Computed tomography as a screening exam in patients with suspected blunt aortic injury

Chest computed tomography (CT) screening of patients with blunt trauma for thoracic aortic injury is controversial. This study was undertaken to determine whether CT could exclude aortic injury and be used to select patients for aortography. Computed tomography and aortography were used to evaluate...

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Bibliographic Details
Published in:Annals of surgery 1994-11, Vol.220 (5), p.699-704
Main Authors: DURHAM, R. M, ZUCKERMAN, D, WOLVERSON, M, HEIBERG, E, LUCHTEFELD, W. B, HERR, D. J, SHAPIRO, M. J, MAZUSKI, J. E, SALLIMI, Z, MURALI SUNDARAM
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aorta, Thoracic - diagnostic imaging
Aorta, Thoracic - injuries
Aortography
Biological and medical sciences
Cardiovascular system
Female
Humans
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Predictive Value of Tests
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Sensitivity and Specificity
Time Factors
Tomography, X-Ray Computed
Wounds, Nonpenetrating - diagnostic imaging
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Summary:Chest computed tomography (CT) screening of patients with blunt trauma for thoracic aortic injury is controversial. This study was undertaken to determine whether CT could exclude aortic injury and be used to select patients for aortography. Computed tomography and aortography were used to evaluate 155 patients with blunt trauma. Computed tomography scans were reviewed separately by four attending radiologists who were unaware of the patients' clinical course and angiographic findings. Eight of 155 patients had aortic injuries requiring operation. Computed tomography scans in five patients were read as positive by all reviewers. One scan was read as positive by three reviewers and as negative by one. Two scans were read as positive by two radiologists and as negative by two. After poor scans were excluded, the combined sensitivity of CT for detecting aortic injury was 88%, specificity was 54%, positive predictive value was 9%, and negative predictive value 99%. The sensitivity of CT scan for indicating the need for aortography is observer dependent. As CT manifestations of aortic injury are often subtle, CT does not reliably exclude aortic injury.
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-199411000-00015