Bensch Frank V, Varjonen Elina A, Pyhältö Tuomo T, Koskinen Seppo K
Department of Radiology, Töölö Trauma Center, Helsinki University Hospital, HUS, Topeliuksenkatu 5, P.O. Box 266, 00029, Helsinki, Finland.
Department of Trauma Surgery, Töölö Trauma Center, Helsinki University Hospital, Helsinki, Finland.
Emerg Radiol. 2019 Aug;26(4):365-372. doi: 10.1007/s10140-019-01677-0. Epub 2019 Feb 12.
BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke.
Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma.
1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p < .0001; OR = 9.77; 95% CI 3.3-28.7). Eleven percent of patients with BCVI would not have met standard screening criteria.
The increase in detection rate for BCVI justifies more liberal screening protocols.
钝性颈椎椎动脉损伤（BCVI）可能导致缺血性中风、残疾和死亡，而其在临床上最初往往没有症状。基于临床发现和创伤机制的BCVI筛查标准提高了检出率，其中丹佛标准最为常用。高达30%的患者不符合BCVI筛查标准。本研究的目的是分析强化丹佛标准对检测的影响，并确定缺血性中风的相对风险。
丹佛筛查标准通过任何颈椎、胸部、腹部或骨盆的高能创伤进行强化。两名经过专科培训的放射科医生对38个月期间所有包括CT血管造影（CTA）的急性钝性创伤全身CT（WBCT）进行回顾性分析，并对初始创伤后的任何脑部影像进行分析。
1544项WBCT研究包括374项CTA（男/女=271/103；平均年龄41.5岁）。最常见的损伤机制是机动车事故（MVA，51.5%）和高处坠落（22.3%）。我们在56例患者中发现了72处BCVI（15.0%），其中13例（23.2%）为多发损伤。49例（68.1%）累及颈内动脉（ICA），23例（31.9%）累及椎动脉。最常见的损伤水平是C2，ICA损伤中Biffl I级和II级最常见，椎动脉损伤中II级和IV级最常见。观察者间一致性良好（Kappa=0.674）。在215例进行成像的患者中，BCVI患者中有16.1%发生脑缺血性中风，其余患者中有1.9%发生脑缺血性中风（p<0.0001；OR=9.77；95%CI 3.3-28.7）。11%的BCVI患者不符合标准筛查标准。
BCVI检出率的提高证明了更宽松的筛查方案是合理的。
