CT Angiography in Trauma

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Technique

The diagnostic quality of a CTA examination depends on many factors, but careful attention to technique and adequate patient preparation are always necessary, especially in the setting of trauma when multiple events often happen simultaneously and every second may be critical.

The importance of proper patient positioning cannot be underestimated. Patients are typically placed supine on a CT table. In the majority of cases (chest, abdomen, pelvis, or lower-extremity imaging), placing both arms

CTA of the chest

Thoracic injuries account for 25% of trauma-related deaths in the United States and the thorax is the third most commonly injured body part in trauma.1 MDCT angiography has rapidly become the imaging modality of choice in evaluating a wide variety of potentially life-threatening acute traumatic injuries of the aorta and other large vessels.2, 3, 4, 5 CTA provides high-resolution axial, multiplanar, and 3-D data sets, which enable rapid diagnosis and characterization of thoracic vascular

CTA of the abdomen

The main purpose of the abdominal CT examination in trauma patients is to detect injuries to and bleeding arising from the solid organs, hollow viscera, and mesentery, but the major abdominal vessels can also be evaluated.20, 21, 22, 23 Currently, specific CTA (arterial phase) images are not routinely obtained as part of the abdominal CT protocol at most large trauma centers. The upper abdominal aorta and its branches, however, are often scanned in a late arterial phase because the lower images

CTA of the pelvis

Patients who suffer major blunt pelvic trauma and sustain displaced fractures have a high risk of major pelvic vascular injuries, with significant mortality and morbidity.38, 39, 40, 41, 42 Approximately 40% of patients with a pelvic fracture may have an associated pelvic vascular injury and hemorrhage is the leading cause of mortality in 60% of cases.26, 39, 40, 41, 43 Rapid detection and assessment of pelvic vascular injury afforded by the shorter acquisition times and increased spatial

CTA of the extremities

Historically, DSA was the primary imaging modality for assessing the vascular integrity of the extremity in trauma patients.47, 48, 49 CTA, however, has increasingly become an invaluable tool in the detection and characterization of extremity vascular injuries.47, 48, 50, 51, 52, 53, 54, 55, 56 More recently, faster CT acquisition times and the development of longer CT tables that allow the acquisition of whole-body CT digital radiographs have led to the development of more complex and robust

CTA of the head and neck

Blunt and penetrating traumatic arterial injuries of the neck have traditionally been assessed by catheter angiography. The high number of negative examinations and the risks associated with catheter angiogram, however, have prompted the use of noninvasive techniques. MDCT angiography is sensitive and specific for the evaluation of carotid and vertebral artery injuries.58, 59, 60, 61 Cerebrovascular injuries occur in 1.2% to 2.7% of blunt trauma patients but up to 25% of patients who have

Summary

Currently, with widely available MDCT technology, the first-line assessment of vascular injury in trauma patients is CTA. CTA affords a rapid, accurate, noninvasive method of detecting vascular injury and appropriately triaging patients to receive the requisite intervention, when necessary. With careful attention to technique and an understanding of commonly encountered vascular injuries in trauma, high-quality, diagnostic CTAs offer an invaluable tool in the imaging evaluation of injured

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