Diagnostic performance of helical CT angiography in trauma to large arteries of the extremities

Purpose: The purpose of this work was to assess the performance of helical CT angiography (CTA) in the diagnosis of injuries to large arteries of the extremities. Method: We performed helical CTA on 45 consecutive patients referred for co nventional angiography for evaluation of suspected arterial injuries after sustaining trauma to the extremities (13 upper, 32 lower). Two radiologists interpreted the helical CTA studies independently. Diagnostic performance parameters evaluated included sensitivity, specificity, receiver operating characteristic (ROC) curves, and interobserver agreement (kappa statistics) . Conventional angiography was used as the standard of reference for determ ination of final diagnoses. Results: Forty-three of 45 patients (96%) had diagnostic helical CTA examin ations. Final diagnoses in these 43 patients were arterial occlusion (n = 7 ), partial obstruction (n = 3), pseudoaneurysm(n = 5), arteriovenous fistul a (n = 1), pseudoaneurysm and arteriovenous fistula(n = 3), and normal find ings (n = 24). Sensitivity and specificity were 90% [95% confidence interva l (CI), 80-99] and 100% (95% CI, 99-100), respectively, for Reader 1 and 10 0% (95% CI, 99-100) and 100% (95% CI, 99-100), respectively, for Reader 2. ROC curve analysis revealed high diagnostic performance, with areas under t he curve of >0.9 for both readers. Interobserver agreement was 0.9. Conclusion: The diagnostic performance of helical CTA for detection of majo r injuries of large arteries of the extremities is high.