Imaging in extremity vascular trauma: can MDCT angiography predict the nature of injury?
Deeksha Bhalla, Atin Kumar, Shivanand Gamanagatti, Sushma Sagar, Subodh Kumar, Amit Gupta
Emerg Radiol . 2022 Aug;29(4):683-690. doi: 10.1007/s10140-022-02050-4. Epub 2022 Apr 25.
Objective: This study aims to evaluate the utility of computed tomography angiography (CTA) signs of vascular injury in the differentiation of vessel transection from pure thrombosis with intact vessel wall.
Methods: Retrospective analysis was done on 146 consecutive patients who had undergone CTA and surgical exploration from January 2015 to September 2019. Twelve imaging parameters were assessed. Chi-square was used to test the difference between groups. In addition, a scoring system was devised where one point each was added for the presence of 5 signs and absence of 3 signs. ROC analysis was done for the variables which had shown significant difference between groups and for the composite score.
Results: On surgical exploration, 87 patients had transection of vessel, while 59 had thrombosis. Significant difference was found among the two groups in non-opacification, pseudoaneurysm, extravasation (p = 0.04 each), thrombosed cord (p < 0.001), collaterals (p = 0.001) and hematoma (p = 0.002), while other signs did not show significant difference. The AUC value for each of these variables was < 0.650, while for the score, AUC was .843(.773-.913). A cut-off value of ≥ 1.5 gave 83.1% sensitivity and 70% specificity for diagnosing transection.
Conclusion: CTA is a useful tool to classify the nature of vascular injury. It is advisable to use a composite score for maximum diagnostic value.
Read Full Article Here: https://doi.org/10.1007/s10140-022-02050-4