Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
J Trauma Acute Care Surg. 2012 Jun;72(6):1601-10. doi: 10.1097/TA.0b013e318246ead4.
Digital subtraction angiography (DSA) is the gold standard for radiographic diagnosis of blunt cerebrovascular injury (BCVI), but use of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) has increased dramatically in BCVI screening. This study explores the utility, effectiveness, and cost of noninvasive CTA and MRA screening for BCVI.
Medical records of 2,025 consecutive adults evaluated for acute blunt neck trauma and BCVI were reviewed retrospectively. The incidence of BCVI, level(s) of cervical injury, involvement of foramina transversaria and internal carotid canals, presence of bony dislocation or subluxation, and subsequent treatment received were assessed. Asymptomatic patients were analyzed based on fracture and injury patterns. The cost effectiveness of CTA compared with DSA and the effects of CTA sensitivity and screening yield were determined.
Of reviewed patients, 196 received CTA or MRA. Thirty-eight patients (19.4%) were diagnosed with BCVI. Screening yield in patients symptomatic at presentation was 48.8%. Large-vessel internal carotid, vertebral, anterior spinal, and basilar artery occlusion were associated with a positive screen, as were concurrent stroke and spinal cord injury (p < 0.01). Of patients with injuries found with noninvasive imaging, 50.0% of BCVI involved C1-3 fracture, 34.2% involved subluxation, and 65.8% involved foramina transversaria. In both symptomatic and asymptomatic patients, CTA screening was more cost effective than DSA.
Noninvasive imaging is a safe, accurate, and cost-effective tool for BCVI screening. Symptomatic presentation was the best predictor of BCVI. Significant cost savings were realized using CTA rather than DSA, with similar effectiveness and patient outcomes.
Diagnostic study, level III; economic analysis, level IV.
数字减影血管造影（DSA）是诊断钝性脑血管损伤（BCVI）的金标准，但在 BCVI 筛查中，计算机断层血管造影（CTA）和磁共振血管造影（MRA）的应用急剧增加。本研究探讨了无创 CTA 和 MRA 筛查在 BCVI 中的应用、有效性和成本效益。
回顾性分析 2025 例连续评估急性钝性颈部创伤和 BCVI 的成年患者的病历。评估 BCVI 的发生率、颈椎损伤的水平、横突孔和颈内动脉管的受累情况、是否存在骨脱位或半脱位以及随后接受的治疗。根据骨折和损伤模式分析无症状患者。比较 CTA 与 DSA 的成本效益，并确定 CTA 敏感性和筛查效果的影响。
在回顾的患者中，196 例接受了 CTA 或 MRA 检查。38 例（19.4%）被诊断为 BCVI。在就诊时出现症状的患者中，筛查阳性率为 48.8%。大动脉颈内、椎动脉、前脊髓和基底动脉闭塞与阳性筛查相关，同时伴有中风和脊髓损伤（p < 0.01）。在通过非侵入性成像发现的损伤患者中，50.0%的 BCVI 涉及 C1-3 骨折，34.2%涉及半脱位，65.8%涉及横突孔。在有症状和无症状患者中，CTA 筛查均比 DSA 更具成本效益。
非侵入性成像技术是一种安全、准确、具有成本效益的 BCVI 筛查工具。症状表现是 BCVI 的最佳预测指标。与 DSA 相比，使用 CTA 可显著节省成本，同时具有相似的效果和患者结局。
诊断性研究，III 级；经济分析，IV 级。
