Anderson Stephan W, Foster Bryan R, Soto Jorge A
Department of Radiology, Boston University Medical Center, 88 E Newton St, 2nd Floor, Boston, MA 02217, USA.
Radiology. 2008 Dec;249(3):1064-73. doi: 10.1148/radiol.2493080652.
To determine the feasibility and report clinical outcomes of upper extremity computed tomographic (CT) angiography with 64-section multidetector CT technology in the evaluation of patients sustaining penetrating trauma.
This HIPAA-compliant retrospective study was approved by the institutional review board and consent was waived. All adult trauma patients who sustained penetrating trauma to the upper extremity and who underwent CT angiography based on the recommendation of the attending trauma surgeon after the initial clinical examination were included. All studies were acquired with 64-section CT technology between April 2005 and September 2007 at our level I trauma center. Two radiologists in consensus retrospectively reviewed all the CT angiograms for evidence of arterial injury. Attenuation was measured with regions of interest placed within the arterial lumen of multiple segments of the upper extremity arteries. Hospital course and disposition were determined by reviewing the patients' medical records, with a mean follow-up of 33 days.
This study included 59 patients (54 men, five women; mean age, 27 years). Nineteen (32%) patients had the following arterial injuries at CT angiography: arterial occlusion (n = 7), arterial extravasation (n = 6), isolated pseudoaneurysm formation (n = 2), isolated focal stenosis (n = 2), occlusion and pseudoaneurysm formation (n = 1), and focal stenosis and pseudoaneurysm formation (n = 1). Of these 19 patients, seven underwent surgical treatment. Evaluation of the technical quality of the upper extremity angiograms demonstrated mean attenuation values of 244 HU. In 48 (81%) of 59 patients, mean attenuation values were higher than 200 HU, with four (7%) patients having mean attenuation values lower than 150 HU.
Upper extremity CT angiograms obtained with 64-section CT demonstrated adequate technical quality in the majority of patients and performed well clinically in patients with penetrating trauma.
确定采用64层多排螺旋CT技术进行上肢计算机断层扫描（CT）血管造影在评估穿透性创伤患者中的可行性并报告临床结果。
本符合健康保险流通与责任法案（HIPAA）的回顾性研究经机构审查委员会批准，且无需患者同意。纳入所有成年上肢穿透性创伤患者，这些患者在初始临床检查后根据主治创伤外科医生的建议接受了CT血管造影。所有研究均于2005年4月至2007年9月在我们的一级创伤中心采用64层CT技术进行。两名放射科医生达成共识后，对所有CT血管造影进行回顾性审查，以寻找动脉损伤的证据。通过在上肢动脉多个节段的动脉腔内放置感兴趣区来测量衰减值。通过查阅患者病历确定住院过程和处置情况，平均随访33天。
本研究纳入59例患者（54例男性，5例女性；平均年龄27岁）。19例（32%）患者在CT血管造影时有以下动脉损伤：动脉闭塞（n = 7）、动脉外渗（n = 6）、孤立性假性动脉瘤形成（n = 2）、孤立性局灶性狭窄（n = 2）、闭塞和假性动脉瘤形成（n = 1）以及局灶性狭窄和假性动脉瘤形成（n = 1）。在这19例患者中，7例接受了手术治疗。上肢血管造影技术质量评估显示平均衰减值为244 HU。在59例患者中的48例（81%）中，平均衰减值高于200 HU，4例（7%）患者平均衰减值低于150 HU。
采用64层CT获得的上肢CT血管造影在大多数患者中显示出足够的技术质量，在穿透性创伤患者中临床效果良好。
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