The Role of 320 Slice CT Angiography in Predicting Vascular Trauma.

Objective: To determine the accuracy of multidetector CT angiography (MDCT angiography) as initial diagnostic technique in depicting and characterizing post traumatic vascular injuries, looking for additional injuries and confirming the findings with intervention and follow-up.

Study Design: Descriptive analytical study.

Place And Duration Of Study: Department of Radiology, Shifa International Hospital, Islamabad, from June 2010 to October 2013.

Methodology: Patients who underwent MDCT angiography for clinically suspected post traumatic vascular injury were included. All MDCT angiographies were performed on 320 slice CT (Aquilion OneTM) and were reviewed by two independent consultant radiologists. The sites of injury were intracranial, neck and maxillofacial, chest, abdomen and extremities. The presence and characteristics of vascular injuries were confirmed by post-operative findings or digital subtraction angiography (DSA). Sensitivity and specificity was calculated.

Results: The age of the patients ranged from 7 to 90 years with 94% (48) males and 6% (3) females. Blunt trauma was commoner than penetrating trauma. The site of injury in majority was extremities. Majority of patients had post-traumatic pseudoaneurysm formation followed by arterial occlusion, thrombosis, active extravasation, spasm, arteriovenous malformation and combination injuries. Twenty-one (41%) patients were reported as having vascular injury and confirmed by surgery or DSA. Fifteen (29.5%) patients were reported as normal and had no intervention on follow-up. The sensitivity and specificity of MDCT angiography was found as 100% and 88%, NPV of 100%, PPV of 94% and accuracy of 96%.

Conclusion: MDCT angiography can be reliably used as an initial diagnostic technique for the evaluation and characterization of post-traumatic vascular injuries.