Using conventional angiography as a gold standard, recent studies using multislice CT scanners with 16 or more detector rows have found CTA to have a reported sensitivity of 41% to 98% and specificity of 81% to 100% for identifying cervical arterial injury [50,54], although, using catheter angiography as the gold standard inherently places CTA at a disadvantage when comparing the two modalities because catheter angiography is assumed to be 100% sensitive and 100% specific. CTA has been shown to detect almost all clinically relevant blunt cervical arterial injuries, with lower complication rates than conventional arteriography [50,52,54,70]. At many institutions, CTA has replaced conventional arteriography for screening of blunt cervical arterial injury in high-risk patients because of the short acquisition time, low complication rate, and ability to perform CTA at the same time as the neck is being imaged for cervical spine injury. MRA Neck MRA of the neck is considered an equivalent imaging modality to CTA in assessment of blunt cervical vascular injury. Similar to CTA, MRA has been shown to be inferior to conventional arteriography in identifying cervical arterial injury [50,54]. However, like CTA, modern MRA does identify almost all clinically significant cervical arterial injuries [54]. Fewer data are available on the performance of MRA in identifying cervical arterial injury compared with CTA. In the only study directly comparing MRA with CTA, CTA was found to be slightly preferable to MRA for identification of blunt cervical arterial injuries [71]. However, because of its superior soft- tissue contrast, MRA may be better than CTA or conventional arteriography in identifying intramural hematoma [71]. A study by Biffl et al [51] in 2002 also found MRA to perform comparably to CTA in diagnosing BCVI, with MRA having a reported sensitivity of 75% and specificity of 67% compared to a sensitivity of 68% and specificity of 67% found in CTA.
Suspected Spine Trauma PCAs. Using conventional angiography as a gold standard, recent studies using multislice CT scanners with 16 or more detector rows have found CTA to have a reported sensitivity of 41% to 98% and specificity of 81% to 100% for identifying cervical arterial injury [50,54], although, using catheter angiography as the gold standard inherently places CTA at a disadvantage when comparing the two modalities because catheter angiography is assumed to be 100% sensitive and 100% specific. CTA has been shown to detect almost all clinically relevant blunt cervical arterial injuries, with lower complication rates than conventional arteriography [50,52,54,70]. At many institutions, CTA has replaced conventional arteriography for screening of blunt cervical arterial injury in high-risk patients because of the short acquisition time, low complication rate, and ability to perform CTA at the same time as the neck is being imaged for cervical spine injury. MRA Neck MRA of the neck is considered an equivalent imaging modality to CTA in assessment of blunt cervical vascular injury. Similar to CTA, MRA has been shown to be inferior to conventional arteriography in identifying cervical arterial injury [50,54]. However, like CTA, modern MRA does identify almost all clinically significant cervical arterial injuries [54]. Fewer data are available on the performance of MRA in identifying cervical arterial injury compared with CTA. In the only study directly comparing MRA with CTA, CTA was found to be slightly preferable to MRA for identification of blunt cervical arterial injuries [71]. However, because of its superior soft- tissue contrast, MRA may be better than CTA or conventional arteriography in identifying intramural hematoma [71]. A study by Biffl et al [51] in 2002 also found MRA to perform comparably to CTA in diagnosing BCVI, with MRA having a reported sensitivity of 75% and specificity of 67% compared to a sensitivity of 68% and specificity of 67% found in CTA.