Stuhlfaut Joshua W, Barest Glenn, Sakai Osamu, Lucey Brian, Soto Jorge A
Department of Radiology, Boston Medical Center, 88 East Newton St., Boston, MA 02118, USA.
AJR Am J Roentgenol. 2005 Oct;185(4):1063-8. doi: 10.2214/AJR.04.1217.
The objective of our study was to assess the impact of the increasing use of MDCT angiography in the setting of blunt and penetrating neck trauma on the use of digital subtraction angiography (DSA) at our institution, a level 1 trauma center.
From January 2001 to December 2003, 57 patients were referred for CT angiography or DSA of the neck after blunt or penetrating neck trauma. All CT angiograms were acquired with a 4-MDCT scanner. The patients were divided into three groups on the basis of consecutive 12-month periods (2001, 2002, and 2003), and the initial imaging technique was recorded. The results of CT and digital subtraction angiograms were compared with operative findings and with clinical course, when available.
In 2001, 12 patients were referred for imaging: nine patients were evaluated initially with DSA and three patients were evaluated with CT angiography and subsequently with DSA. In 2002 and 2003, 11 and 34 patients, respectively, underwent CT angiography as the initial imaging examination. During these 2 years, no patient underwent DSA as the initial diagnostic test, but five patients underwent DSA after CT angiography for the following indications: evaluation of nondiagnostic CT angiograms (n = 1), confirmation of findings when requested by the clinical service (n = 2), and catheter-guided therapy (n = 2).
CT angiography has essentially replaced DSA as the study of choice for the initial evaluation of the neck vessels in the setting of blunt or penetrating trauma at our institution. CT angiography is adequate for the initial evaluation, allows appropriate triage of patients to conventional angiography or surgery for appropriate treatment, and can guide conservative management when appropriate.
我们研究的目的是评估在一所一级创伤中心，颈部钝性和穿透性创伤情况下多层螺旋CT血管造影（MDCTA）使用的增加对数字减影血管造影（DSA）使用的影响。
2001年1月至2003年12月，57例患者在颈部钝性或穿透性创伤后接受颈部CT血管造影或DSA检查。所有CT血管造影均使用4层MDCT扫描仪获取。根据连续的12个月时间段（2001年、2002年和2003年）将患者分为三组，并记录初始成像技术。将CT和数字减影血管造影的结果与手术结果以及临床病程（如可用）进行比较。
2001年，12例患者被转诊进行成像检查：9例患者最初接受DSA评估，3例患者接受CT血管造影评估，随后接受DSA评估。2002年和2003年，分别有11例和34例患者接受CT血管造影作为初始成像检查。在这两年中，没有患者将DSA作为初始诊断检查，但有5例患者在CT血管造影后因以下指征接受DSA检查：评估非诊断性CT血管造影（n = 1）、临床科室要求时对检查结果进行确认（n = 2）以及导管引导治疗（n = 2）。
在我们机构，CT血管造影已基本取代DSA，成为颈部钝性或穿透性创伤情况下颈部血管初始评估的首选检查。CT血管造影足以进行初始评估，能将患者适当地分流至传统血管造影或手术以进行适当治疗，并在适当的时候指导保守治疗。
