AJR:196, March 2011 W309 acute craniocervical scoring system has been proposed to select blunt trauma patients for MDCTA evaluation; it includes cervical sub- luxations–dislocations, fracture lines reaching an arterial structure, and high-impact mecha- nisms of injury (1 point each). The authors reported a risk of arterial injury of 21.9% for patients with a score of 2 and 52.2% for patients with a score of 3 [8]. Unfortunately, 20–22% of patients with blunt vascular injuries may not fulfill these clinical screening criteria [6], so whole-body MDCT surveys performed at some institutions on severe blunt polytrauma patients have been advocated for detection of such injuries. Sliker et al. [1] found no signifi- cant differences between dedicated 16-MDCTA and whole-body MDCT as part of a routine trauma protocol. MDCTA is currently the most frequently used modality in the evaluation of patients suspected of having blunt vascular injuries. The objective of this article is to familiarize the reader with the MDCT 3D imaging find- ings of cervical vascular injuries. Technique Neck CTA is performed using automatic exposure control on a 64-MDCT scanner with 0.6-mm configuration. The patient is injected IV with 50–100 mL of iodinated contrast ma- terial at 5 mL/s, followed immediately by a 40-mL 0.9% saline bolus at 5 mL/s through an 18- or 20-gauge catheter located in an ante- cubital vein. We use an automated triggering device with a region of interest placed in the ascending aorta. Anatomic coverage for the dedicated neck CTA is from the aortic arch 64-MDCT Angiography of Blunt Vascular Injuries of the Neck Falgun H. Chokshi 1 Felipe Munera 2 Luis A. Rivas 2 Robert P. Henry 2 Robert M. Quencer 1 Chokshi FH, Munera F, Rivas LA, Henry RP, Quencer RM 1 Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL. 2 Department of Radiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital/Ryder Trauma Center, 1611 NW 12th Ave. (WW-279), Miami, FL 33136. Address correspondence to F. Munera (fmunera@med.miami.edu). Neuroradiology/Head฀and฀Neck฀Imaging฀•฀Pictorial฀Essay WEB This is a Web exclusive article. AJR 2011; 196:W309–W315 0361–803X/11/1963–W309 © American Roentgen Ray Society B lunt vascular injuries result in damage to the carotid and verte- bral arteries secondary to direct, nonpenetrating trauma to the neck. Up to 80% of blunt vascular injuries are caused by motor vehicle accidents, and symp- tomatic patients present with focal neurologic deficit unexplained by neuroimaging. These injuries, however, can have an initial silent course without any neurologic manifestations for up to 48 hours after injury [1]. Therefore, early and efficient screening is necessary for accurate diagnosis and treatment [2]. The need for screening has been strengthened by studies showing a significant improvement in outcome with early treatment [3, 4]. Screening for blunt vascular injuries in- volves a combination of careful clinical and radiologic evaluation of the patient’s injuries. Neurologically nonsymptomatic patients may present with seatbelt contusions, facial wound hemorrhage, or neck pain, with or without hematoma. Radiologically, patients may have severe injuries, including basilar skull fracture, cervical spine fractures in- volving C1–C3, foramen transversarium, or severe hyperextension or hyperflexion mech- anisms. Facial fractures of the LeFort II or III type are also associated with blunt vas- cular injuries. Furthermore, patients with a Glasgow coma scale score < 8 or severe chest injuries also have been associated with blunt vascular injuries [5–7]. Most studies that have assessed the accu- racy of CT angiography (CTA) in blunt neck trauma patients show equivalent accuracy when compared with catheter angiography [8]. An Keywords: blunt neck trauma, craniocerebral trauma, craniocervical arterial dissection, CT angiography, MDCT angiography DOI:10.2214/AJR.10.4548 Received March 3, 2010; accepted after revision August 20, 2010. OBJECTIVE. CT angiography (CTA) using 64-MDCT enables timely evaluation of inju- ries associated with blunt neck trauma. The purpose of this article is to familiarize the reader with the most frequent CTA signs of blunt vascular injury. CONCLUSION. CTA is a valuable tool to detect blunt vascular injuries, especially us- ing its multiplanar and 3D reconstruction capabilities. Chokshi et al. CTA of Blunt Vascular Injuries of the Neck Neuroradiology/Head and Neck Imaging Pictorial Essay Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved