Bryan Robert Foster MD, Presenter: Nothing to Disclose

Stephan Anderson MD, Abstract Co-Author: Nothing to Disclose

Jennifer W. Uyeda BS, Abstract Co-Author: Nothing to Disclose

James Travis Rhea MD, Abstract Co-Author: Stockholder, General Electric Company

Jorge A. Soto MD, Abstract Co-Author: Researcher, General Electric Company Researcher, Koninklijke Philips Electronics NV Researcher, Bracco Group Researcher, Schering AG (Berlex Inc)

To describe our experience with upper extremity 64-MDCT angiography in trauma at a major Level I trauma center.

The IRB approved this HIPAA compliant, retrospective study. Patients who underwent CT angiography (CTA) of the upper extremities in the setting of trauma between May 2005 and March 2007 were identified. All examinations were acquired with a LightSpeed VCT scanner (GE Medical Systems, Milwaukee, WI), using 0.625 mm thickness. For dedicated angiograms a timing bolus was used to calculate scan delay then 60 mL of contrast was administered at a rate of 4-5 mL/sec. In the setting of multi-trauma imaging, CTA images of the extremity were acquired just prior to or during the chest acquisition, using 100 mL of IV contrast and a fixed scan delay. When indicated, images were then immediately obtained through the abdomen and pelvis in the portal venous phase. Findings on follow-up imaging studies, operative intervention, and/or clinical follow-up were used as the standard of reference.

In the 22-month period, 39 CTAs were performed: 33 for penetrating injuries and 6 for blunt injuries. Five examinations were acquired as part of a multiphasic study of the chest, abdomen and pelvis, while 2 were performed prior to acquisition of the thorax alone. There were 10 positive exams (26%) with injuries to 13 arterial segments (occlusion, n=5; narrowing, n=3; pseudoaneurysm, n=3; active extravasation, n=2). Five patients were explored and all injuries were confirmed in the OR. The remaining patients underwent non-operative management. No patient underwent conventional angiography. There were no delayed injuries, indicating false negative CTA, identified by clinical follow up. Two studies were considered non-diagnostic secondary to poor timing of the bolus. Studies of 3 patients were limited by retained bullet fragments and one required operative therapy.

CTA of the upper extremities is a reliable method to screen for and detect significant vascular injuries, with some limitations. Integration with multiphasic body CT is feasible, but experience is limited at this point.

Upper extremity CTA is a frequently used first line vascular examination in the setting of trauma.

Foster, B, Anderson, S, Uyeda, J, Rhea, J, Soto, J, Upper Extremity CT Angiography in Trauma: Early Experience with 64-Multidetector CT.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5013552.html