State-of-the-art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls, and pitfalls
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REVIEW ARTICLE
State-of-the-art 3DCT angiography assessment of lower extremity trauma: typical findings, pearls, and pitfalls Jan Fritz & David T. Efron & Elliot K. Fishman
Received: 2 October 2012 / Accepted: 14 November 2012 / Published online: 27 November 2012 # Am Soc Emergency Radiol 2012
Abstract Multi-detector computed tomography angiography (MDCTA) of the lower extremities is an integral part of the decision-making process of lower extremity trauma. MDCTA can be integrated into multiphasic whole-body trauma MDCT and has replaced the traditional gold standard of catheter-based angiography as the preferred technique for the initial assessment of lower extremity trauma in many institutions worldwide. Advances in MDCT technology enable high speed simultaneous evaluation of both complete lower extremities, rapid image reconstruction, and advanced image visualization for the noninvasive and accurate diagnosis of vascular, including hematoma, active extravasation, vasospasm, stenosis, external compression, occlusion, intimal injury and dissection, arteriovenous fistulas, and pseudoaneurysm formation. In this exhibit, we outline the role of MDCTA in the management of lower extremity trauma, review current MDCT protocols and the practical use of advanced visualization techniques, and illustrate typical MDCTA findings, pearls, and pitfalls, which help to accurately characterize vascular injury and guide management. Keywords Computed tomography angiography . Lower extremity trauma . Vascular injury . Pseudoaneurysm . Vascular occlusion . Intimal injury . Active extravasation
J. Fritz : E. K. Fishman (*) Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287, USA e-mail: [email protected] D. T. Efron Department of Surgery, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21212, USA
Introduction Multi-detector computed tomography angiography (MDCTA) has evolved into an essential part of the initial assessment of acutely injured patients and has replaced the traditional gold standard of catheter-based digital subtraction angiography in many institutions worldwide [1–7]. Table 1 provides a list of advantages and limitations of MDCT angiography in comparison with catheter angiography. Advances in MDCT technology enable high speed simultaneous evaluation of both complete lower extremities with a single peripheral intravenous power-injected bolus of iodine-based contrast medium [8]. Reformation of data acquired through a single scan sequence rapidly provides high-resolution multi-planar views and three-dimensional reconstructions with minimal motion artifact. Polytrauma MDCT protocols have been developed to integrate lower extremity MDCTA into multiphasic wholebody trauma MDCT [9]. Familiarity with the epidemiology and clinical signs of vascular lower extremity trauma, current MDCT technology, pertinent vascular MDCT anatomy, and typical imaging findings, pearls, and pitfalls help to guide manage
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