METHODS: Patients screened for BCVI using CTA and DSA (reference) at a Level 1 trauma center during the 12-month period ending in May 2012 were identified. Results of CTA and DSA, complications, and strokes were retrospectively reviewed and compared. RESULTS: A total of 594 patients met criteria for BCVI screening and underwent both CTA and DSA. One hundred twenty-eight patients (22% of those screened) had 163 injured vessels: 99 (61%) carotid artery injuries and 64 (39%) vertebral artery injuries. Sixty-four-channel CTA demonstrated an overall sensitivity per vessel of 68% and specificity of 92%. The 52 false-negative findings on CTA were composed of 34 carotid artery injuries and 18 vertebral artery injuries; 32 (62%) were Grade I injuries. Overall, positive predictive value was 36.2%, and negative predictive value was 97.5%. Six procedure-related complications (1%) occurred with DSA, including two iatrogenic dissections and one stroke. CONCLUSION: Sixty-four-channel CTA demonstrated a significantly improved sensitivity of 68% versus the 51% previously reported for the 32-channel CTA (p = 0.0075). Sixty-two percent of the false-negative findings occurred with low-grade injuries. Considering complications, cost, and resource demand associated with DSA, this study suggests that 64-channel CTA may replace DSA as the primary screening tool for BCVI. LEVEL OF EVIDENCE: Diagnostic study, level III.

AB - BACKGROUND: Aggressive screening to diagnose blunt cerebrovascular injury (BCVI) results in early treatment, leading to improved outcomes and reduced stroke rates. While computed tomographic angiography (CTA) has been widely adopted for BCVI screening, evidence of its diagnostic sensitivity is marginal. Previous work from our institution using 32-channel multidetector CTA in 684 patients demonstrated an inadequate sensitivity of 51% (Ann Surg. 2011,253: 444-450). Digital subtraction angiography (DSA) continues to be the reference standard of diagnosis but has significant drawbacks of invasiveness and resource demands. There have been continued advances in CT technology, and this is the first report of an extensive experience with 64-channel multidetector CTA. METHODS: Patients screened for BCVI using CTA and DSA (reference) at a Level 1 trauma center during the 12-month period ending in May 2012 were identified. Results of CTA and DSA, complications, and strokes were retrospectively reviewed and compared. RESULTS: A total of 594 patients met criteria for BCVI screening and underwent both CTA and DSA. One hundred twenty-eight patients (22% of those screened) had 163 injured vessels: 99 (61%) carotid artery injuries and 64 (39%) vertebral artery injuries. Sixty-four-channel CTA demonstrated an overall sensitivity per vessel of 68% and specificity of 92%. The 52 false-negative findings on CTA were composed of 34 carotid artery injuries and 18 vertebral artery injuries; 32 (62%) were Grade I injuries. Overall, positive predictive value was 36.2%, and negative predictive value was 97.5%. Six procedure-related complications (1%) occurred with DSA, including two iatrogenic dissections and one stroke. CONCLUSION: Sixty-four-channel CTA demonstrated a significantly improved sensitivity of 68% versus the 51% previously reported for the 32-channel CTA (p = 0.0075). Sixty-two percent of the false-negative findings occurred with low-grade injuries. Considering complications, cost, and resource demand associated with DSA, this study suggests that 64-channel CTA may replace DSA as the primary screening tool for BCVI. LEVEL OF EVIDENCE: Diagnostic study, level III.

UR - http://www.scopus.com/inward/record.url?scp=84894164684&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894164684&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000000101

DO - 10.1097/TA.0000000000000101

M3 - Article

VL - 76

SP - 279

EP - 285

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 2

ER -