Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds

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.