For evaluating vascular injuries in patients with neck trauma, the recommended imaging modality is computed tomography angiography (CTA), which provides rapid, detailed visualization of vascular structures and is considered the first-line investigation in blunt neck trauma with suspected vascular injury. CTA is preferred due to its high sensitivity and specificity for detecting arterial injuries such as dissections, pseudoaneurysms, and occlusions, and it can be performed concurrently with CT scans assessing cervical spine and head injuries, facilitating comprehensive trauma assessment NICE NG232 Liang et al. 2013Rodriguez et al. 2023.
Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) may be used as adjuncts or in cases where CTA is contraindicated, offering detailed soft tissue and vessel wall characterization, but are not recommended as primary imaging in acute trauma due to longer acquisition times and limited availability in emergency settings NICE NG232 Bitar & Touska 2020Rodriguez et al. 2023.
Conventional catheter angiography remains the gold standard for vascular injury diagnosis but is now reserved for cases requiring endovascular intervention or when non-invasive imaging is inconclusive, given its invasive nature and resource intensity NICE NG232 Liang et al. 2013.
Plain X-rays and non-contrast CT scans are insufficient for vascular injury evaluation but are used primarily to assess bony injuries and cervical spine trauma, which often coexist with vascular injuries in neck trauma NICE NG232.
Key References
- NG232 - Head injury: assessment and early management
- NG41 - Spinal injury: assessment and initial management
- (Liang et al., 2013): Imaging of blunt vascular neck injuries: a review of screening and imaging modalities.
- (Bitar and Touska, 2020): Imaging in trauma of the facial skeleton and soft tissues of the neck.
- (Rodriguez et al., 2023): Vascular Injuries in Head and Neck Trauma.