Blunt cerebrovascular injury: diagnosis at whole-body MDCT for multi-trauma

Abstract

PurposeTo analyse the prevalence of blunt cerebrovascular injuries (BCVIs) in multi-trauma patients by means of a post-contrast acquisition of neck vessels included into the whole-body multi-detector computed tomography (MDCT) protocol performed at admission and to correlate it with the presence of risk factors (Memphis approach).Materials and methodsA retrospective study was undertaken for the period January 2005 to November 2011, involving 976 multi-trauma patients. Post-contrast images of neck vessels in MDCT scan were evaluated by two experienced radiologists; carotid, vertebral and basilar arteries were rated according to the Biffl classification. The presence of clinical and/or CT risk factors for BCVI was assessed.ResultsBCVI were present in 32/976 (3.3 %) multi-trauma patients. Risk factors for BCVI were present in 247/976 (25.3 %) patients. The group of patients presenting risk factors showed a significantly higher prevalence of cerebrovascular injuries (8.1 %) compared with the group of patients without risk factors (1.6 %) (p = 0.009); however, 12/32 (37.5 %) patients presenting BCVI did not show any of the risk factors proposed by the Memphis group.ConclusionAn investigation for the presence of BCVI should be performed on all multi-trauma patients despite the absence of clinical-radiological risk factors.Key Points BCVIs are present in 3.3 % of multi-trauma patients. BCVIs are significantly associated to the Memphis risk factors. Of the multi-trauma patients affected by BCVIs, 37.5 % do not show clinical-radiological risk factors. A screening for BCVI should be performed on all multi-trauma patients.