What imaging modalities are recommended for evaluating vascular injuries in patients with neck trauma?

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 ¹ (Liang et al., 2013; Rodriguez 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 ¹ (Bitar and Touska, 2020; Rodriguez 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 ¹ (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 ¹.