Computed tomographic angiography for the diagnosis of blunt cervical vascular injury

Question: Is computed tomographic angiography (CTA) as effective as catheter angiography in diagnosing blunt cervical vascular injury (BCVI)? Design: Prospective cohort study. Setting: Trauma unit at an academic centre. Patients: Computed tomographic angiography was performed on 162 patients who sustained blunt trauma and met at least 1 criterion of a modification of the Denver screening criteria for blunt cerebrovascular injuries. Ninety percent of the patients (146) had these findings confirmed with standard catheter angiography. Description of test and diagnostic standard: Patients underwent CTA using a 16-channel CT scanner, and interpretation was performed using axial source images and 2- and 3-dimensional maximum-intensity pixel and volume reading display techniques. Catheter angiography of the head and neck, which is considered to be the gold standard, was performed using a Siemens Artis BA biplane neuroangiographic unit. An attending neuroradiologist performed both readings; CTA was primarily read without any knowledge of catheter angiography results. Main outcome: Sensitivity, specificity, positive and negative predictive values and accuracy of CTA. Results: Forty-six percent of BCVIs were identified among 43 patients. In 45 of 46 patients (98%), the results of CTA and catheter angiography were in agreement. There was a single false-negative CTA; the remaining 103 patients had normal CTAs confirmed by normal catheter angiography. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CTA for the diagnosis of BCVI were 97.7%, 100%, 100%, 99.3% and 99.3%, respectively. Conclusion: Computed tomographic angiography is an effective and sensitive diagnostic test for the detection of BCVIs.