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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

Advanced screening for blunt craniocervical vessel injuries: whole body CT trauma imaging with adapted CT angiography

Erweitertes Screening für stumpfe kraniozervikale Gefässverletzungen: Ganzkörper-Polytrauma-CT mit adaptierter CT-Angiographie

Meeting Abstract

  • corresponding author S. Fleck - Klinik und Poliklinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald
  • S. Langner - Institut für Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt-Universität Greifswald
  • J. Baldauf - Klinik und Poliklinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald
  • M. Kirsch - Institut für Diagnostische Radiologie und Neuroradiologie, Ernst-Moritz-Arndt-Universität Greifswald
  • H. Schroeder - Klinik und Poliklinik für Neurochirurgie, Ernst-Moritz-Arndt-Universität Greifswald

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.11.10

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc116.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Fleck et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Trauma associated with blunt craniocervical vessel injuries (BCVI) are often not detected but the evaluation evolved over the past years. Recent studies using more advanced imaging techniques and more inclusive screening criteria have found BCVI in up to 1,6%. The purpose of this study was to determine the incidence of traumatic craniocervical artery injury in polytrauma patients using a standardized whole body trauma CT with an adapted CT angiography (CTA) of the craniocervical vessels.

Methods: We conducted a prospective screening of 368 patients requiring a whole body trauma CT due to the mechanism of injury and their injury patterns. All examinations were performed using a 16 row MSCT (Sensation 16, Siemens). Initially a spiral scan of the neurocranium was acquired. Then a CT angiography of the craniocervical vessels with 40 ml of iodinated contrast agent (flow 4 ml/s; 40 ml saline flush, flow 4 ml/s) was performed starting at the level of Th1 up to the roof of the lateral ventricles (100 kV, 120 mAs, collimation 16 x 0.75). The scan was started using bolus tracking. Finally a contrast-enhanced spiral thoraco-abdominal scan was performed with a delay of 20 sec after administering a second contrast bolus of 60 ml. The craniocervical vessels were analyzed in the source images using 20 mm thin slice MIP-reconstructions.

Results: We found isolated cervical spine injuries in 11 patients, isolated cranial injuries in 81 and combined cervical and cranial lesions in 8 patients. These injury patterns were associated with vessel injuries in 18,2% of cervical spine fractures, in 3,8% of isolated cranial injuries and in 12,5% of combined lesions. Furthermore, vascular lesions were evaluated in 0,75% of patients without other craniocervical injuries. The overall rate of trauma associated vessel lesions was 1,61%.

Conclusions: The adapted scanning protocol for blunt craniocervical vessel injuries is a rapid and relatively non-invasive examination technique and should be used for emergency patients depending on the mechanism of trauma and on the injury patterns. It allows the initiation of further therapeutic options to prevent the patient from severe consequences such as cerebral infarction. The overall rate of BCVI was 1,61%. The incidence is much higher (up to 18,2%) in different injury patterns of the skull and cervical spine.