John Paul Kim MD, Presenter: Nothing to Disclose

Osamu Sakai MD, Abstract Co-Author: Nothing to Disclose

Neck trauma can result in vascular injury, which can be difficult to diagnose clinically. Since the advent of helical multidetector CT angiography (CTA), CTA has largely replaced conventional angiography as the initial modality to assess for vascular injury at our institution. The purpose of our study was to determine the clinical yield of CTA in traumatic vascular injury of the neck.

A retrospective RIS system review was performed at a level I trauma center to identify post-trauma neck CTA studies from 4/05 to 1/07. Indications for studies included fracture or ligamentous injury in structures adjacent to great vessels, or high clinical suspicion for injury based on mechanism. 273 studies in 267 patients were identified and reviewed. Patients ranged in age from 2 to 93 years. Studies were performed by 64-slice multidetector CT at 0.625 mm slice thickness. Studies which were positive for vascular injury to the major arteries of the neck (common, internal, and external carotids, and vertebrals) were listed as positive. Fractures of the skullbase or spine concerning for vascular injury were also recorded.

Of 273 studies, 11 studies (4.0%) were positive for vascular injury. 3 studies (1.1%) were limited due to poor image quality. 4 studies (1.4%) were positive for injury to distal arterial branches. 255 (93.4%) studies were negative for vascular injury. Of 11 positive studies, 6 (54.5%) had cervical spine fractures, 1 (9.0%) had skullbase fractures, and 1 (9.0%) had both skullbase and cervical spine fractures. Of the 262 studies without definite injury to major vessels, 32 (12.2%) had skullbase fractures, 59 (22.5%) had spine fractures, and 7 (1.6%) had both. 8 of the 106 (7.5%) patients with fractures had vascular injury, while 3 of the 167 (1.7%) patients without fractures had vascular injury.

At our institution, 4% of all CTA examinations performed for neck trauma were positive for vascular injury to a major vessel. Patients with fractures in the skullbase or spine were 4.2 times more likely to have vascular injury.

Trauma patients with neck fractures are more likely to have vascular injury on CTA examniation of the neck than patients without fractures.

Kim, J, Sakai, O, Clinical Yield of CT Angiography of the Neck in Trauma Patients.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5003823.html