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Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture
T C Fabian1, K A Davis, M L Gavant
1Department of Surgery, University of Tennessee, Memphis 38163, USA.
Insights
Helical computed tomography of the thorax (HCTT) accurately diagnoses blunt aortic injury (BAI), replacing aortography. Early HCTT diagnosis and antihypertensive treatment prevent aortic rupture.
Area of Science:
- Trauma surgery
- Diagnostic imaging
- Cardiovascular surgery
Background:
- Aortography is the traditional standard for diagnosing blunt aortic injury (BAI).
- Conventional CT has limited diagnostic value for BAI.
- Helical CT scanning offers improved speed and resolution over conventional CT.
Purpose of the Study:
- To evaluate helical computed tomography of the thorax (HCTT) for diagnosing blunt aortic injury (BAI).
- To assess the efficacy of beta-blockers, with or without nitroprusside, in preventing aortic rupture.
Main Methods:
- Prospective study comparing HCTT with aortography for BAI diagnosis.
- Evaluation of an antihypertensive protocol (beta-blockers +/- nitroprusside) for preventing aortic rupture.
Main Results:
- HCTT demonstrated 100% sensitivity and 83% specificity for BAI.
- Aortography showed 92% sensitivity and 99% specificity.
- No in-hospital aortic ruptures occurred with early HCTT diagnosis and treatment.
Conclusions:
- HCTT is highly sensitive for diagnosing intimal injuries and pseudoaneurysms.
- Negative HCTT scans obviate the need for further evaluation.
- Aortography is reserved for indeterminate HCTT findings; early diagnosis and treatment prevent rupture.
Objective:
There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of beta-blockers with or without nitroprusside in preventing aortic rupture.
Summary Background Data:
Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture.
Methods:
A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of beta-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries.
Results:
Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100% for HCTT versus 92% for aortography. Specificity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography. Negative predictive value was 100% for HCTT versus 97% for aortography. No patient had spontaneous rupture in this study.
Conclusions:
HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.