Blunt cerebrovascular injury: diagnosis at whole-body MDCT for multi-trauma

PURPOSE: To analyse the prevalence of blunt cerebrovascular injuries (BCVIs) in multi-trauma patients by means of a post-contrast acquisition of neck vessels included into the whole-body multi-detector computed tomography (MDCT) protocol performed at admission and to correlate it with the presence of risk factors (Memphis approach). MATERIALS AND METHODS: A retrospective study was undertaken for the period January 2005 to November 2011, involving 976 multi-trauma patients. Post-contrast images of neck vessels in MDCT scan were evaluated by two experienced radiologists; carotid, vertebral and basilar arteries were rated according to the Biffl classification. The presence of clinical and/or CT risk factors for BCVI was assessed. RESULTS: BCVI were present in 32/976 (3.3 %) multi-trauma patients. Risk factors for BCVI were present in 247/976 (25.3 %) patients. The group of patients presenting risk factors showed a significantly higher prevalence of cerebrovascular injuries (8.1 %) compared with the group of patients without risk factors (1.6 %) (p = 0.009); however, 12/32 (37.5 %) patients presenting BCVI did not show any of the risk factors proposed by the Memphis group. CONCLUSION: An investigation for the presence of BCVI should be performed on all multi-trauma patients despite the absence of clinical-radiological risk factors. KEY POINTS: BCVIs are present in 3.3 % of multi-trauma patients. BCVIs are significantly associated to the Memphis risk factors. Of the multi-trauma patients affected by BCVIs, 37.5 % do not show clinical-radiological risk factors. A screening for BCVI should be performed on all multi-trauma patients.