Both have since been broadened into the modified Denver criteria and the modified Memphis criteria, with the more recently introduced Boston criteria being based on the modified Denver criteria. For clinicians or providers who are not currently committed to a screening criteria for BCVI, one simple option is the 2010 guidelines from the Eastern Association for the Surgery of Trauma [56]: Arteriography Cervicocerebral Although catheter angiography is the historical reference standard and offers the highest spatial/temporal resolution for imaging evaluation of vascular pathology, noninvasive CTA is faster, has fewer safety concerns, and is most useful in the initial imaging evaluation of suspected intracranial arterial injury [45]. With modern CT equipment, accuracy has been shown to be comparable. One prospective study of 146 trauma patients who received both catheter angiography and CTA (16-slice multidetector-row) reported the latter to have a sensitivity of 97.7% and a specificity of 100% for the diagnosis of vascular injury [60]. Catheter angiography may be useful when CTA is inconclusive (eg, possible arteriovenous fistula) or when endovascular intervention is being considered [45]. Head Trauma CT Head Please refer to CTA for neurovascular imaging evaluation of suspected intracranial arterial injury. Concurrent CT may be useful in the clinical setting of suspected intracranial arterial injury for assessing structural changes to the brain since the most recent neuroimaging study (eg, new or progressive neurologic deficit). Concurrent head CT is also useful in the initial imaging evaluation of head trauma when there is no prior imaging. CTA Head and Neck Although catheter angiography is the historical reference standard and offers the highest spatial/temporal resolution for imaging evaluation of vascular pathology, noninvasive CTA is faster, has fewer safety concerns, and is most useful in the initial imaging evaluation of suspected intracranial arterial injury [45].
Head Trauma PCAs. Both have since been broadened into the modified Denver criteria and the modified Memphis criteria, with the more recently introduced Boston criteria being based on the modified Denver criteria. For clinicians or providers who are not currently committed to a screening criteria for BCVI, one simple option is the 2010 guidelines from the Eastern Association for the Surgery of Trauma [56]: Arteriography Cervicocerebral Although catheter angiography is the historical reference standard and offers the highest spatial/temporal resolution for imaging evaluation of vascular pathology, noninvasive CTA is faster, has fewer safety concerns, and is most useful in the initial imaging evaluation of suspected intracranial arterial injury [45]. With modern CT equipment, accuracy has been shown to be comparable. One prospective study of 146 trauma patients who received both catheter angiography and CTA (16-slice multidetector-row) reported the latter to have a sensitivity of 97.7% and a specificity of 100% for the diagnosis of vascular injury [60]. Catheter angiography may be useful when CTA is inconclusive (eg, possible arteriovenous fistula) or when endovascular intervention is being considered [45]. Head Trauma CT Head Please refer to CTA for neurovascular imaging evaluation of suspected intracranial arterial injury. Concurrent CT may be useful in the clinical setting of suspected intracranial arterial injury for assessing structural changes to the brain since the most recent neuroimaging study (eg, new or progressive neurologic deficit). Concurrent head CT is also useful in the initial imaging evaluation of head trauma when there is no prior imaging. CTA Head and Neck Although catheter angiography is the historical reference standard and offers the highest spatial/temporal resolution for imaging evaluation of vascular pathology, noninvasive CTA is faster, has fewer safety concerns, and is most useful in the initial imaging evaluation of suspected intracranial arterial injury [45].