Journal ArticleDOI
Noninvasive diagnosis of blunt cerebrovascular injuries: a preliminary report.
Walter L. Biffl,Charles E. Ray,Ernest E. Moore,Michael L. Mestek,Jeffrey L. Johnson,Jon M. Burch +5 more
TLDR
CTA and MRA can identify BCVI, but they miss grade I, II, and III injuries, and future technical modifications may improve their accuracy.Abstract:
Background : In light of their potential for devastating consequences, a liberalized screening approach for blunt cerebrovascular injuries (BCVI) is becoming increasingly accepted. The gold standard for diagnosis of BCVI is arteriography; however, noninvasive diagnostic alternatives offer clear advantages. Recent series have demonstrated the ability of computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) to identify BCVI, but have not compared their accuracy with arteriography. We hypothesized that CTA or MRA could reliably identify BCVI, obviating the need for arteriography. The purpose of this study was to determine the accuracy of CTA and MRA in identifying BCVI in asymptomatic patients. Methods: Asymptomatic patients meeting criteria for BCVI screening underwent arteriography, according to our institutional standard. A subset of patients requiring computed tomographic scanning underwent CTA; a subset of patients requiring magnetic resonance imaging underwent MRA. All of the studies were interpreted by radiologists in a blinded manner. Data were analyzed for sensitivity and specificity. Results: Forty-six patients underwent both CTA and arteriography. Of 23 with a normal CTA examination, 7 (30%) had BCVI on arteriography. Of 23 with an abnormal CTA examination, 8 (35%) had a normal arteriogram. The sensitivity, specificity, positive predictive value, and negative predictive value of CTA were 68%, 67%, 65%, and 70%, respectively. CTA missed 55% of grade I injuries, 14% of grade II injuries, and 13% of grade III injuries. Sixteen patients underwent both MRA and arteriography. One (11%) had a false-negative MRA result, and four (57%) had false-positive MRA results (75% sensitivity, 67% specificity, 43% positive predictive value, 89% negative predictive value). Conclusion: CTA and MRA can identify BCVI, but they miss grade I, II, and III injuries. Future technical modifications may improve their accuracy. A prospective multicenter trial is warranted to define the capabilities and limitations of these noninvasive modalities. In the interim, arteriography remains the gold standard for diagnosis, but if arteriography is not available, CTA or MRA should be used to screen for BCVI in patients at risk.read more
Citations
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Journal ArticleDOI
Treatment-Related Outcomes From Blunt Cerebrovascular Injuries: Importance of Routine Follow-Up Arteriography
Walter L. Biffl,Charles E. Ray,Ernest E. Moore,Reginald J. Franciose,Somer Aly,Mary Grace Heyrosa,Jeffrey L. Johnson,Jon M. Burch +7 more
TL;DR: Routine follow-up arteriography is warranted in patients with grade I and II BCVIs because most of these patients (61% in this series) will require a change in management, and heparin may improve the neurologic outcome in Patients with ischemic deficits and may prevent stroke in asymptomatic patients.
Journal ArticleDOI
Neuroimaging in traumatic brain imaging
Bruce Y. Lee,Andrew B. Newberg +1 more
TL;DR: Neuroimaging techniques have become an important part of the diagnostic work up of TBI patients and can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions.
Journal ArticleDOI
Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma
William J. Bromberg,Bryan Collier,Larry N. Diebel,Kevin M. Dwyer,Michelle Holevar,David G. Jacobs,Stanley Kurek,Martin A. Schreiber,Mark L. Shapiro,Todd R. Vogel +9 more
TL;DR: An EBM guideline for the screening, diagnosis, and treatment of blunt injury to the carotid or vertebral vessels is developed and it is noted that change in the diagnosis and management of this injury constellation is rapid due to technological advancement and the difficulties inherent in performing randomized prospective trials in this patient population.
Journal ArticleDOI
Anticoagulation is the gold standard therapy for blunt carotid injuries to reduce stroke rate.
C. Clay Cothren,Ernest E. Moore,Walter L. Biffl,David J. Ciesla,Charles E. Ray,Jeffrey L. Johnson,John B. Moore,Jon M. Burch +7 more
TL;DR: The authors' prospective evaluation of blunt CAIs suggests that early diagnosis and prompt anticoagulation reduce ischemic neurologic events and their disability.
Journal ArticleDOI
Computed tomographic angiography for the diagnosis of blunt cervical vascular injury: is it ready for primetime?
TL;DR: CTA, using a 16-channel detector, can be used to accurately screen at-risk patients for BCVI and is shown to be able to diagnose blunt cervical vascular injury at least to that of invasive catheter angiography.
References
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TL;DR: Heparin therapy, when instituted before onset of symptoms, ameliorates neurologic deterioration and therapy with heparin is highly efficacious, significantly reducing neurologic morbidity and mortality.
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The Unrecognized Epidemic of Blunt Carotid Arterial Injuries: Early Diagnosis Improves Neurologic Outcome
Walter L. Biffl,Ernest E. Moore,Robert K. Ryu,Patrick J. Offner,Zina Novak,Douglas M. Coldwell,Reginald J. Franciose,Jon M. Burch +7 more
TL;DR: Screening allows the identification of asymptomatic BCI and thereby facilitates early systemic anticoagulation, which is associated with improved neurologic outcome, and the role of endovascular stents in the treatment of blunt traumatic pseudoaneurysms remains to be defined.
Journal ArticleDOI
Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography.
TL;DR: MR angiography is a reliable, noninvasive method for use in diagnosis and follow-up of extracranial internal carotid artery dissection, however, conventionalAngiography remains useful in vertebral artery dissections.