Abstract
Recently, the use of invasive routine angiography in stable patients has been discouraged because of the high number of negative examinations13-15 and the availability of alternative noninvasive diagnostic methods, such as helical or multislice CTA.1,2,4,5-7 In some recent series, the sensitivity and specificity of CT angiography for diagnosis of cervical vascular injuries have been reported to be in the range of 90% to 100%.1,4,5,7 CT angiography can also provide additional information about nonarterial injuries, such as those of the cervical spine and the aerodigestive tract.2,4,7 In gunshot wounds to the neck, CT can delineate the bullet trajectory and help identify potential injuries, thus reducing the need for additional studies such as endoscopy and/or contrast esophageal studies in patients whose trajectories are clearly away from the aerodigestive tract. Recent literature suggests that the true incidence of blunt cerebrovascular injury is higher than was initially described.16 Centers performing an aggressive screening of selected patients using angiography have reported a higher incidence of 0.33 to 2.7%.16-21 Although noninvasive techniques, such as multislice CTA and magnetic resonance angiography (MRA). have potential as screening tools in patients with blunt cerebrovascular injury, angiography is still considered the study of choice.19-22 Recently, CT of the carotid and vertebral arteries in all trauma patients who are scheduled to undergo CT of the cervical spine has been recommended by Mutze et al.21 The use of CTA as a screening method for these blunt cerebrovascular injuries will require further investigation.