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

Bonatti M, Vezzali N, Ferro F, Manfredi R, Oberhofer N, Bonatti G - Insights Imaging (2013)

Bottom Line: BCVI were present in 32/976 (3.3 %) multi-trauma patients.Risk factors for BCVI were present in 247/976 (25.3 %) patients.An investigation for the presence of BCVI should be performed on all multi-trauma patients despite the absence of clinical-radiological risk factors. • 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, San Maurizio Hospital, 5 Boehler Street, 39100, Bolzano, Italy, matteobonatti@hotmail.com.

ABSTRACT

Purpose: To 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 methods: A 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.

Results: BCVI 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.

Conclusion: An 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.

No MeSH data available.


Related in: MedlinePlus

Low-grade blunt cerebrovascular injury (BCVI) (grade I and II lesions according to the Biffl classification). a A 42-year-old man who had suffered a motorcycle accident. The axial MPR image (3-mm thickness) shows a slight irregularity in the posterior wall of the left internal carotid artery (arrow) responsible of a calibre reduction <25 % (grade I lesion). No clinical-radiological risk factors for BCVI were present. The man did not undergo anti-aggregation because of the presence of severe abdominal injuries and developed an infarction in the territory of the left median cerebral artery. b An 83-year-old woman struck by a car. The axial MPR image (3-mm thickness) shows an eccentric calibre reduction of the left vertebral artery (arrow) >25 % (grade 2 lesion). Cervical spine fractures, including a fracture of the spinous process of C3 (arrowhead) were present. The vertebral artery lesion had not been described on the radiological report and, therefore, no therapy had been administered. The woman developed a cerebellar infarction. c, d A 34-year-old man who had suffered a motorcycle accident. The axial MIP reconstruction (c) (3-mm thickness) shows a lumen wall irregularity of the right internal carotid artery (arrow) responsible of a calibre reduction >25 % (grade II lesion); the lesion is better depicted on the sagittal MIP reconstruction d (5-mm thickness). No clinical-radiological risk factors for BCVI were present. The men underwent anti-aggregation and no neurological deficit occurred
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Fig1: Low-grade blunt cerebrovascular injury (BCVI) (grade I and II lesions according to the Biffl classification). a A 42-year-old man who had suffered a motorcycle accident. The axial MPR image (3-mm thickness) shows a slight irregularity in the posterior wall of the left internal carotid artery (arrow) responsible of a calibre reduction <25 % (grade I lesion). No clinical-radiological risk factors for BCVI were present. The man did not undergo anti-aggregation because of the presence of severe abdominal injuries and developed an infarction in the territory of the left median cerebral artery. b An 83-year-old woman struck by a car. The axial MPR image (3-mm thickness) shows an eccentric calibre reduction of the left vertebral artery (arrow) >25 % (grade 2 lesion). Cervical spine fractures, including a fracture of the spinous process of C3 (arrowhead) were present. The vertebral artery lesion had not been described on the radiological report and, therefore, no therapy had been administered. The woman developed a cerebellar infarction. c, d A 34-year-old man who had suffered a motorcycle accident. The axial MIP reconstruction (c) (3-mm thickness) shows a lumen wall irregularity of the right internal carotid artery (arrow) responsible of a calibre reduction >25 % (grade II lesion); the lesion is better depicted on the sagittal MIP reconstruction d (5-mm thickness). No clinical-radiological risk factors for BCVI were present. The men underwent anti-aggregation and no neurological deficit occurred

Mentions: Two radiologists (with 22 and 12 years of experience in emergency radiology, respectively), who were unaware of the trauma dynamics and of the clinical conditions of the patient, independently evaluated the post-contrast CT images of cerebrovascular vessels. Discrepancies were solved by consensus. Common carotid arteries, internal carotid arteries, vertebral arteries and basilar artery were evaluated on 2-mm MPR images and each vessel was classified as follows, according to the angiographic classification proposed by Biffl et al. [36] (Figs. 1, 2, 3, 4 and 5): normal (grade 0), lumen wall irregularity or lumen narrowing <25 % (grade I) (Fig. 1a); intraluminal thrombus or lumen narrowing >25 % (grade II) (Fig. 1b–d); pseudoaneurysm (grade III) (Fig. 2a–d); complete occlusion (grade IV) (Fig. 3a–d); transection associated to active extravasation of contrast media (grade V) (Fig. 4a–c).Fig. 1


