Multislice CT Helps Detect Traumatic Carotid Lesions

BY PATRICE WENDLING

< previous article | Table of Contents | next article >

CHICAGO -- Thin-slice axial reconstructions derived from multislice whole-body CT scans are a reliable and robust technique for imaging the carotid artery in patients with multiple traumas, Dr. Ingitha Borisch reported during a poster presentation at the annual meeting of the Radiological Society of North America.

Earlier studies with single-slice CT scanners led to controversy over the use of CT angiography in the detection of traumatic carotid artery lesions. A systemic review of 43 articles concluded there wasn't enough high-quality evidence to accurately estimate the sensitivity and specificity of CT angiography for blunt or penetrating trauma (Eur. J. Radiol. 2003;48:88-102).

But the advent of multirow scanners has made the screening of potentially life-threatening dissections of the carotid artery both possible and practical, Dr. Borisch said. The incidence of carotid artery dissection, now between 1% and 5%, is rising because of an increase in deceleration automobile accidents, she said. Intracerebral hemorrhage resulting in persistent neurologic deficits is seen in up to 37% of these patients.

Dr. Borisch presented data from a study of 87 consecutive polytrauma patients who underwent a routine 16-slice CT whole-body scan, including a postcontrast scan of the supraaortic vessels. Reconstructed axial slice thickness was 3 mm. There were 44 head injuries, including 34 intracerebral hemorrhages, and 11 cervical spine injuries. Each vessel was divided into 7 segments, with a total of 3,642 vessel segments evaluated. Contrast was rated good or sufficient for diagnosis in 99.8% of segments, reported Dr. Borisch and colleagues, the University Hospital Regensburg, Germany. Overall, 67% of vessel segments were artifact free. Artifacts from dental implants (8%) and bones (22%) impaired image quality in 4% of vessel segments.

Four dissections (5% of the patients) were diagnosed by all three radiologists evaluating the images. No differences were seen by the three readers in localization, extension, and severity of the resulting vessel stenosis. No pseudoaneurysms were found. Perivascular hematomas were seen by one reader in two cases.

Current practice in Dr. Borisch's clinic is to perform a whole-body scan from the top of the head to the knee in all patients rated as polytraumatized by the trauma surgeon. Four-vessel CT angiography is used when it has a significant impact on the treatment protocol, she said.

Moderator Dr. Stuart E. Mirvis said multislice CT scans starting at the circle of Willis and continuing down have been routinely performed on trauma patients the past 2 years at the University of Maryland's R. Adams Cowley Shock Trauma Center, Baltimore, where he is director of emergency and trauma radiology.

"What you learn when you do that is that a lot of patients have these injuries--far more than we ever suspected--in the carotids, in the vertebrals," he said. "This is a very important paper."

< previous article | Table of Contents | next article >

Society for Vascular Surgery - 633 N. St. Clair, 24th Floor; Chicago, IL 60611; Phone: 312-334-2300 or 800-258-7188; Fax: 312-334-2320; Email: vascular@vascularsociety.org
© 2010 VascularWeb. All rights reserved. Use of the VascularWeb site constitutes acceptance of all of the policies, rules and regulations for the site.