Berne John D, Reuland Kurt S, Villarreal David H, McGovern Thomas M, Rowe Stephen A, Norwood Scott H
Division of Trauma Surgery, East Texas Medical Center, Tyler, Texas 75701, USA.
J Trauma. 2006 Jun;60(6):1204-9; discussion 1209-10. doi: 10.1097/01.ta.0000220435.55791.ce.
Blunt cerebrovascular injuries (BCVI) are rare but potentially devastating injuries, particularly if the diagnosis is delayed. Only four-vessel cerebral angiography (FVCA) has been shown to be adequately sensitive and specific as a screening tool for BCVI but is resource-intensive and invasive. Computed tomography (CT) angiography has emerged as a possible alternative, but its accuracy has been poor, particularly for low-grade injuries. Recent advances in CT technology, particularly the use of a multi-detector array for image acquisition should improve the accuracy of this technique. This study is the first reported experience of the role of the 16-slice multi- detector CT scanner in screening for BCVI.
From January 2, 2003 to October 31, 2004, all patients who met predefined screening criteria were screened for blunt injury to the carotid (BCI) and vertebral (BVI) arteries with a 16-slice multi-detector CT scanner with angiographic reconstruction (CTA). If CTA was positive or equivocal for BCVI, FVCA was performed as a confirmatory test. If CTA was negative, no further diagnostic studies were performed.
There were 435 patients who met criteria and were screened with CTA. Of these, 25 injuries were identified in 24 patients for an incidence of BCVI of 1.2% (24/2023) among all blunt admissions (BTA) and 5.5% (24/435) among screened patients (SP). This was increased compared with the four-slice era (0.38% BTA, 2.4% SP, p<0.01). No patient with a negative CTA was subsequently identified as having, or developed neurologic symptoms attributable to a missed BCVI.
Sixteen-slice multi-detector CT angiography is an excellent tool to screen for BCVI and detects all clinically significant injuries. The detected incidence of BCVI increased more than threefold with the 16-slice scanner when compared with the four-slice scanner. This demonstrates a clear technological improvement in our ability to screen for these injuries.
钝性脑血管损伤（BCVI）虽罕见，但可能造成毁灭性后果，尤其是诊断延误时。只有四血管脑血管造影（FVCA）被证明作为BCVI的筛查工具具有足够的敏感性和特异性，但它资源消耗大且具有侵入性。计算机断层扫描（CT）血管造影已成为一种可能的替代方法，但其准确性较差，尤其是对轻度损伤。CT技术的最新进展，特别是使用多探测器阵列进行图像采集，应能提高该技术的准确性。本研究是首次报道16层多探测器CT扫描仪在筛查BCVI中的作用的经验。
从2003年1月2日至2004年10月31日，所有符合预定义筛查标准的患者均使用具有血管造影重建功能的16层多探测器CT扫描仪（CTA）筛查颈动脉钝性损伤（BCI）和椎动脉钝性损伤（BVI）。如果CTA对BCVI呈阳性或不确定，则进行FVCA作为确诊试验。如果CTA为阴性，则不进行进一步的诊断研究。
有435例患者符合标准并接受了CTA筛查。其中，在24例患者中发现了25处损伤，所有钝性入院患者（BTA）中BCVI的发生率为1.2%（24/2023），筛查患者（SP）中为5.5%（24/435）。与四层时代相比有所增加（BTA为0.38%，SP为2.4%，p<0.01）。随后没有CTA阴性的患者被确定患有或出现因漏诊BCVI导致的神经系统症状。
16层多探测器CT血管造影是筛查BCVI的优秀工具，能检测出所有具有临床意义的损伤。与四层扫描仪相比，16层扫描仪检测到的BCVI发生率增加了两倍多。这表明我们在筛查这些损伤的能力上有了明显的技术改进。
