COMPARISON OF DIGITAL SUBTRACTION AND CUT FILM ARTERIOGRAPHY IN THE EVALUATION OF SUSPECTED THORACIC AORTIC INJURY

PURPOSE: To determine whether intraarterial digital subtraction arteri ography (DSA) is as sensitive and specific as cut film arteriography ( CFA) in the evaluation of suspected aortic injury resulting from blunt chest trauma. MATERIALS AND METHODS: Both CFA and DSA images of the t horacic aorta were obtained in the right posterior oblique (RPO) proje ction in 100 of 103 consecutive patients undergoing arteriography afte r blunt chest trauma, Diagnoses based on blinded separate review of bo th studies (CFA vs DSA) by four independent reviewers were compared, R eviewers graded their confidence in their diagnoses from 1 (certain) t o 10 (uncertain), RESULTS: Eleven of 100 patients had aortic or great vessel injuries confirmed by operation (n = 10) or transesophageal ech ocardiography (n = 1), Three hundred eighty-eight of 400 diagnoses bas ed on RPO CFA and 390 of 400 diagnoses based on RPO DSA agreed with th e correct diagnoses, The sensitivity, specificity, and diagnostic accu racy of CFA versus DSA were not significantly different, The reviewers ' confidence in their diagnoses was equivalent between CFA (average co nfidence score, 1.313) and DSA (average confidence score, 1.375). CONC LUSION: DSA and CFA yield equivalent sensitivity, specificity, and dia gnostic accuracy in the evaluation of blunt chest trauma.