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Patients with high-risk radiologic predictors of injury can benefit from an aggressive screening policy for cerebrovascular injury, researchers from the University of Wisconsin affirm. Patients with high-risk radiologic predictors of injury can benefit from an aggressive screening policy for cerebrovascular injury, researchers from the University of Wisconsin affirm.

In their study, whose results were presented this Sunday at the 2007 Radiological Society of North America (RSNA) annual meeting, in Chicago, the diagnostic images and clinical records of 1975 consecutive patients presenting to a level I trauma centre with blunt craniocervical trauma were reviewed in order to identify patients with cerebrovascular injury (CVI).

Several radiographic factors were analysed to identify patients that were at highest risk for traumatic CVI and deserving of vascular imaging workup.

Venous and arterial injuries were identified in three (n=59) and 1.7 per cent (n=34) of the 1975 patients, respectively. Following radiographic analysis, 16 per cent (n=328) of patients were considered to be in a group at highest risk for CVI.

Of those patients in the highest risk group, 18 and ten per cent had injuries of the cerebral veins and arteries, respectively; 4.3 per cent of the 93 patients with documented CVI had fatal injuries; 6.4 and 5.4 per cent of CVI patients developed venous and arterial infarctions, respectively.

The team identified a significantly higher incidence of CVI associated with blunt craniocervical trauma than previously reported (0.05-1 per cent) in the literature, and concluded: patients with high-risk facial, skull base, and temporal bone fractures that propagate into the carotid canal, cervical spine fractures that involve the foramen transversarium, and fractures which cross major dural venous sinuses confer a significantly higher risk of CVI and should be routinely worked up with CTA or MRA.

"We concluded that there are certain radiographic factors that are suggestive of underlying traumatic CVI and those can, and should, be used", said chief researcher Dr Nila Alsheik. "An aggressive screening policy in patients with high-risk radiologic predictors of injury can result in more expedient diagnosis and treatment".

According to the researcher, patients with blunt craniocervical trauma without these high risk factors do not significantly benefit from routine vascular imaging.