Alessandro A. Lemos MD, Presenter: Nothing to Disclose

Michele Ciulla MD, Abstract Co-Author: Nothing to Disclose

James Marsh Sternberg MD, Abstract Co-Author: Nothing to Disclose

Ugo Cioffi MD, Abstract Co-Author: Nothing to Disclose

Matilde De Simone MD, Abstract Co-Author: Nothing to Disclose

Pietro R. Biondetti MD, Abstract Co-Author: Nothing to Disclose

The purpose of our study was to compare diagnostic accuracy, scan time, radiation dose and image quality of “whole-body” versus “focused” multi-detector CT angiography in the detection of blunt cerebrovascular injuries (BCVI)in multi-system trauma patients

The study design was divided in two phases:the first phase (September 2000-October 2006) consisted of a retrospective cohort study. The second phase (October 206-February 2007) consisted of a case-control cohort.We estimated the diagnostic accuracy of both CT protocols (i.e. sensitivity, specificity)in the detection of BCVI. The reference test applied to all patients was clinical follow-up until day 90. Definitive imaging tests comprised DSA and MR angiography. Comparison of Radiation dose was calculated using a mathematical phantom ( ImPACT CT Patient Dosimetry Calculator, version 0,99x 01/02/2006). Image quality was categorized as high,intermediate, or poor. Student’s t test was used to compare radiation doses and scan times between the two methods whereas the Wilcoxon test was used to compare image quality.

A total of 1041 patients underwent MDCT angiography, 507 using the focused acquisition protocol(FCT), and the remaining 434 using the whole-body acquisition protocol (WBCT). Twenty-eight patients(3%)had BCVI, 16(1.6%) were detected using the WBCT, whereas the remaining 12(1.4%)using the FCT. Sensitivity, specificity and overall accuracy of WBCT were 63%,96%,and 90%, respectively , while for FCT they were 65%,99%,and 92%, respectively. There was no statistical difference with regard to image quality between the two protocols(p>1). Radiation dose was greater using FCT than WBCT(Mean TED 17 vs 11 mSv, SD ± 3.2 )(p=.01).Scan time was greater using FCT than WBCT(Mean 60 vs 32 sec, SD ± 2.5)(p=.03).

Whole-body MDCT angiography is not only feasible , but results in significantly faster image collection and lower radiation dosage than focused MDCT angiography, while maintaining similar diagnostic accuracy and image quality.

Whole -body MDCT angiography should be considered the method of choice for BCVI screening in patients who have sustained multiple trauma.

Lemos, A, Ciulla, M, Sternberg, J, Cioffi, U, De Simone, M, Biondetti, P, Whole Body versus Focused Multidetector CT Angiography as a Screening Tool for Blunt Cerebrovascular Injuries in Multisystem Trauma Patients.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5003671.html