From the Departments of Radiology (L.W., D.C., L.C., J.V., C.C., D.S.H., M.M.B.) and Neurologic Surgery (C.W., R.H.B.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195-0005; and Department of Surgery, University of Colorado, Denver, Colo (C.W.).
Radiology. 2020 Nov;297(2):428-435. doi: 10.1148/radiol.2020192866. Epub 2020 Sep 8.
Background Blunt cerebrovascular injury (BCVI) is associated with increased stroke and mortality risk. However, the most appropriate follow-up strategy remains uncertain. Purpose To better understand the natural history of BCVI and help define the most optimal timing and length of follow-up imaging. Materials and Methods In this retrospective HIPAA-compliant study, data from all patients treated for BCVI at a level I trauma center between April 1, 2005, and June 30, 2015, were reviewed. For patients with at least one follow-up study, time-to-event analysis was performed to assess the trend in injury evolution. Association of injury grade and injury evolution was also assessed. The Fisher exact test and multivariable logistic regression were used to evaluate association of the number of injured vessels, vessel grade, and vessel type (internal carotid artery, vertebral artery) with BCVI-associated stroke. Results A total of 1204 patients (800 men; mean age ± standard deviation, 45 years ± 22) with 1604 vessel injuries were evaluated. High-grade (grades 3-5) injuries were less likely to resolve (hazard ratio [HR], 0.2; < .001) than low-grade injuries. High-grade injuries were more likely to progress than low-grade injuries (HR, 3.3; = .005). Of the injuries that improved or resolved (343 of 419 [81.9%]), 76% (259 of 343) changed within 30 days after the initial injury, and the remaining 24% (84 of 343) changed between 30 and 90 days. Of the injuries that progressed (46 of 419 [11.0%]), 87% (40 of 46) changed within 90 days. Beyond 90 days, no improvement or resolution occurred, and only 1.4% (six of 419) of injuries progressed. Higher injury grade (adjusted odds ratio, 2.0 per one-grade increase [95% confidence interval {CI}: 1.6, 2.4]; < .001), carotid injuries versus vertebral artery injuries (49 of 420 [11.7%] vs 35 of 667 [5.2%]; < .001), and increasing number of vessels injured per patient (adjusted odds ratio, 1.6 per one-vessel increase [95% CI: 1.3, 2.2]; < .001) were associated with increased risk for BCVI-related stroke. Conclusion Most blunt cerebrovascular injury-related changes occurred within 30 days; changes rarely occurred beyond 90 days. Follow-up imaging is therefore unlikely to be helpful beyond 90 days. © RSNA, 2020 See also the editorial by Talbott in this issue.
背景 钝性脑血管损伤 (BCVI) 与增加的中风和死亡风险相关。然而，最合适的随访策略仍不确定。目的 为了更好地了解 BCVI 的自然史，并帮助确定最合适的随访成像时间和长度。材料与方法 在这项回顾性 HIPAA 合规性研究中，对 2005 年 4 月 1 日至 2015 年 6 月 30 日期间在一级创伤中心接受 BCVI 治疗的所有患者的数据进行了回顾。对于至少有一次随访研究的患者，进行了时间事件分析以评估损伤演变的趋势。还评估了损伤等级和损伤演变之间的关系。Fisher 精确检验和多变量逻辑回归用于评估损伤血管数量、血管等级和血管类型（颈内动脉、椎动脉）与 BCVI 相关中风的关系。结果 共评估了 1204 例患者（800 例男性；平均年龄±标准差，45 岁±22 岁）和 1604 个血管损伤。高级（等级 3-5）损伤不太可能解决（风险比[HR]，0.2；<.001），而低级损伤则可能解决。高级损伤比低级损伤更有可能进展（HR，3.3；=.005）。在改善或解决的损伤中（419 例中的 343 例[81.9%]），76%（259 例中的 343 例）在最初损伤后 30 天内发生变化，其余 24%（343 例中的 84 例）在 30 至 90 天之间发生变化。在进展的损伤中（419 例中的 46 例[11.0%]），87%（46 例中的 40 例）在 90 天内发生变化。90 天以后，没有改善或解决，只有 1.4%（419 例中的 6 例）的损伤进展。更高的损伤等级（调整优势比，每增加一级增加 2.0[95%置信区间{CI}：1.6, 2.4]；<.001），颈动脉损伤与椎动脉损伤（49 例中的 420 例[11.7%]与 35 例中的 667 例[5.2%]；<.001），以及每位患者受伤血管数量的增加（调整优势比，每增加一个血管增加 1.6[95%CI：1.3, 2.2]；<.001）与 BCVI 相关中风的风险增加相关。结论 大多数与钝性脑血管损伤相关的变化发生在 30 天内；90 天以后很少发生变化。因此，90 天以后的随访成像不太可能有帮助。©RSNA，2020 也请参阅本期 Talbott 的社论。
