RSNA 2016: CT angiography of extremities for vascular trauma does not require venous phase

Zachary Masi, MD, presented his findings in the study, “Evaluation of the Diagnostic Value of a Venous Phase in CT Angiography of the Extremities in the Setting of Trauma,” at RSNA in Chicago. He found that the venous phase of computed tomography angiography (CTA) extremity studies for trauma can be accurately performed with an arterial phase only and does not require a venous phase.  

“Patients with traumatic injury to extremities are often evaluated at hospital trauma centers by CTA to evaluate for vascular injury, which can utilize arterial and venous phases,” Masi said. “The purpose of this study is to assess whether the venous phase contributes added value to the diagnostic study.”

Retrospective analysis of 157 adult patients were evaluated, including 49 upper and 108 lower extremities. The images were evaluated by a diagnostic radiology in which 99 were diagnosed no injury, 35 arterial injuries, 16 vasospasms and seven venous injuries.

Four diagnoses were changed between interpreting the arterial phase alone and both phases together. Deep vein thrombosis was the only case resulting in clinical management. Overall, no significant difference was made in diagnosis between both methods. There was high agreement for diagnosis of no injury, arterial injury and vasospasm, and moderate agreement in diagnosing venous injury.

“The venous phase of CTA extremity studies for trauma does not add statistically significant value in diagnosing vascular injury. The results of this study show that the perceived benefit of rescanning patients after the arterial phase does not alter patient care and may be safely removed from the routine imaging protocol, thereby decreasing patient scan time and radiation dose,” said Masi.