MDCT eliminates need for catheter angiography for aortic injury diagnosis

Contrast-enhanced 64-MDCT that definitively reveals acute trauma to the aorta does not need confirmation from invasive catheter angiography, which saves valuable time in treating patients in trauma centers, according to a new study by researchers from the Medical University of South Carolina in Charleston.

Time is of the essence in evaluating acutely injured patients, and this is especially true in the diagnosis of aortic injuries, said Scott Steenburg, MD, lead author of the study. "Coming up with a definitive diagnosis of aortic injury takes only minutes with 64-MDCT without the need for mobilizing an angiography team. This allows the trauma and cardiothoracic surgeons to begin treatment almost immediately. For the patient, this means saving precious time; as morbidity and mortality increase dramatically for untreated aortic injuries, even with only a few hours of delay," said Dr. Steenburg.

For the study, the authors reviewed 581 patients over a period of 18 months who were imaged for suspicion of aortic injury. Of the 581 patients, 16 were accurately diagnosed with the injury using MDCT, 15 from car collisions and one from a fall. Of the original 581 patents, a total of 10 catheter angiograms were performed after positive, negative, or equivocal diagnoses on MDCT. The authors discovered that the findings correlated between the two imaging methods in all 10 of those cases.

According to the study authors, MDCT has become the standard for rapid imaging evaluation of trauma patients, and is excellent in general for evaluating the aorta for injuries. "Since March 2005, practically every trauma patient seen in our trauma center gets some imaging with our 64-MDCT scanner; however, we knew of no study showing the effectiveness of 64-MDCT for aortic injuries. Recently, our surgeons have been taking these patients with evidence of aortic injuries directly to surgery, and we wanted to look back at the data to see how good we were doing with 64-MDCT," said Dr. Steenburg.

MDCT works so well for diagnosing aortic injuries that trauma centers rarely do direct catheter angiograms for aortic injuries anymore, say the study authors. "The surgical staff is confident in our diagnoses because of the excellent images we are able to generate. We have done a handful of angiograms for difficult or equivocal cases since installing our 64-MDCT scanner, but the same diagnostic uncertainties are apparent in both imaging methods and are open to interpretive subjectivity," said Dr. Steenburg.

The full results of the study were presented during the American Roentgen Ray Society Annual Meeting in Orlando, FL.