Diagnostic yield and utilization patterns of head and neck computed tomography angiography
Kolos Kalman Nagy1, Jantzen Brandt Orton1, Abdul Awal2
1School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, United States.
Journal of Clinical Imaging Science
|July 6, 2026
Summary
Head and neck computed tomography angiography (CTAHN) scans in the emergency department often yield low-value results, particularly when guidelines are not followed. Improving adherence to criteria like the modified Denver criteria can reduce overutilization and improve efficiency.
Area of Science:
- Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Blunt cerebrovascular injury screening in the emergency department (ED) relies on imaging like head and neck computed tomography angiography (CTAHN).
- Overutilization of CTAHN may lead to unnecessary radiation exposure and decreased ED efficiency.
Purpose of the Study:
- To evaluate the diagnostic yield and utilization patterns of CTAHN in ED patients screened for blunt cerebrovascular injury.
- To assess the correlation between CTAHN yield and adherence to the modified Denver criteria, transfer status, and trauma severity.
Main Methods:
- Retrospective chart review of 643 patients (age >16) who underwent CTAHN or CTAN after blunt traumatic injury.
- Multivariable regression analysis to examine factors associated with CTA yield.
Main Results:
- 74.2% of CTAHN/CTAN examinations were negative, correlating with nonadherence to the modified Denver criteria.
- No significant association found between CTAHN yield and transfer status or trauma level.
- 71.8% of actionable findings were identified in patients adhering to the modified Denver criteria.
Conclusions:
- A high proportion of ED-ordered CTAHN/CTAN studies yield low-value results, linked to nonadherence to the modified Denver criteria.
- Enhanced guideline compliance is a modifiable target to reduce diagnostic imaging overutilization and improve ED efficiency.
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