Adibi Ali, Krishnam Mayil S, Dissanayake Sumudu, Plotnik Adam N, Mohajer Kiyarash, Arellano Cesar, Ruehm Stefan G
Diagnostic Cardiovascular Imaging, Department of Radiological Sciences, University of California, Los Angeles, CA, USA,
Eur Radiol. 2014 Jul;24(7):1586-93. doi: 10.1007/s00330-014-3174-1. Epub 2014 May 8.
To assess the role of CT angiography in the evaluation of patients with lower extremity gunshot wounds in the emergency room.
Eighty patients (73 male, 7 female, mean age 26 years) underwent CT angiography for the evaluation of lower extremity gunshot injuries. Imaging was conducted on the basis of standardized protocols utilizing 16-slice and 64-slice multidetector systems and images were qualitatively graded and assessed for various forms of arterial injury.
CT angiography findings indicative of arterial injury were observed in 24 patients (30%) and a total of 43 arterial injuries were noted; the most common form was focal narrowing/spasm (n = 16, 37.2%); the most common artery involved was the superficial femoral artery (n = 12, 50%). In qualitative assessment of images based on a 4-point grading system, both readers considered CT angiography diagnostically excellent (grade 4) in most cases. Surgical findings were consistent with CT angiography and follow-up of patients' medical records showed no arterial injuries in patients with normal findings on initial imaging.
Our findings demonstrate that CT angiography is an effective imaging modality for evaluation of lower extremity gunshot wounds and could help limit more invasive procedures such as catheter angiography to a select group of patients.
• CT angiography efficiently evaluates lower extremity gunshot wounds. • CT angiography provides image quality sufficiently reliable for assessment of gunshot injuries. • CT angiography could help limit invasive procedures to select patients.
评估CT血管造影在急诊室对下肢枪伤患者评估中的作用。
80例患者（男73例，女7例，平均年龄26岁）接受CT血管造影以评估下肢枪伤。成像基于标准化方案，使用16层和64层多探测器系统进行，对图像进行定性分级，并评估各种形式的动脉损伤。
24例患者（30%）观察到CT血管造影显示动脉损伤，共记录到43处动脉损伤；最常见的形式是局灶性狭窄/痉挛（n = 16，37.2%）；受累最常见的动脉是股浅动脉（n = 12，50%）。在基于4分制分级系统的图像定性评估中，两位阅片者在大多数情况下都认为CT血管造影诊断效果极佳（4级）。手术结果与CT血管造影一致，对患者病历的随访显示，初始成像结果正常的患者未出现动脉损伤。
我们的研究结果表明，CT血管造影是评估下肢枪伤的一种有效成像方式，有助于将更多侵入性操作（如导管血管造影）限制在特定患者群体中。
• CT血管造影能有效评估下肢枪伤。• CT血管造影提供的图像质量足以可靠地评估枪伤。• CT血管造影有助于将侵入性操作限制在特定患者中。
