Blunt cerebrovascular injuries: imaging with multidetector CT angiography.

Blunt cerebrovascular injuries (BCVIs) can cause ischemic stroke and are associated with high mortality rates. However, treatment of BCVI can prevent or limit stroke. Although digital subtraction angiography is the diagnostic standard for detecting BCVI, recent studies indicate that multidetector computed tomographic (CT) angiography may be an accurate, rapid, noninvasive diagnostic alternative. Various manifestations of BCVI at multidetector CT angiography include minimal intimal injury, raised intimal flap, dissection with intramural hematoma, pseudoaneurysm, occlusion, transection, and arteriovenous fistula. Multidetector CT angiography can be used to grade and follow up BCVIs, providing significant prognostic information and influencing management decisions. Several other injuries and injury patterns can be used to identify patients with a high likelihood of concurrent BCVI, and these patterns can be used as indications to screen for BCVI. By facilitating early diagnosis and treatment of BCVI, such screening has been shown to improve the clinical outcomes of affected patients. Familiarity with the various imaging manifestations of injury at multidetector CT angiography, as well as with the diagnostic limitations of this modality and the various clinical factors that affect its use, is necessary if it is to be used effectively to diagnose and influence the management of BCVIs. (c) RSNA, 2008.