Aims and objectives
Thoracic aortic dissections,
as part of the acute aortic syndrome,
have hospital mortality rates of 1 in 3 patients for the type of dissection requiring surgical management (Type A) and thus are medical and surgical emergencies.1-2 Accurate and quick diagnosis is necessary,
as a result,
computed tomography (CT) has become the imaging modality of choice.
Contrast-enhanced CT has a sensitivity of 100% and a specificity of 98% and has the advantage of being faster,
and in some cases,
more accessible,
than magnetic resonance imaging or...
Methods and materials
We did a retrospective review,
for which consent was waived from the REB,
and searched for studies performed between Jan 2007 and February 2018 that used a "CT chest dissection protocol" (NC-CT followed by a CE-CT).
100 CT imaging studies were selected for review by a radiologist who was not involved in further imaging interpretation,
of which 50 patients were reported negative and 50 patients positive for aortic dissections.
Patients with treated dissection/intramural hematoma indicated on the requisition were excluded.All patients were imaged on Canon...
Results
The mean age of patients in Group 1 was 72.9 and in Group 2 was 46.
The female to male ratio in Group 1 was 28:32 and in Group 2 was 12:28 (p=14).
The Calc score in Group 1 was 2.03 and Group 2 was 0.70 (p<0.001).
The area-under-the-curve (AUC) for all patients,
Group 1 and Group 2,
for reader 1,2 3 and pooled was (0.91,
0.90,0.94),
(0.95,
0.97,0.91),
(0.92,
0.97,
0.84) and (0.96,0.98,0.96),
respectively.
The sensitivity and specificity in all patients for reader 1,2,...
Conclusion
Non-contrast chest CT is generally not sensitive enough to reliably detect aortic dissections; however,
the detection rate is higher in elderly patients with more atherosclerotic calcifications than in younger patients with fewer calcifications.
References
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Presentation,
Diagnosis,
and outcomes of acute aortic dissection: 17- year trends from the international registry...