Diagnostic yield of CT angiography performed for suspected cervical artery dissection in the emergency department

Abstract

Background and purpose: Computed tomography angiographies are frequently performed in the emergency department (ED) for the assessment of cervical artery dissection (CeAD) due to the high risk of associated morbidity, but their diagnostic utility is not fully evaluated. We assessed the radiological outcomes and clinical correlates of CTAs performed for suspected CeAD.

Materials and methods: CTAs for all indications (Indication_ALL) over a 10-year period were evaluated to identify those with CeAD. A subgroup of CTAs performed for suspected CeAD (Indication_DISSECTION) was identified and further assessed for clinical findings predictive of CeAD. Magnetic resonance angiography/fat-saturated images (MRA/FSI) performed after CTA were also assessed.

Results: Nine-thousand-two-hundred-four CTAs were performed by our ED for Indication_ALL of which 850 (9.2%) were for Indication_DISSECTION. CeAD was noted in 1.5% (142/9204) among Indication_ALL and in 6.1% (53/850) of Indication_DISSECTION CTAs. The most common radiological findings were mural thrombus and eccentric lumen. In the Indication_DISSECTION group, new headache (OR: 2.5, 95%CI: 1.2-5.7) and partial Horner syndrome (OR: 14.4, 95%CI: 4.2-49.9) predicted carotid dissection and cervical fracture (OR: 5.5, 95%CI: 2.1-14.6) predicted vertebral artery dissections. MRA/FSI confirmed CeAD in all positive cases, but in 2 CTAs read as negative, MRA/FSI was positive for vertebral artery dissection.

Conclusion: Although the yield of CTAs for clinically suspected CeAD is low, the paucity of reliable clinical predictors, high risk of morbidity, availability in ED, and comparable performance to MRA/FSI justifies its widespread utilization for initial diagnosis of CeAD.

Keywords: Computed tomography angiography; Diagnostic yield; Dissection; Internal cranial artery; Magnetic resonance angiography; Vertebral artery.