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

Bonatti M, Vezzali N, Ferro F, Manfredi R, Oberhofer N, Bonatti G - Insights Imaging (2013)

Low-grade blunt cerebrovascular injury (BCVI) (grade I and II lesions according to the Biffl classification). a A 42-year-old man who had suffered a motorcycle accident. The axial MPR image (3-mm thickness) shows a slight irregularity in the posterior wall of the left internal carotid artery (arrow) responsible of a calibre reduction <25 % (grade I lesion). No clinical-radiological risk factors for BCVI were present. The man did not undergo anti-aggregation because of the presence of severe abdominal injuries and developed an infarction in the territory of the left median cerebral artery. b An 83-year-old woman struck by a car. The axial MPR image (3-mm thickness) shows an eccentric calibre reduction of the left vertebral artery (arrow) >25 % (grade 2 lesion). Cervical spine fractures, including a fracture of the spinous process of C3 (arrowhead) were present. The vertebral artery lesion had not been described on the radiological report and, therefore, no therapy had been administered. The woman developed a cerebellar infarction. c, d A 34-year-old man who had suffered a motorcycle accident. The axial MIP reconstruction (c) (3-mm thickness) shows a lumen wall irregularity of the right internal carotid artery (arrow) responsible of a calibre reduction >25 % (grade II lesion); the lesion is better depicted on the sagittal MIP reconstruction d (5-mm thickness). No clinical-radiological risk factors for BCVI were present. The men underwent anti-aggregation and no neurological deficit occurred
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig1: Low-grade blunt cerebrovascular injury (BCVI) (grade I and II lesions according to the Biffl classification). a A 42-year-old man who had suffered a motorcycle accident. The axial MPR image (3-mm thickness) shows a slight irregularity in the posterior wall of the left internal carotid artery (arrow) responsible of a calibre reduction <25 % (grade I lesion). No clinical-radiological risk factors for BCVI were present. The man did not undergo anti-aggregation because of the presence of severe abdominal injuries and developed an infarction in the territory of the left median cerebral artery. b An 83-year-old woman struck by a car. The axial MPR image (3-mm thickness) shows an eccentric calibre reduction of the left vertebral artery (arrow) >25 % (grade 2 lesion). Cervical spine fractures, including a fracture of the spinous process of C3 (arrowhead) were present. The vertebral artery lesion had not been described on the radiological report and, therefore, no therapy had been administered. The woman developed a cerebellar infarction. c, d A 34-year-old man who had suffered a motorcycle accident. The axial MIP reconstruction (c) (3-mm thickness) shows a lumen wall irregularity of the right internal carotid artery (arrow) responsible of a calibre reduction >25 % (grade II lesion); the lesion is better depicted on the sagittal MIP reconstruction d (5-mm thickness). No clinical-radiological risk factors for BCVI were present. The men underwent anti-aggregation and no neurological deficit occurred
Mentions: Two radiologists (with 22 and 12 years of experience in emergency radiology, respectively), who were unaware of the trauma dynamics and of the clinical conditions of the patient, independently evaluated the post-contrast CT images of cerebrovascular vessels. Discrepancies were solved by consensus. Common carotid arteries, internal carotid arteries, vertebral arteries and basilar artery were evaluated on 2-mm MPR images and each vessel was classified as follows, according to the angiographic classification proposed by Biffl et al. [36] (Figs. 1, 2, 3, 4 and 5): normal (grade 0), lumen wall irregularity or lumen narrowing <25 % (grade I) (Fig. 1a); intraluminal thrombus or lumen narrowing >25 % (grade II) (Fig. 1b–d); pseudoaneurysm (grade III) (Fig. 2a–d); complete occlusion (grade IV) (Fig. 3a–d); transection associated to active extravasation of contrast media (grade V) (Fig. 4a–c).Fig. 1

Bottom Line: BCVI were present in 32/976 (3.3 %) multi-trauma patients.Risk factors for BCVI were present in 247/976 (25.3 %) patients.An investigation for the presence of BCVI should be performed on all multi-trauma patients despite the absence of clinical-radiological risk factors. • 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, San Maurizio Hospital, 5 Boehler Street, 39100, Bolzano, Italy, matteobonatti@hotmail.com.

ABSTRACT

Purpose: To 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 methods: A 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.

Results: BCVI 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.

Conclusion: An 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.

No MeSH data available.


Related in: MedlinePlus