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  • Title: Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds.
    Author: Adibi A, Krishnam MS, Dissanayake S, Plotnik AN, Mohajer K, Arellano C, Ruehm SG.
    Journal: Eur Radiol; 2014 Jul; 24(7):1586-93. PubMed ID: 24804632.
    Abstract:
    OBJECTIVE: To assess the role of CT angiography in the evaluation of patients with lower extremity gunshot wounds in the emergency room. MATERIALS AND METHODS: Eighty patients (73 male, 7 female, mean age 26 years) underwent CT angiography for the evaluation of lower extremity gunshot injuries. Imaging was conducted on the basis of standardized protocols utilizing 16-slice and 64-slice multidetector systems and images were qualitatively graded and assessed for various forms of arterial injury. RESULTS: CT angiography findings indicative of arterial injury were observed in 24 patients (30%) and a total of 43 arterial injuries were noted; the most common form was focal narrowing/spasm (n = 16, 37.2%); the most common artery involved was the superficial femoral artery (n = 12, 50%). In qualitative assessment of images based on a 4-point grading system, both readers considered CT angiography diagnostically excellent (grade 4) in most cases. Surgical findings were consistent with CT angiography and follow-up of patients' medical records showed no arterial injuries in patients with normal findings on initial imaging. CONCLUSION: Our findings demonstrate that CT angiography is an effective imaging modality for evaluation of lower extremity gunshot wounds and could help limit more invasive procedures such as catheter angiography to a select group of patients. KEY POINTS: • CT angiography efficiently evaluates lower extremity gunshot wounds. • CT angiography provides image quality sufficiently reliable for assessment of gunshot injuries. • CT angiography could help limit invasive procedures to select patients.
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