Vascular complications of penetrating brain injury: comparison of helical CT angiography and conventional angiography

Autor:	Alexis R. Boscak, Thorsten R. Fleiter, Jaroslaw Krejza, Kathirkamanathan Shanmuganathan, Giulia van der Byl, David Dreizin, Paul M. Jaffray, Stuart E. Mirvis, Bizhan Aarabi, Uttam K. Bodanapally, Ashis K. Roy
Rok vydání:	2014
Předmět:	medicine.medical_specialty medicine.diagnostic_test business.industry Traumatic brain injury Conventional angiography Digital subtraction angiography Penetrating Brain Injury medicine.disease Predictive value Helical ct Angiography Medicine Radiology business
Zdroj:	Journal of Neurosurgery. 121:1275-1283
ISSN:	1933-0693 0022-3085
DOI:	10.3171/2014.7.jns132688
Popis:	Object The authors conducted a study to compare the sensitivity and specificity of helical CT angiography (CTA) and digital subtraction angiography (DSA) in detecting intracranial arterial injuries after penetrating traumatic brain injury (PTBI). Methods In a retrospective evaluation of 48 sets of angiograms from 45 consecutive patients with PTBI, 3 readers unaware of the DSA findings reviewed the CTA images to determine the presence or absence of arterial injuries. A fourth reader reviewed all the disagreements and decided among the 3 interpretations. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CTA were calculated on a per-injury basis and in a subpopulation of patients with traumatic intracranial aneurysms (TICAs). Results Sensitivity of CTA for detecting arterial injuries was 72.7% (95% CI 49.8%–89.3%); specificity, 93.5% (95% CI 78.6%–99.2%); PPV, 88.9% (95% CI 65.3%–98.6%); and NPV, 82.9% (95% CI 66.4%–93.4%). All 7 TICAs were correctly identified by CTA. Sensitivity, specificity, PPV, and NPV of CTA in detecting TICAs were 100%. To compare agreement with DSA, the standard of reference, confidence scores categorized as low, intermediate, and high probability yielded an overall effectiveness of 77.8% (95% CI 71.8%–82.9%). Conclusions Computed tomography angiography had limited overall sensitivity in detecting arterial injuries in patients with PTBI. However, it was accurate in identifying TICAs, a subgroup of injuries usually managed by either surgical or endovascular approaches, and non-TICA injuries involving the first-order branches of intracranial arteries.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::eafaac8532859e3ed7a0b6b1e1ab8f90 https://doi.org/10.3171/2014.7.jns132688 Zobrazit plný text záznamu