Diagnosis of arterial injuries caused by penetrating trauma to the neck: Comparison of helical CT angiography and conventional angiography

PURPOSE: To determine the sensitivity and specificity of helical computed t omographic (CT) angiography in the diagnosis of carotid and vertebral arter ial injuries caused by penetrating neck trauma. MATERIALS AND METHODS: A prospective study was conducted during 24 months i n 60 patients with penetrating neck trauma who were referred for convention al ventional angiography owing to clinical suspicion of arterial injury, in the patient population, 146 arteries (77 carotid, 69 vertebral) were studi ed by means of conventional angiography. In all patients, conventional angi ography and helical CT angiography were completed within 6 hours. Two radio logists interpreted helical CT angiographic studies by means of consensus. Conventional angiography was the standard of reference for determining the sensitivity and specificity of helical CT angiography. RESULTS: Conventional angiograms showed arterial injuries in 10(17%) of 60 patients. Conventional angiographic findings were arterial occlusion (n = 4 ), arteriovenous fistula (n = 2), pseudoaneurysm (n = 3), pseudoaneurysm wi th arteriovenous fistula (n = 1), and normal arteries (n = 1 36). Nine of 1 0 arterial injuries and all normal arteries were depicted adequately at hel ical CT angiography. Sensitivity of helical CT angiography was 90%, specifi city was 100%, positive predictive value was 100%, and negative predictive value was 98%. CONCLUSION: The sensitivity and specificity of helical CT angiography are h igh for detection of major carotid and vertebral arterial injuries resultin g from penetrating trauma.