Cervicocerebral angiography in trauma using split-bolus whole-body CT - comparison with dedicated neuroradiological CT angiography

This is the authors' abstract. We don't add key points for this paper.

OBJECTIVES: To determine whether split-bolus whole-body computed tomography (WBCT) provides sufficient cervicocerebral arterial opacification and diagnostic evaluability for vascular assessment in polytrauma compared with dedicated neuroradiological computed tomography angiography (CTA). METHODS: In this retrospective single-centre study, 130 polytrauma patients undergoing split-bolus WBCT were age- and sex-matched to 130 patients undergoing dedicated head-and-neck CTA between January 2023 and June 2025. Arterial attenuation was measured in 15 cervicocerebral segments. Adequate vessel opacification was defined as ≥ 250 HU. Five radiologists independently assessed arterial contrast, venous contamination, overall image quality, and diagnostic evaluability. Statistical analysis included unpaired t-tests, Mann-Whitney U tests, and Fisher's exact tests with multiple-comparison correction. RESULTS: 260 patients were included (mean age 56.3 ± 24 years; 90 female). Dedicated CTA demonstrated significantly higher attenuation in all segments except the cervical internal carotid artery (ICA) (p = 0.08). Mean and median attenuation exceeded 250 HU in all segments for both protocols. Measurements <250 HU were more frequent with split-bolus WBCT, reaching significance only in the petrous ICA (p = 0.02). Subjectively, dedicated CTA showed higher arterial contrast and less venous contamination (both p < 0.01), whereas overall image quality varied across readers. Diagnostic evaluability was high in both cohorts, with no significant differences in four of five readers. CONCLUSIONS: Despite lower arterial enhancement, split-bolus WBCT provided adequate cervicocerebral arterial opacification and high diagnostic evaluability, supporting feasibility for initial vascular assessment in polytrauma. ADVANCES IN KNOWLEDGE: The findings support the feasibility of split-bolus WBCT for initial cervicocerebral vascular assessment in polytrauma patients.