Upper extremity CT angiography in penetrating trauma: Use of 64-section multidetector CT

Purpose: To determine the feasibility and report clinical outcomes of upper extremity computed tomographic (CT) angiography with 64-section multidetector CT technology in the evaluation of patients sustaining penetrating trauma. Materials and Methods: This HIPAA-compliant retrospective study was approved by the institutional review board and consent was waived. All adult trauma patients who sustained penetrating trauma to the upper extremity and who underwent CT angiography based on the recommendation of the attending trauma surgeon after the initial clinical examination were included. All studies were acquired with 64-section CT technology between April 2005 and September 2007 at our level I trauma center. Two radiologists in consensus retrospectively reviewed all the CT angiograms for evidence of arterial injury. Attenuation was measured with regions of interest placed within the arterial lumen of multiple segments of the upper extremity arteries. Hospital course and disposition were determined by reviewing the patients' medical records, with a mean follow-up of 33 days. Results: This study included 59 patients (54 men, five women; mean age, 27 years). Nineteen (32%) patients had the following arterial injuries at CT angiography: arterial occlusion (n = 7), arterial extravasation (n = 6), isolated pseudoaneurysm formation (n = 2), isolated focal stenosis (n = 2), occlusion and pseudoaneurysm formation (n = 1), and focal stenosis and pseudoaneurysm formation (n = 1). Of these 19 patients, seven underwent surgical treatment. Evaluation of the technical quality of the upper extremity angiograms demonstrated mean attenuation values of 244 HU. In 48 (81%) of 59 patients, mean attenuation values were higher than 200 HU, with four (7%) patients having mean attenuation values lower than 150 HU. Conclusion: Upper extremity CT angiograms obtained with 64-section CT demonstrated adequate technical quality in the majority of patients and performed well clinically in patients with penetrating trauma.