Eficacia de la angiotomografía con multidetectores en el diagnóstico del trauma arterial de extremidades / Efficacy of multidetector computed angiotomography in the diagnosis of limb arterial injuries

Objetivo: Determinar la eficacia diagnóstica de la angiotomografía multidetectores en el diagnóstico del trauma arterial de las extremidades en pacientes con sospecha de lesión arterial sin indicación de cirugía inmediata. Métodos Durante 44 meses, entre agosto del 2004 y abril del 2008, se realizó angiotomografía multidetectores de 64 canales a 99 extremidades con sospecha de lesión vascular traumática. Los estudios fueron interpretados por el radiólogo de turno y sus hallazgos se compararon con los de cirugía o los del seguimiento clínico. Se evaluó la variabilidad interobservador comparando la lectura de la angiotomografía realizada por el radiólogo de turno con la lectura retrospectiva de un radiólogo experto en trauma. Resultados La angiotomografía multidetectores como método diagnóstico del trauma vascular de las extremidades interpretada por el radiólogo general demostró una sensibilidad del 98% (IC 95%: 93-100), una especificidad del 88% (IC 95%: 77-99), un valor predictivo positivo del 91% (IC 95%: 82-99), un valor predictivo negativo del 97% (IC 95%: 90-100), una razón de verosimilitud positiva de 8,24 (3,6-18,7) y una razón de verosimilitud negativa de 0,02 (0-0,15). La variabilidad interobservador comparando la interpretación de la angiotomografía del radiólogo de turno con la del radiólogo experto en trauma tuvo una kappa de 0,869.ConclusiónLa angiotomografía con multidetectores es un método de imagen con una alta precisión diagnóstica en el trauma arterial de las extremidades permitiendo un adecuado y oportuno enfoque terapéutico. Podría considerarse como nuevo patrón de oro para el diagnóstico del trauma arterial de extremidades (AU)

Objective: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. Methods: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on99 limbs suspected of having a traumatic vascular injury over a 44-monthperiodbetween August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Interobserver variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. Results: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI:77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97%(95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869.Conclusion: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate (..) (AU)

[Efficacy of multidetector computed angiotomography in the diagnosis of limb arterial injuries]. / Eficacia de la angiotomografía con multidetectores en el diagnóstico del trauma arterial de extremidades.

OBJECTIVE: To determine the diagnostic usefulness of multidetector computed angiotomography in the diagnosis limb arterial injuries in patients with suspicion of arterial injury with no indication of immediate surgery. METHODS: Non-invasive 64-channel multidetector computed tomography (MDCT) was performed on 99 limbs suspected of having a traumatic vascular injury over a 44-month period between August 2004 and April 2008. The results were interpreted by the duty radiologist and his findings were compared with those from surgery or clinical follow-up. Inter-observer variability was evaluated by comparing the reading of the MDCT by the duty radiologists with the retrospective reading by radiology specialist in trauma. RESULTS: MDCT as a diagnostic method of vascular injury of the limbs, interpreted by a general radiologist showed a sensitivity of 98% (95% CI: 93-100), a specificity of 88% (5% CI: 77-99), a positive predictive value of 91% (95% CI: 82-99), a negative predictive value of 97% (95% CI: 90-100), a positive likelihood radio of 8.24 (3.6-18.7), and a negative likelihood radio of 0.02 (0-0.15). The inter-observer variability by comparing the interpretation of the MDCT by the duty radiologist with that of the radiology specialist in trauma had a kappa of 0.869. CONCLUSION: Multidetector computed angiotomography is a high precision diagnostic imaging method in arterial injury of the limbs, offering a suitable and appropriate therapeutic approach, and could be considered as new gold standard for the diagnosis of arterial injuries of the limbs.