AJR Am J Roentgenol 2001 May;176(5):1267-1272
Making the Transition: The Role of Helical CT in the Evaluation of
Potentially Acute Thoracic Aortic Injuries.
Parker MS, Matheson TL, Rao AV, Sherbourne CD, Jordan KG, Landay MJ, Miller GL, Summa JA..
OBJECTIVE. The purpose of this study was to show that helical CT could be used at our
center in lieu of routine aortography to examine patients who have had serious blunt chest
trauma. We also wanted to assess the potential savings of using CT to avoid unnecessary
aortography. MATERIALS AND METHODS. The institutional review board approved the parallel
imaging-CT immediately followed by aortography-of patients presenting with blunt chest
trauma between August 1997 and August 1998. To screen patients for potential aortic
injuries, we performed parallel imaging on 142 patients, and these patients comprised our
patient population. CT examinations of the patients were reviewed for signs of injury by
radiologists who were unaware of each other's interpretations and the aortographic
results. Findings of CT examinations were classified as negative, positive, or
inconclusive for injury. Aortography was performed immediately after CT. The technical and
professional fees for both transcatheter aortography and helical CT were also compared.
RESULTS. Our combined kappa value for all CT interpretations was 0.714. The aortographic
sensitivity and negative predictive value were both 100%. Likewise, the sensitivity and
negative predictive value of CT were 100%. The total costs of performing aortography were
estimated at approximately $402,900, whereas those for performing helical CT were
estimated at $202,800. CONCLUSION. Helical CT has a sensitivity and negative predictive
value equivalent to that of aortography. Using CT to eliminate the possibility of
mediastinal hematoma and to evaluate the cause of an abnormal aortic contour in a trauma
patient allows us to use aortography more selectively. Avoiding the performance of
unnecessary aortography will expedite patient care and reduce costs. We report the results
of our experience with CT and how our center successfully made this transition in the
initial examination of patients with serious thoracic trauma.
PMID: 11312193
