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Penetrating Neck Injuries: Helical CT Angiography for Initial Evaluation¹

¹ From the Departments of Radiology (F.M., J.A.S., D.M.P., J.C., J.E.G.) and Surgery, Divisions of Trauma Surgery (C.M., A.S.) and Vascular Surgery (G.G.), Universidad de Antioquia, Medellín, Colombia. Received May 29, 2001; revision requested June 26; revision received November 9; accepted January 7, 2002. Address correspondence to F.M., Department of Radiology (R019), University of Miami School of Medicine/Jackson Memorial Hospital, Ryder Trauma Center, 1611 NW 12th Ave, West Wing 279, Miami, FL 33136 (e-mail: fmunera@med.miami.edu).

PURPOSE: To report an experience with helical computed tomographic (CT) angiography as the initial procedure to rule out arterial lesions caused by penetrating neck injuries.

MATERIALS AND METHODS: During 27 months, 175 patients were referred for helical CT angiography of the neck because of clinical suspicion of arterial injuries. The protocol included a 100-mL bolus of nonionic contrast material injected at 4.5 mL/sec, with 11-second scanning delay, 3-mm collimation, and pitch of 1.3–2.0. CT images were interpreted prospectively by the emergency radiologist, and two radiologists retrospectively interpreted studies with consensus. Outcome was determined with examination of patients and their charts. The sensitivity, specificity, and positive and negative predictive values were calculated.

RESULTS: Studies in two patients were considered inadequate for diagnosis; these patients were referred for conventional arteriography and had normal findings. In 27 patients (15.6%), arterial lesions were detected. One patient had two arterial injuries. Lesions demonstrated with helical CT angiography were arterial occlusion (n = 14), pseudoaneurysm (n = 8), pseudoaneurysm and arteriovenous fistulae (n = 4), and partial thrombosis (n = 2). The remaining 146 patients had normal arteries. On the basis of these findings, patients were treated with surgery (n = 21), endovascular intervention (n = 7), and observation alone (n = 146).

CONCLUSION: Results indicate that helical CT angiography can be used as the initial method for evaluation in patients with possible arterial injuries of the neck.

© RSNA, 2002

Index terms: Arteries, injuries, 90.411, 90.4124, 90.494, 90.732 • Carotid arteries, angiography, 904.1222 • Computed tomography (CT), angiography, 90.12912, 90.12915, 90.12916, 90.12917 • Gunshot injuries, 90.411, 90.494, 90.732

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