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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

Blunt cerebrovascular occlusion (grade IV lesions according to the Biffl classification). a, b A 51-year-old man who had suffered a motorcycle accident. The axial MPR image (a) (3-mm thickness) shows the absence of contrast material within the right vertebral artery (arrow) and the coexistence of a C4 lateral mass fracture (arrowhead) involving the right vertebral channel; the same findings (arrows and arrowhead) are clearly detectable on the sagittal MPR image on which the presence of contrast material is detectable within the right vertebral artery upstream and downstream the occlusion. The patient underwent anti-aggregation and no neurological deficit occurred. c, d A 28-year-old man who had suffered a bicycle accident. The axial MPR image (c) (3-mm thickness) shows multiple skull basis fractures (arrows) involving the clivus too and no contrast material within the basilar artery (arrowhead). Mid-face fractures were also present. The sagittal MIP reconstruction (d) (4-mm thickness) confirms a focal absence of contrast material within the lumen of the basilar artery. The patient did not undergo anti-aggregation because of high haemorrhagic risk and developed a brainstem infarction responsible of a locked in syndrome
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Fig3: Blunt cerebrovascular occlusion (grade IV lesions according to the Biffl classification). a, b A 51-year-old man who had suffered a motorcycle accident. The axial MPR image (a) (3-mm thickness) shows the absence of contrast material within the right vertebral artery (arrow) and the coexistence of a C4 lateral mass fracture (arrowhead) involving the right vertebral channel; the same findings (arrows and arrowhead) are clearly detectable on the sagittal MPR image on which the presence of contrast material is detectable within the right vertebral artery upstream and downstream the occlusion. The patient underwent anti-aggregation and no neurological deficit occurred. c, d A 28-year-old man who had suffered a bicycle accident. The axial MPR image (c) (3-mm thickness) shows multiple skull basis fractures (arrows) involving the clivus too and no contrast material within the basilar artery (arrowhead). Mid-face fractures were also present. The sagittal MIP reconstruction (d) (4-mm thickness) confirms a focal absence of contrast material within the lumen of the basilar artery. The patient did not undergo anti-aggregation because of high haemorrhagic risk and developed a brainstem infarction responsible of a locked in syndrome

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)

Blunt cerebrovascular occlusion (grade IV lesions according to the Biffl classification). a, b A 51-year-old man who had suffered a motorcycle accident. The axial MPR image (a) (3-mm thickness) shows the absence of contrast material within the right vertebral artery (arrow) and the coexistence of a C4 lateral mass fracture (arrowhead) involving the right vertebral channel; the same findings (arrows and arrowhead) are clearly detectable on the sagittal MPR image on which the presence of contrast material is detectable within the right vertebral artery upstream and downstream the occlusion. The patient underwent anti-aggregation and no neurological deficit occurred. c, d A 28-year-old man who had suffered a bicycle accident. The axial MPR image (c) (3-mm thickness) shows multiple skull basis fractures (arrows) involving the clivus too and no contrast material within the basilar artery (arrowhead). Mid-face fractures were also present. The sagittal MIP reconstruction (d) (4-mm thickness) confirms a focal absence of contrast material within the lumen of the basilar artery. The patient did not undergo anti-aggregation because of high haemorrhagic risk and developed a brainstem infarction responsible of a locked in syndrome
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3675247&req=5

Fig3: Blunt cerebrovascular occlusion (grade IV lesions according to the Biffl classification). a, b A 51-year-old man who had suffered a motorcycle accident. The axial MPR image (a) (3-mm thickness) shows the absence of contrast material within the right vertebral artery (arrow) and the coexistence of a C4 lateral mass fracture (arrowhead) involving the right vertebral channel; the same findings (arrows and arrowhead) are clearly detectable on the sagittal MPR image on which the presence of contrast material is detectable within the right vertebral artery upstream and downstream the occlusion. The patient underwent anti-aggregation and no neurological deficit occurred. c, d A 28-year-old man who had suffered a bicycle accident. The axial MPR image (c) (3-mm thickness) shows multiple skull basis fractures (arrows) involving the clivus too and no contrast material within the basilar artery (arrowhead). Mid-face fractures were also present. The sagittal MIP reconstruction (d) (4-mm thickness) confirms a focal absence of contrast material within the lumen of the basilar artery. The patient did not undergo anti-aggregation because of high haemorrhagic risk and developed a brainstem infarction responsible of a locked in syndrome
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