Current Concepts in Imaging Diagnosis and Screening of Blunt Cerebrovascular Injuries.

Tiffany Y So,Lei Wang,Apurva Sawhney,Yi Xiang J Wang

doi:10.3390/tomography8010033

Abstract

Blunt cerebrovascular injury (BCVI) is an often underrecognized injury occurring in the carotid or vertebral arteries, associated with a risk of ischemic stroke and potential for poor neurological outcome or death. Computed tomographic angiography (CTA) is the most common modality for initial screening and diagnosis. Vessel wall intimal injuries, intraluminal thrombus, dissection, intramural hematoma, pseudoaneurysm, vessel transection, and arteriovenous fistula, are potential findings to be considered in approach to imaging. Identification of high-risk trauma patients based on clinical and radiological risk factors can determine patients at risk of BCVI for targeted screening.

Highlights

Most guidelines recommend the use of ≥16 section multidetector Computed tomographic angiography (CTA) for Blunt cerebrovascular injury (BCVI) detection; these showing sensitivities of 64–98% and specificities of 92–100% compared to digital subtraction angiography (DSA) for BCVI diagnosis in recent studies [12,13,14,15,16,17,18,19,20]
Standard magnetic resonance (MR) angiography (MRA) has typically shown low diagnostic accuracy for BCVI detection compared with DSA and CTA, with sensitivities of 50–75% and specificities of 67% compared to DSA [15,16,19,21]
Imaging findings in BCVI are diverse, paralleling the range of pathological injury which can extend from intimal injury, to complete wall disruption and transection or arteriovenous fistula

Summary

Introduction

Blunt cerebrovascular injury (BCVI) is a potentially devastating, yet often underrecognized, non-penetrating injury which occurs in the carotid or vertebral arteries. Most often associated with high energy trauma, BCVI most commonly occurs as a complication of high-speed motor vehicle accidents, pedestrian versus car accidents, falls from heights or assaults [1,2,3]. Recent data shows that ischemic stroke is the main cause of morbidity and mortality from BCVI, which is linked to underdiagnosis or delayed diagnosis. 32–67% and mortality rates of 17–38% have been reported. Mortality rates of 8–18% have been reported for untreated vertebral injuries [10]. Screening of high-risk trauma patients may facilitate earlier diagnosis and decision of appropriate treatment.

Imaging Techniques

Imaging Findings of Arterial Injury

Screening for Blunt Cerebrovascular Injury

Treatment and Follow-Up

Conclusions