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]. The development of >8-slice multidetector-row CT has allowed CTA to become the standard in diagnosis of suspected cerebrovascular injury, with reported sensitivities up to 100% (somewhat dependent on both CT technology and radiologist expertise) [57]. There is a Biffl grading scale for arterial injury, which was originally developed for catheter angiography and carotid artery injury but has also been shown to be reliable for CTA and vertebral artery injury [56]. Grade I = dissection with <25% luminal narrowing (intimal irregularity), Grade II = dissection with >25% luminal narrowing (intramural hematoma), Grade III = pseudoaneurysm (contained hematoma), Grade IV = occlusion, and Grade V = transection or hemodynamically significant arteriovenous fistula (eg, carotid cavernous fistula). Medical therapy with antiplatelet or anticoagulation may be appropriate management for the lower grades of arterial injury, whereas the higher grades of arterial injury are more likely to require endovascular or surgical treatment [56,57]. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the imaging evaluation of suspected intracranial arterial injury. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of SPECT in the imaging evaluation of suspected intracranial arterial injury. MR Spectroscopy Head There is no relevant literature to support the use of MRS in the imaging evaluation of suspected intracranial arterial injury.
Head Trauma PCAs. 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]. The development of >8-slice multidetector-row CT has allowed CTA to become the standard in diagnosis of suspected cerebrovascular injury, with reported sensitivities up to 100% (somewhat dependent on both CT technology and radiologist expertise) [57]. There is a Biffl grading scale for arterial injury, which was originally developed for catheter angiography and carotid artery injury but has also been shown to be reliable for CTA and vertebral artery injury [56]. Grade I = dissection with <25% luminal narrowing (intimal irregularity), Grade II = dissection with >25% luminal narrowing (intramural hematoma), Grade III = pseudoaneurysm (contained hematoma), Grade IV = occlusion, and Grade V = transection or hemodynamically significant arteriovenous fistula (eg, carotid cavernous fistula). Medical therapy with antiplatelet or anticoagulation may be appropriate management for the lower grades of arterial injury, whereas the higher grades of arterial injury are more likely to require endovascular or surgical treatment [56,57]. FDG-PET/CT Brain There is no relevant literature to support the use of FDG-PET/CT in the imaging evaluation of suspected intracranial arterial injury. HMPAO SPECT or SPECT/CT Brain There is no relevant literature to support the use of SPECT in the imaging evaluation of suspected intracranial arterial injury. MR Spectroscopy Head There is no relevant literature to support the use of MRS in the imaging evaluation of suspected intracranial arterial injury.