Soenue Langner MD, Presenter: Nothing to Disclose

Steffen Fleck MD, Abstract Co-Author: Nothing to Disclose

Michael Kirsch MD, Abstract Co-Author: Nothing to Disclose

Joerg Baldauf, Abstract Co-Author: Nothing to Disclose

Norbert Hosten MD, Abstract Co-Author: Nothing to Disclose

The incidence of traumatic craniocervical artery dissection varies in published trauma series and is associated with cervical spine trauma. The purpose of this study was to determine the frequency of traumatic craniocervical artery injury in polytrauma patients by using a standardized whole body trauma CT with an adapted CT angiography (CTA) of the craniocervical vessels.

Within 12 months 273 patients requiring a whole body trauma CT due to the mechanism of their injury were analyzed retrospectively. All examinations were performed using a 16 row MDCT (Sensation 16, SIEMENS). Initially a plain spiral scan of the neurocranium was acquired. Then a CT angiography of the craniocervical vessels with 40 ml of iodinated contrast agent (flow 4ml/s; 40 ml saline flush, flow 4ml/s) was performed starting at the level of TH2 up to the roof of the lateral ventricles (100kV, 120mAs, collimation 16 x 0.75). Finally a contrast-enhanced spiral thoraco-abdominal scan was performed with a delay of 20 sec after administering a second contrast bolus of 60 ml. The craniocervical vessels were analyzed in the source images and using 20mm thin slice MIP-reconstructions.

CTA was diagnostic in all patients. Isolated cervical spine injuries were observed in 11 patients (4%), isolated cranial injuries in 59 patients (21,7%) whereas combined cervical and cranial lesions were seen in 5 patients (1,8%). Injuries of craniocervical vessels were observed in 2 cases (0,98%) (1 vertebral artery dissection and 1 carotid dissection combined with carotid cavernous fistula) in isolated cervical and skull base fracture respectively. In one case there was a dissection of both carotid arteries without cervical spine trauma.

Craniocervical vessel injury is a rare event in case of high velocity injury. Whole body trauma CT scan with an adapted scanning protocol for the craniocervical vessels is a fast, safe and feasible method for detecting vascular injuries in the craniocervical region. It allows prompt further treatment if necessary.

Whole body trauma CT scan with an adapted scanning protocol for the craniocervical vessels is a fast, safe and feasible method for detecting vascular injuries.

Langner, S, Fleck, S, Kirsch, M, Baldauf, J, Hosten, N, Whole Body CT Trauma Imaging with Adapted CT Angiography of the Cranio-Cervical Vessels: Incidence of Associated Vessel Injury.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5001768.html