Biffl Walter L
Division of Trauma and Surgical Critical Care, Rhode Island Hospital, and Brown Medical School, Providence, Rhode Island, USA.
Curr Opin Crit Care. 2003 Dec;9(6):530-4. doi: 10.1097/00075198-200312000-00011.
Blunt cerebrovascular injuries (BCVI) are being increasingly recognized. The optimal criteria for screening, and the best diagnostic test, remain a matter of controversy. This review analyzes the available literature to propose management guidelines for the diagnosis of BCVI.
A number of centers are screening asymptomatic patients for BCVI. The criteria vary from center to center. The incidence of injuries diagnosed is proportional to the breadth of screening criteria. Noninvasive diagnostic modalities such as duplex ultrasonography, computed tomographic angiography, and magnetic resonance angiography have been proposed as screening tools. Although they are all capable of identifying many injuries, prospective comparisons reveal inaccuracies.
Screening for BCVI is appropriate. Institutions should adopt formal criteria, recognizing that more restrictive criteria are likely to miss injuries. Noninvasive modalities must be used with caution, because they have been found to be inferior to arteriography.
钝性脑血管损伤（BCVI）越来越受到重视。筛查的最佳标准以及最佳诊断测试仍存在争议。本综述分析现有文献，以提出BCVI诊断的管理指南。
许多中心对无症状患者进行BCVI筛查。各中心的标准各不相同。诊断出的损伤发生率与筛查标准的广度成正比。已提出将诸如双功超声、计算机断层血管造影和磁共振血管造影等非侵入性诊断方法作为筛查工具。尽管它们都能够识别许多损伤，但前瞻性比较显示存在不准确之处。
对BCVI进行筛查是合适的。机构应采用正式标准，同时认识到更严格的标准可能会漏诊损伤。必须谨慎使用非侵入性方法，因为已发现它们不如动脉造影。
