The role of neuroimaging in the latent period of blunt traumatic cerebrovascular injury

Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center

OBJECT

Screening for vertebral artery injury (VAI) following cervical spine fractures is routinely performed across trauma centers in North America. From 2002 to 2007, the total number of neck CT angiography (CTA) studies performed in the Medicare population after trauma increased from 9796 to 115,021. In the era of cost-effective medical care, the authors aimed to evaluate the utility of CTA screening in detecting VAI and reduce chances of posterior circulation strokes after traumatic cervical spine fractures.

METHODS

A retrospective review of all patients presenting with cervical spine fractures to Northeast Ohio's Level I trauma institution from 2002 to 2012 was performed.

RESULTS

There was a total of 1717 cervical spine fractures in patients presenting to Northeast Ohio's Level I trauma institution between 2002 and 2012. CTA screening was performed in 732 patients, and 51 patients (0.7%) were found to have a VAI. Fracture patterns with increased odds of VAI were C-1 and C-2 combined fractures, transverse foramen fractures, and subluxation of adjacent vertebral levels. Ten posterior circulation strokes were identified in this patient population (0.6%) and found in only 4 of 51 cases of VAI (7.8%). High-risk fractures defined by Denver Criteria, VAI, and antiplatelet treatment of VAI were not independent predictors of stroke.

CONCLUSIONS

Cost-effective screening must be reevaluated in the setting of blunt cervical spine fractures on a case-by-case basis. Further prospective studies must be performed to elucidate the utility of screening for VAI and posterior circulation stroke prevention, if identified.

Imaging of blunt vascular neck injuries: a clinical perspective

OBJECTIVE

We will review the common injuries and anatomic distributions of blunt cerebrovascular injuries (BCVIs) of the neck, explain the grading criteria, and discuss the corresponding management. Artifacts associated with BCVI on CT will also be examined.

CONCLUSION

Identifying common injury patterns and anatomic distributions associated with BCVI can help decide the grade and management earlier and reduce the risk for potential complications. Recognizing the common artifacts associated with BCVI helps the reader successfully recognize a true BCVI.